The Variability of Data and Importance of Personalized Lung Cancer Care

Dr. Jacob Sands explained that he believes patients should be having more personalized, nuanced conversations with their oncologists.

Dr. Jacob Sands, a physician at the Dana-Farber Cancer Institute in Boston, explained that he believes patients should be having more personalized, nuanced conversations with their oncologists, emphasizing that overall data does not reflect the full spectrum of patient experiences.

“The field is moving fast, and I'm very optimistic about further advances as we go forward. We're talking about one significant step forward now, but I trust there will be many more to follow, even in the few years ahead at this pace,” he added in an interview with CURE.

In the interview, Sands — who also serves as associate chief of the Lowe Center for Thoracic Oncology and oncology medical director of International Patient Center at the Dana-Farber, as well as assistant professor at Harvard Medical School — underscores the importance of tailoring information to what drives the patient’s decision-making, as every patients needs are different. Overall, he emphasized the importance of personalized care for this group of patients.

This conversation happened following the June 2025 U.S. Food and Drug Administration Approval (FDA) approval of Datroway (datopotamab deruxtecan-dlnk) for the treatment of non-small cell lung cancer (NSCLC) that has an epidermal growth factor receptor (EGFR) mutation.

CURE: What questions should patients ask their oncologist if they’re interested in learning whether Datroway might be a fit for their treatment plan?

Sands: I think for all patients, in any stage or setting, it's important to ask what the benefit of a treatment is. Often, when patients tell me about their discussions with other oncologists, it seems like the median is what's discussed. The median is an endpoint, like the median progression-free survival and the median overall survival. These are endpoints in our clinical trials, but I think it's really quite limited if you're just talking about the median. The median is essentially the point at which half of patients have experienced something. For example, with disease control, it's how long half of the patients experienced disease control. With survival, it's how long half of the patients lived. But if you're only talking about that number, the majority of people experienced something different. When a discussion is focused on the median, I think it's too limited.

I think the question for the oncologist, although it gives you a broad kind of more information that is sometimes okay, is to ask, "What is the worst-case scenario?" I mean, what is the realistic worst-case scenario, not the overwhelming worst? And then, "What is the realistic best-case scenario?" You want a broader timeframe to look at, along with the possible side effects. But what are the expected side effects? You should focus on the side effects that are expected. That doesn't mean you're going to get those, and it doesn't mean you're not going to get others, but it kind of narrows the list.

How can patients better understand and contextualize the risks and side effects associated with treatment, especially when the list of potential outcomes feels overwhelming?

When I talk with patients about any line of therapy, and we are doing the consent for it, I'll often say, "If I were to ask them what's going to happen on my drive home, most people would say, 'You might hit some traffic, but you'll be fine,' and not to worry about it." But if I say, "What are all the things that can happen?" that becomes a long, scary list. Now, I want to be very clear: I am not saying that my drive home is the same as getting treated for cancer. Those are obviously completely different things. But I think the analogy is to make the point that there is a long list of possibilities, and that doesn't mean they're expected.

Sometimes for patients going through what they're going to get for treatment, they've heard all kinds of things. And so there's this kind of fear that everything the oncologist discusses is something that they're going to experience, when in reality, there might be two or three things that we expect. That doesn't mean you're going to get those, either. There are some patients that do unbelievably well with treatments where we kind of expect some real side effects, and they continue working and are active. There are others where we don't expect a lot, and sometimes there can be a lot. So there's nothing guaranteed. You want to know what you can expect as the more likely best case, the more likely worst case, and what you can expect from side effects. You do that for each of the treatment options.

Now, that's one thing, but just as care is individualized, I think the discussion is individualized. If that kind of information is not going to drive your decision-making, I don't think you have to feel pressured to ask those things. You want to ask what's going to matter for your own decision-making for a treatment option. If your oncologist tells you, "Hey, these are the two options," you should be weighing those out for treatment.

But if you're kind of deciding on how to live your life, the most common question I get is people asking how long they're going to live or how long the treatment is going to work. And I understand the question. People want to know how this is going to go. The truth is, we just never know. There is a broad range of possibilities, and that's what I've described. But if that timeframe isn't going to impact your decision-making, it's not something you have to ask either. If you're saying, "Look, I want to know because I'm planning a vacation in six months, is this realistic? Can I do this? And what should I plan?" Then you're going to have a discussion around that. That's okay. But if it's more just a timeframe for a timeframe; your oncologist is not going to be able to be precise about that, either.

The first thing is to sort out what is going to matter to you in having that discussion. What is driving your decision-making, and what are those bits of information that are going to impact your decision-making around this as well? Because that'll give you a frame for this kind of information, too. Frankly, it's often so overwhelming for the individuals that I'm talking to. I think part of my job in that discussion is to recognize when the room is just swirling around them and how to kind of bring it back. Let's start again. Let me pick up where it matters or where you lost me in this, as well. I think you have to factor that into what is going to matter to you. How is that again going to impact any decision-making you have? And then you ask those questions to fit that in and consider whatever the decision is that you're working with.

How would you describe the pace of progress in lung cancer treatment, and what should patients understand about how their care options might evolve over time?

One thing to acknowledge is that this field is moving fast. We first had targeted therapy for EGFR mutations a little over 15 years ago, when we saw the big study that clearly showed we were able to target this. In just 15 years, we now have an array of different targets and a number of different treatment options; in many cases, multiple treatment options for each of those targets. And now, we're adding a whole new class of drugs with antibody-drug conjugates.

So, for anyone I'm counseling about their cancer, someone with a new diagnosis, know that your first treatment will hopefully work for many years. However, at some point, if things start growing, it's likely that the field will have evolved again. The work is ongoing. The advances being made in cancer treatment are happening at a much faster pace than what many in the public realize. Even physicians outside of medical oncology or oncology-related specialties often don't realize how much is happening right now. With rare exceptions, anybody diagnosed with any lung cancer right now is getting a drug that is new within the last five to ten years.

The field is moving fast, and I'm very optimistic about further advances as we go forward. We're talking about one significant step forward now, but I trust there will be many more to follow, even in the few years ahead at this pace. The field is evolving, and we're working as fast as we can to develop new and better treatments. We're not stopping until we can control everyone's cancer.

Transcript has been edited for clarity and conciseness.

Reference

1. “Datopotamab Deruxtecan in Advanced or Metastatic Non–Small Cell Lung Cancer With Actionable Genomic Alterations: Results From the Phase II TROPION-Lung05 Study,” by Dr. Jacob Sands, et al., Journal of Clinical Oncology.

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