In many ways, the outlook for people with lung cancer is more hopeful than ever. According to the American Lung Association, the five-year survival rate has increased by 26% over the past decade.
But if you are somebody who has been diagnosed with lung cancer, hope isn’t enough. Though an improvement, this survival rate remains among the lowest of all cancers.
David Raben, MD, Genentech’s vice president of product development, oncology, for Lung, Head and Neck, Tumor Agnostic, Skin and Rare Cancers, is committed to urgent and efficient action to effect faster, more dramatic change for people facing this deadly disease. The longtime radiation oncologist and translational scientist stressed that while treatment is at the core of this approach, people with lung cancer need more than treatment advancements alone.
“What we need is a holistic approach that goes beyond cancer medicine and takes into account the patient journey to better customize care,” he said. “At Genentech, we’re focusing on three key elements: biomarker testing, clinical trials, and barriers to care such as stigma and low screening.”
Harnessing biomarkers’ full potential
Staggering statistics show only about 7% of people treated for non-small cell lung cancer in community oncology practices are tested for all seven biomarkers recommended in National Comprehensive Cancer Network clinical practice guidelines.,
Achieving widespread access to biomarker testing is a critical step in improving patient outcomes. Genentech recognizes this requires close collaboration with the oncology community and with other industry partners. “We are actively working with external organizations — including government, private, and patient advocacy groups — to develop practical approaches for standardizing and harmonizing biomarker testing,” noted Raben.
Another step, explained Raben, is amplifying efforts to assess exactly how to use data from biomarkers. “With biomarker testing, we’re unlocking information about the genetic and immunological makeup of the tumor,” he said. “When we collect ctDNA (circulating tumor DNA), for example, we can begin to understand whether or not the person is likely to respond to a specific drug — and why. If someone is failing one therapy, or initially responds and then becomes refractory, we can quickly change the treatment approach.”
“I firmly believe comprehensive biomarker testing is going to help us find the right treatment approach for each person with lung cancer based on their specific diagnosis. That gives me hope that personalized care will achieve better outcomes for more people,” Raben added.
Evolving clinical trials
Biomarkers also have the potential to improve clinical trial design. Many clinical trials today include hundreds of people with diverse forms of lung cancer. However, Raben noted that biomarkers, including those identified using ctDNA, may help investigators refine trials to focus on people who might have the highest chance of responding. This could not only reduce the number of people who need to be enrolled for registrational trials, but also may help reduce the risk of potentially effective investigational treatments missing their study endpoints. In addition, patients without evidence of ctDNA after definitive cancer management might be spared unnecessary treatments.
Another point of emphasis for Genentech is bringing clinical trials directly to the people who may be eligible, in hopes of improving access and creating a more comfortable, convenient experience for participants. “Suppose testing reveals something in an individual who lives in a small rural town,” said Raben. “How can we in the industry and medical community help enable a patient’s local oncologist to become their principal investigator? How can we work together to help patients remain with their family while reducing the stress, costs, and other burdens of travel — especially in the Covid-19 environment?”
The location of clinical trial sites also matters in terms of ensuring different patient populations have access to research, explained Raben. “Bringing trials to the community is a small step toward addressing some of the health disparities we see among various racial, ethnic, and socioeconomic groups,” he said. “This is a critical priority for us, and we’re continuing to work closely with the community, trial investigators, and patient advocacy partners to make it happen.”
Less stigma, more screening
Many people with advanced lung cancer — far more than with any other cancer — never receive the treatment they need. Among the key barriers to care are societal stigma and misconceptions about the disease.
“Back in the day, it was true that your chances of surviving with advanced lung cancer were minimal. We didn’t have a lot of success, and in my practice the stigma and hopelessness experienced by patients was evident,” said Raben. “But the clinical data emerging over the last approximately five years shows that we can start thinking about managing lung cancers as chronic conditions rather than terminal illnesses. We’re getting a message out there that’s exciting, promising, and encouraging. We can now begin to say to our patients: ‘Let’s grow old together.’”
Indeed, evidence has emerged that perceptions about lung cancer may be changing for the better. Research on implicit biases conducted by Genentech and the Inova Schar Cancer Institute recently found a “significant decrease in the number of people who associate lung cancer with shame, stigma, and hopelessness,” compared with results from a 2012 study that found 3 out of 4 people had a negative bias toward people with lung cancer. More progress is yet to be made, and Genentech is continuing research aimed at changing implicit biases.
This progress is critical, given stigma may be a factor in preventing people from receiving the care they need, including lung cancer screening. The American Cancer Society recommends yearly screening for people who are between 55 and 74 years old, have a heavy history of smoking, and smoke now or have quit within the past 15 years. And yet, screening rates for high-risk individuals are only 4.2% nationally. More education and advocacy are needed to boost screening rates, a necessity in order to help enhance patient care and outcomes.
The time is now
Raben argued that to truly move the needle with lung cancer, industry must support the community across the entire disease spectrum. This will require continued advancements in biomarker research, clinical trials, and overcoming other barriers to care. He believes we will see many more breakthroughs in lung cancer care over the next five years.
“My ultimate goal for the future,” said Raben, “is for every person with lung cancer to have care that’s thoughtful, rational, and individualized for them, so that we can look them in the eye and say, ‘You’re not going to die of this disease.’”
To learn more about Genenetech’s advancements in lung cancer, visit https://www.gene.com/topics/lung-cancer.