Personalized cancer care: Treating the ‘new face’ of lung cancer in Canada

Dr. Zhi Xiuyi examines an X-ray of a patient's lungs.
Dr. Zhi Xiuyi examines an X-ray of a patient's lungs. Tim Johnson/Getty Images)

TORONTO – He’d never tried smoking, but when Joseph Neale was 20 years old, he was diagnosed with lung cancer.

It was coughing fits that alerted the Toronto-based singer and songwriter to get medical help. They were so bad, he couldn’t get through a sentence.

“During this conversation, I would have coughed at least 100 times. I would be coughing between words and I couldn’t get a word out,” Neale told Global News.

Doctors were taken aback by his youth – they thought it was pneumonia, or a benign tumour, even tuberculosis. A few months later, they learned the tumour was cancerous and it was metastasizing.

“Just to know that something that random came into my life – I was thinking I might not see the future,” Neale said.

The tumour was blocking the bottom right of one of his lungs, blocking 50 per cent of oxygen. By October 2012, surgeons went through Neale’s ribs to cut out two thirds of his right lung, removing the cancer.

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Only months later, as a cancer survivor, Neale is already back in studio making music. But he’s still dealing with shortness of breath.

He had never smoked a cigarette, and was healthy with an active lifestyle of playing basketball and working out with his brothers.

The new face of lung cancer

Lung cancer has been dubbed the smokers’ cancer, but one Canadian doctor says the new face of the disease is those who have never smoked, women and East Asians.

That’s because these subgroups of lung cancer patients seem to have a common thread between them: a specific genetic mutation that doctors have learned to treat in fighting the cancer.

“Lung cancer, until recently, was always thought about as one disease and everyone was treated in a similar manner but research is pointing out that lung cancer isn’t one disease. Its multiple subtypes of disease, and knowing this information allows us to better individualize our treatment,” Dr. Sunil Verma said.

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Verma is a medical oncologist at Sunnybrook Hospital where he treats cancer patients and conducts research.

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Less than a decade ago, as doctors tested new lung cancer therapies, they noticed a “tremendous” response in some patients – some female non-smokers, for example. In trying to understand why, the doctors learned that some patients had the epidermal growth factor receptor mutation – or EGFR. This group was more responsive to some cancer therapies.

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The mutation seems to be most common in never-smokers, non-smoking women and those of East Asian descent.

“Why Asian patients and non-smokers get this (mutation), we don’t know. Clearly, this is a very important area of research to understand what it is about our ethnicity, what is it about our smoking status…and what’s being driven by certain biomarkers,” Verma said.

Unlike Angelina Jolie’s case, in which she carries a BRCA-1 gene that made her likelihood of getting breast cancer dramatically increase, there is no link between the EGFR gene and getting lung cancer, Verma said.

Read more: Breast cancer and genetics: Angelina Jolie’s double mastectomy

Patients are typically tested for the gene and response to treatment in the advanced lung cancer stages, but some research is looking into its value at the onset of lung cancer, before it’s spread.

About 15 per cent of lung cancer patients have this gene. About 60 to 70 per cent of the time, patients who have the gene are from China, Hong Kong or Malaysia.

“This is where we are seeing a great propensity of those tumours to have these mutations,” Verma explained.

That group tries personalized treatment that targets the EGFR mutation and the tumour while others turn to chemotherapy, which is more potent and hard on the body.

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Genetic information aids in personalized cancer treatment

Personalized cancer care is a burgeoning field of medicine in which doctors rely on patients’ genetic information to put together a tailored treatment plan.

This weekend, new research on this personalized approach will be presented at the American Society of Clinical Oncology Meeting in Chicago.

Those with the genetic mutation even have longer survival rates, Verma said. It could be because this group has its first-line defence of personalized medicine that the body can tolerate a lot easier than chemotherapy.

Normal patients with advanced lung cancer, on average, have a 12-month survival rate. Meanwhile those who turn to personalized medicine based on their EGFR mutation have about a two-year survival rate.

“I have some patients in my clinical practice who have had similar drugs who live 4, 5, 6 years, which was unheard of in lung cancer before,” Verma said.

“The likelihood of someone surviving two years was less than one per cent. Now we have 15 to 20 per cent surviving more than two years,” he told Global News.

Read more: Smokers who quit before 40 save a decade of their lives: study

The EGFR receptor is present in normal cells and is meant to function in the regeneration of our skin. In the mutation, it tells the cell to start dividing rapidly, spreading to other areas.

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Over the past two decades, Verma suggests there is anecdotal evidence pointing to non-smoking women getting diagnosed with lung cancer.

So far, about 15 per cent of women with the disease are non-smokers, while it’s 10 per cent for men.

Neale said his doctors told him his lung cancer was slowly growing for four or five years.

“So when I was 14 or 15, this thing was starting already without showing side effects,” he told Global News.

Neale said his voice became a bit raspier following his surgery. Just months after the operation, he sang this cover of Skyfall. Watch here.

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