73
Some specific gene mutations that contribute to lung cancer have been identified in the past five to 10 years. Young people and nonsmokers who get lung cancer often have a mutation in a gene called epidermal growth factor receptor (EGFR), which can be treated after surgery with a targeted therapy in the form of an oral pill. Other genetic abnormalities that may respond to targeted therapies are rearrangements in genes known as ALK or ROS1.
But medical treatment before or after surgery still depends on the stage and aggressiveness of the cancer, which is determined by a pathologist, says Dr. Chiang. “If the tumor is aggressive, the doctor might recommend chemotherapy after surgery. If a large tumor has spread to lymph nodes in the chest, the treatment might be a multimodality therapy, which combines surgery, radiation, and chemotherapy or immunotherapy.”
There has been exciting progress in treating lung cancer with immunotherapy, which activates the body’s immune system to specifically kill cancer cells. But clinical studies have shown that this treatment
tends to work better in smokers than in nonsmokers, Dr. Chiang says.
What can nonsmokers do if they
are worried about lung cancer?
This can be a difficult question, as there are no symptoms of lung cancer in its early stages, and it is still uncommon enough that routine screenings are not recommended for nonsmokers and never-smokers. Most often, when early-stage lung cancer is found in nonsmokers it is due to “incidental findings,” Dr. Boffa says. “Most had an X-ray or CT scan done for some other reason and the radiologist sees something on the lung,”
he says.
But family history is important, and people can talk to their doctors if they are concerned about a family history of lung cancer—if there is a first-degree relative or multiple family members who had the disease, or a family member who was diagnosed at a young age. It’s also important to bring up concerns about exposure to secondhand smoke, radon, industrial pollution, or other known contributors.
How is Yale Medicine unique in
the treatment of lung cancer in nonsmokers?
Patients who seek treatment at the Yale Cancer Center at Smilow Cancer Hospital have access to new cancer therapies that are in development. Through clinical trials, patients may be able to benefit from groundbreaking treatment options not available elsewhere. “At Yale, we have led
the way in developing important therapies for lung cancer patients by designing and implementing clinical trials that try to improve outcomes for our patients,” says
Dr. Chiang.
Important research is being conducted through Yale Cancer Center’s Specialized Program of Research Excellence (SPORE) for lung cancer. This is one of only three lung cancer-focused SPOREs funded by the National Cancer Institute to study non-small cell lung cancers, which include the adenocarcinoma that is common in nonsmokers. The Yale Medicine program brings together experts in oncology, immunotherapy, pharmacology, molecular biology, pathology, epidemiology, and addiction science to attack lung cancer. “There is a lot of research going on here,” says Dr. Chiang.
https://www.yalemedicine.org/conditions/lung-cancer-in-nonsmokers
###