Here are four things that every newly diagnosed lung cancer patient should ask their doctors before starting treatment.
1. What stage is my lung cancer?
The very first thing you should ask is how advanced your lung cancer is. The answer to that will drive all of your care team’s decisions.
It’s critical to answer this question as accurately as possible, too, because every treatment carries at least some risk. And, once you embark down a particular treatment path, it can lead to both temporary and permanent side effects, or even limit your ability to get other treatments.
We see this all the time here at MD Anderson. A patient will come to us after having received immunotherapy elsewhere, before even having been tested for genetic mutations. And, as a result, they may not qualify for a clinical trial that could have given them a much more beneficial drug. Or, we’ll see someone who had radiation therapy at another hospital, when the tumor could’ve been treated more effectively with chemotherapy first, or even removed fairly easily here with surgery.
Some of our patients have also been told, “Let’s just get the tumor out first. We’ll worry about the details later.” But that’s not really the best way to approach it. Because you’ve got to know what you’re dealing with before you initiate therapy. So, staging a cancer accurately is much more important than getting to the operating room quickly.
2. Does my cancer have any genetic mutations for which a targeted therapy is available?
Because of an explosion in new lung cancer therapies over the past seven or eight years, this has become an increasingly important question to ask.
That’s because lung cancer treatments fall into one of two “buckets”: local therapies and systemic therapies. Local therapies focus on one particular place in the body, and include things like surgery and radiation therapy. Systemic treatments affect the entire body, and include things like chemotherapy, targeted therapy, and immunotherapy.
But we didn’t have access to all of the targeted therapy and immunotherapy drugs a decade ago that we do today. We only had chemotherapy back then. Now, we have much more sophisticated drugs at our disposal, which allow us to target specific mutations.
A cancer’s stage will always be the main driver of your treatment. But proper staging tells us which bucket we should be drawing it from. If you come to us with a super-early-stage lung cancer, for instance — even if you have known genetic mutations — we’re probably never going to treat you with a targeted agent. Because if we’ve caught your cancer early enough, we can just remove it surgically or use radiation therapy. And the risk of recurrence is so low that you may not need any additional therapy.
On the other hand, as the risk of lung cancer spreading increases, we’re more likely to have to use systemic therapies like chemotherapy and immunotherapy. That’s why we have to answer the staging question as early and accurately as possible. Because which buckets we draw your treatment options from are determined by the stage of your cancer.
3. Are there any clinical trials available that might give me access to newer treatment options?
Most targeted therapy and immunotherapy drugs have only been approved by the Food and Drug Administration (FDA) as a first line of treatment for lung cancer patients with stage IV diagnoses. But MD Anderson has many open clinical trials right now that are making these drugs available to patients much sooner: some as early as stage Ib. The only way to get those drugs is on a clinical trial, though, so it’s important to ask your doctor if you qualify to participate in one.
Some of our most exciting clinical trials combine targeted therapy with what we call aggressive local controls (radiation therapy and surgery), in patients with metastatic lung cancer. A few of our patients have actually achieved cures through these clinical trials.
That is an absolutely tremendous development. Prior to this, if you had stage IV lung cancer, you got chemotherapy and maybe radiation to treat your symptoms — or sometimes, just supportive care to keep you comfortable. Now, we’re giving patients immunotherapy or targeted therapy and then removing all visible traces of the disease with a combination of surgery and radiation. These studies are still in the very early stages, but we’re finding that this combination is greatly extending the lives of many of our stage IV lung cancer patients.
4. Could any of my other medical conditions interfere with my treatment?
Discussing your medical history with your doctor during your first visit is a very smart move, because certain conditions can absolutely affect your treatment choices. Severe emphysema, for instance, might limit your ability to have surgery. And diseases such as ulcerative colitis or rheumatoid arthritis may make you ineligible for certain chemotherapy drugs, immunotherapy drugs, and even some forms of radiation.
Once you’ve answered these four questions, you’ll be ready to choose a treatment plan. But the most important question to ask is the first one, so don’t skip it. Because if we underestimate the stage of your cancer, you may not be offered something that could prove beneficial. And if we overestimate it, you might receive something unnecessary that doesn’t provide any benefit at all. That’s why we won’t even begin discussing how to treat your cancer until we know exactly how advanced it is.