Vials of epigenetic therapy
Chemotherapy and other types of targeted drug therapy are the foundational treatment for lung cancer of all types: small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC), mesothelioma, and rarer types as well.
Depending on the patient’s stage (how far the cancer has advanced and where), the tumor’s type and location, and other factors, medical oncologists work with other specialists at Johns Hopkins to determine if chemotherapy will be given before or after surgery and with or without radiation.
Standards of care
Established standards of care guide medical oncologists in determining what drugs to use for each patient, depending on the location of the tumor, the type of tumor, the cancer stage, and the patient’s health. The National Comprehensive Cancer Network (NCCN), an alliance of 21 of the world's leading cancer centers, including Johns Hopkins, is one organization that sets those standards.
- For small cell and non-small cell lung cancer, most patients will receive platinum-based combination chemotherapy, either alone or in conjunction with other treatment such as surgery and radiation therapy.
- Patients with advanced stage mesothelioma also receive chemotherapy, generally with cisplatin or carboplatin with pemetrexed.
Depending on each individual’s case, the medical oncologist will also use several other chemical agents. Those decisions are made based on the patient’s histology, toxicity of the chemotherapy regimen, and the length of time needed for the treatment.
Beyond the standard
As a world-renowned research and treatment center, Johns Hopkins goes beyond the standards of care to provide lung cancer patients with the most promising and newest combinations of cancer-fighting drugs. Researchers and clinicians work together at Johns Hopkins to find new ways to attack lung cancer. Many of those researchers also are clinicians who treat patients and many of the clinicians conduct research. This cross-disciplinary way of working offers fertile ground for discovery and the ability to put that discovery into practice if it is beneficial.
These new approaches to targeted drug therapy are being offered to patients at Johns Hopkins either as part of a treatment plan or through clinical trials:
Epigenetic therapy treats cancer not by killing cancer cells but by reprogramming their patterns of gene expression so that they lose their capacity for uncontrolled growth. Through the study of cancer cells’ epigenomes, the biochemical reactions that turn genes “on” or “off,” Hopkins medical oncologists can prescribe chemotherapy regimens for lung cancer that cause the epigenomes to turn on genes that fight cancer cells.
Immunotherapy, a promising new approach to treatment, harnesses the use of the body’s own immune system to attack cancer cells. Monoclonal antibodies, created in a laboratory from immune system cells, can attach to cancer cells to kill them, stop their growth, or keep them from spreading. Several clinical trials are underway at Johns Hopkins to improve the ability of the immune system to recognize and eliminate lung cancer from the body.
Personalized chemotherapy is based on genetic testing of a patient’s tumor. Through the identification of biomarkers that determine how a patient will respond to chemotherapy, the medical oncologist can prescribe a chemotherapy regimen matched to the genetic abnormality and that is most likely to decrease the size of the tumor. Patients with adenocarcinoma are the most likely to have mutations that will respond to the drugs currently available. For example, if the cancer tumor has a EGFR mutation, a patient will receive an EGFR inhibitor, such as erlotinib, as first-line therapy. Another group of patients with a specific mutation—EML4ALK translocation—receive crizotonib. There are an increasing number of examples of genetic alterations that can be matched to specific drugs that work to shrink the lung cancer.
The lung cancer program can offer patients clinical trials for every stage of lung cancer, particularly for those patients whose cancer has metastasized or spread to other locations.
For an appointment and answers to your questions
As a leading treatment center for lung cancer, Johns Hopkins offers its patients personalized care, specialized treatment, and pioneering therapies to extend life.
To make an appointment or if you have questions, call 410-955-LUNG (5864).