There are few diagnoses worse than late-stage lung cancer. It kills more people than any other type of cancer, and few patients survive once it has spread. At this stage, the cancer may respond for a brief time to chemotherapy or cancer-gene-targeted therapies, but almost always resurges even stronger. Recent breakthroughs in the use of immunotherapy—which harnesses the power of the body’s own immune system—are offering new hope to many lung cancer patients.
A Stunning Diagnosis
John Ryan, 72, began experiencing symptoms in 2013 when he coughed up a small amount of blood. The husband and father of eight thought it was strange, but with no pain or other symptoms, he was stunned to learn he had the most advanced stage of a common form of lung cancer known as non-small cell lung cancer. The cancer had already spread to a rib.
Medically speaking, Ryan’s diagnosis was stage 4 non-small cell adenocarcinoma of the lung. In May 2013, his prognosis was six to nine months without treatment, or 12 to 18 months with treatment. He worried if he would live long enough to see major milestones in his children’s lives.
For a brief time, chemotherapy worked, but the treatment came at great physical cost. The simplest tasks became difficult. His body was weakening, and worse, he learned his cancer was no longer responding to the treatment. Genetic testing of his tumor did not reveal any mutations that would make him a candidate for targeted therapies. It seemed he was out of options, until his doctor suggested he go to the Johns Hopkins Sidney Kimmel Cancer Center and meet with Julie Brahmer, M.D., director of thoracic oncology.
Promising New Treatment
Dr. Brahmer was one of the lead investigators on an experimental clinical study of anti-PD-1 immunotherapy. Ryan’s form of lung cancer was among the cancers that showed unprecedented responses to this form of treatment.
“Before I began immunotherapy, I struggled to sit at my kitchen table,” says Ryan. “After just four treatments, the tumor shrunk by 65 percent and I felt like a human being again.” A few more treatments and Ryan’s rapidly growing lung cancer was nearly gone. The cancer that spread to his rib was eliminated. His only side effect? Some minor skin irritations he compared to a mosquito bite.
Ryan is not an isolated case. About one quarter of lung cancer patients in Johns Hopkins studies have responded to the treatment. The numbers are even higher for melanoma and kidney cancer patients. Anti-PD-1 has proven effective in treating as many as 14 other cancer types, making it a pivotal breakthrough in the cancer world.
With Ryan’s cancer stable—no longer shrinking, but not growing either—Dr. Brahmer keeps him on this anti-PD-1 treatment, and hopes to learn more about how long patients need to stay on it. Ryan continues his regular trips from his home near Middleburg, Va., to the Kimmel Cancer Center for bi-weekly treatments. He also participates in a Stand Up To Cancer-funded study providing blood samples that help researchers understand more about how immunotherapy works against cancer. For the past two years, Ryan has participated as a consumer reviewer on a congressionally directed medical research program for lung cancer.
“Immunotherapy lets me resume a normal daily routine, and enabled me to witness college graduations for a son and two daughters in 2015 and 2016,” Ryan says.
Battling Lung Cancer with Immunotherapy
Watch John Ryan and Julie Brahmer, M.D., discuss the hope of immunotherapy for people with squamous-non-small cell lung cancer.
Still Much to Learn
Not every patient responds to immunotherapy. Those whose tumor cells express the PD-L1 protein have the best chance of responding to treatment, but even some of them do not. Patients like Ryan help investigators solve those mysteries and discover ways to help more patients.
“I feel that this is really not about me,” says Ryan. “Immunotherapy saved my life, and I want to bring this message of hope to others. I know how fortunate I was to have this wonderful team of doctors and nurses at Johns Hopkins. They are my heroes,” he says. “Three years ago, in a very short period of time, I went from feeling fine to being in serious trouble. Time was critical, and I was fortunate to get into the right hands quickly.”
Today, Ryan says he feels better than he has in years. During the past two summers, he’s served as crew chief for his son’s grueling 100-mile ultra-marathons in the mountains.
“My friends and family were shocked by how much energy I had,” he remembers. Ryan is currently planning for his son’s next mountain trek in Utah this September.
“The immunotherapy made possible by many years of dedicated research has been a true life saver for me,” says Ryan. “It represents a very real source of hope to cancer patients and loved ones as they search for timely and viable treatment options.”
For more information or to make an appointment at the Johns Hopkins Lung Cancer Program, call 410-955-LUNG (5864).