Lung Cancer Treatment: From Nihilism to Enthusiasm

Over the course of her career, this medical oncologist has driven an incredible transformation in outcomes for lung cancer patients.

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Over the course of her career, medical oncologist Frances Shepherd has helped drive a seismic shift in the treatment of lung cancer.

“When I started treating lung cancer patients, there was enormous nihilism,” says Shepherd. “Our drugs were very toxic, not very active, and there was a general perception that it almost wasn’t worth treating lung cancer patients.”

Shepherd, professor of medicine at the University of Toronto and medical oncologist at the Princess Margaret Cancer Centre, won the 2018 Canada Gairdner Wightman Award as one of the global leaders who helped change the tide for lung cancer patients.

Her work in clinical trials has led to new treatments that have changed lung cancer treatment internationally. She led the Canadian Clinical Trials Group Lung Cancer Site, showing that post-operative chemotherapy leads to more cures, and that even in advanced stages of disease, molecularly targeted treatments improve survival.

“Enthusiastically now we treat lung cancer patients, not just in the first line, but in the second line, and third line, and we have many, many different options to treat them,” adds Shepherd.

In the past five to 10 years, technology has also advanced to the point where a lung cancer’s specific genetic and molecular-level changes can be targeted for better outcomes, says Shepherd. In the past, all patients might have received the same treatment even if it only worked for a quarter of the population; targeted treatments are expected to be much more effective, with a positive response in the range of 60-80 percent of patients.

“It is wonderful when we find one of these cancers with gene drivers,” says Shepherd. “To be able to tell them, ‘You’re going to get treatment with one pill a day, you’re not going to lose your hair, you’re not going to be vomiting. We expect that when we see you in four weeks, you will be feeling better, your breathing will be better, you’ll be reducing your pain medications quickly in response to these personalized treatments.’”

This is a huge improvement over the days when chemotherapy itself caused so many side effects for so little benefit.

“I can’t emphasize enough how important the science has been that has then led to the development of the drugs that have led to improvements in outcomes,” says Shepherd.

“Our new treatments have really contributed to our ability to give hope to patients. That hope is not just for improvement in symptoms and living months to years longer, that hope is for a cure.”

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