Beating the Elusive Lung Cancer

Hallways sprawl with people: Residents hurry with coffee and breakfasts, an elderly couple seek the receptionist’s help, and a daughter wheels her father to the elevator. But there’s much more than meets the eye.

On the ground floor, behind a maze of hallways and doors, there’s a team of Dedicated doctors who have relentlessly been on a quest to beat lung cancer - not an easy task because this cancer is very good at hiding.

I interviewed the three experts who are leading the VA Lung Precision Oncology Program (LPOP) focused on improving outcomes for Veterans at risk or with lung cancer. Dr. Steve Dubinett is a pulmonologist, Dr. Drew Moghanaki is a radiation oncologist, and Dr. Ahmed El-Sherief is a radiologist.

Who should be screened?

“Scientists across the VA have been trying to figure out what causes lung cancer for nearly a century,” said Moghanaki. “Individual with a history of smoking are in the highest risk category. However, people who never smoked also develop lung cancer.”

“Therefore, lung cancer is likely caused by a combination of genetics and other environmental exposures such as asbestos, radon and pollution.”

The Elusive Cancer

Cancer cells can grow in the body because they can hide from the immune system. What happens is that they mimic the immune systems “off switches.”

“Our normal immune system is very good at fighting not only bacteria and viruses, but also cancer cells that can develop in our bodies. However, our immune system has off switches. It also knows when to turn off so that it doesn’t remain constantly active after it has finished fighting,” explained Dubinett.

“When it comes to lung cancer, it has in a way, through a very intricate mechanism, adopted these off switches to hide the tumors from our immune system. It takes a lot to battle those very strong forces that are at play immunologically,” explained Dubinett.

Before it turns into cancer

I wanted to know if there’s a premalignant stage so we can prevent the cells from turning into cancer.
“There is premalignancy in the lung, and one of the things that our LPOP investigators are studying is how do you get from a normal cell in the lung to premalignancy and then how does premalignancy become actual cancer,” Dubinett said.

One of the challenges that the team faces is that it’s very difficult for us to detect premalignancy in the lung.

“But new techniques are being made available, such as robotic bronchoscopy, and we anticipate finding more and more so that research in LPOP will help us understand that sequence that gets us from healthy cells to premalignancy and then to cancer,” said Dubinett.

“There are some very interesting early findings that suggest that, in fact our immune system can actually kill that premalignancy. So, one of the basic goals would be to find those lesions to determine which are destined to become malignancy and then treat them by boosting the immune system.”

“A lot of people with lung cancer today are being treated by FDA approved immunotherapy. It doesn’t necessarily kill the cancer cells directly, like chemotherapy, but it removes that shield
that the cancer hides behind, so that the immune system can fight the cancers,” Moghanaki said.

These three scientists strongly suggest you ask your primary care doctor to give you a referral to be screened. “No judgement is passed, we’re here to take care of you,” Moghanaki said.

“If you smoke or used to smoke, come in,” El-Sherief said. “We’re here to help you extend your life to be blissful among your family and friends.”