I have been training all summer, balancing my patients, research, teaching, family, and friends, to complete the Chicago Marathon on October 12. It has been a busy time, and I’ve often felt like it was pure madness to even consider adding training for a marathon to my already full plate. One of my favorite patients, Carol, was in large part my inspiration. She reminded me this past spring that 2014 would mark her 10-year anniversary as a survivor of stage IV lung cancer. So, always up for a challenge, this year I’m running to celebrate Carol and all of the others with advanced lung cancer who are here “10 years strong.”
Even though I’ve always been active, and I enjoy all sorts of exercise, I’ve learned a lot from my training experience. Training for a marathon requires discipline, humility, and confidence. Planning time for my runs on top of a full day of work has required that I focus on efficiency and what I hope to achieve. On some of my long runs this summer, I felt I couldn’t up my mileage any more. The hot and humid weather made it difficult to catch my breath and made me feel like I was gasping for air. I persevered, but I realized that I was feeling what some of my patients feel every day when they can’t breathe deeply.
Each week, as I’ve built my mileage, I’ve also had time to reflect on the patients that have inspired me, the tragic losses we’ve faced, and the incredible courage and love that I’ve seen individuals display as they valiantly fought despite the diagnosis of advanced lung cancer. This time to think deeply has given me a chance for remembrance and has helped me focus on the voice of hope, courage, and determination that tells you to keep going because you know you can—both while running and in life.
I’ve often counseled my patients over the years that living despite advanced lung cancer is like a marathon. Each incremental step counts, there are setbacks, humor helps, and you’ve got to think of the long game. I tell them that we have to keep going until science catches up. Years of steady progress building upon foundational science have led to improvements in survival, and we’re beginning to see the fruit of years of basic scientific research. Just look at Carol!
2004, the year I first met Carol, was actually a remarkable year for lung cancer treatment. Two pivotal drugs, pemetrexed (Alimta) and erlotinib (Tarceva), were approved by the U.S. Food and Drug Administration (FDA). At that time, we didn’t know which patients would benefit from treatment with these drugs, and in retrospect, they were approved on modest survival advantages. As we learned more about the biology of why they can be so effective in some individuals, we found that EGFR mutations could predict dramatic responses for some patients. We learned that pemetrexed could not only improve survival in patients with non-squamous cell lung cancer, but that it was remarkably well tolerated and could be used as maintenance therapy. This was new territory for lung cancer—we could actually make lung cancer a chronic disease.
I know that 10-year survival for patients with advanced lung cancer remains extremely rare, but I’m excited by the remarkable breakthroughs we have made in understanding the genetic underpinnings of lung cancer, the availability of precision medicine, and the promise of immune therapy. I can only hope that by 2024, we will all be celebrating more 10-year anniversaries like Carol’s.