The approach to treating lung cancer has significantly changed over the last year as a result of new preoperative systemic therapy paradigm shifts. Historically, a patient presenting with a new lung cancer diagnosis in the early stages and confined to the chest would be referred directly for surgery, possibly followed by chemotherapy. Today, the care pathway is shifting to include medical oncology intervention with neoadjuvant treatment prior to surgery which has provided better outcomes, particularly in stage three disease where the rate of relapse is over 50% after surgery and chemotherapy.

“Therapy using immunomodulation, which harnesses the immune system to fight lung cancer, has been one of the biggest advances in the treatment of lung cancer in the past five years,” notes Susan Scott, M.D., assistant professor of Oncology at Johns Hopkins University. Scott, who received her fellowship from Johns Hopkins University School of Medicine, joins Dr. Benjamin Levy in treating lung cancers in the greater Washington area.

In March 2022, following an international phase three trial led by Johns Hopkins researchers, the FDA approved a systemic combination of neoadjuvant chemotherapy and immunotherapy. “Given intravenously for about nine weeks before surgery, the therapies have been shown to work together to stimulate the patient’s immune system to shrink the tumor,” says Scott. “We believe this also creates a durable response using the patient’s immune system to prevent any cancer cells remaining post-surgery from growing again. This is practice changing.” 

One challenge in all stages of lung cancer is to increase rates of response to immunotherapy to provide benefit to more patients, and much of the answer may be found in combination therapies. Targeted therapy is also an ongoing area of interest and investigation in clinical trials. When a specific mutation in the DNA of the tumor is known, targeted therapy may offer new pharmacologic advances to address the mutations driving the tumor, allowing treatment to be tailored specifically to the tumor.  New research aims to study use of targeted therapies in the perioperative setting as well.

“In addition to this being life-extending therapy, our goal in treating lung cancer using combinations of systemic therapy, such as chemotherapy, immunotherapy or targeted therapy plus surgery, is that the disease will not return after surgery to create a durable cancer cure,” says Scott. 

As part of the Johns Hopkins multidisciplinary team, Johns Hopkins medical oncologists combine this new standard-of-care approach with the expertise of surgical and radiation oncologists, pulmonologists and pathologists, helping patients live longer with lung cancer.