Reshaping lung cancer outcomes

Lung cancer, a disease once considered a near-certain death sentence, has entered a transformative era. Advances in screening, genetic research, and minimally invasive surgeries are redefining treatment possibilities and improving survival rates. Stanford has established itself as a significant center for lung cancer treatment in California and is the largest-volume lung cancer surgery center in the state.

 At the forefront of these efforts is Stanford’s thoracic surgery team, led by Stanford Cancer Institute member Joe Shrager , MD, professor and division chief of thoracic surgery, who is pioneering approaches that target early detection, address genetic disparities, and leverage cutting-edge surgical techniques. Together, these innovations are reshaping lung cancer care, offering new hope to patients and changing the disease’s trajectory from fatal to manageable. 

Transforming treatment: New frontiers in lung cancer care

Lung cancer survival and cure rates have improved remarkably in recent years, driven by advancements in minimally invasive surgeries and new drug therapies. Shrager highlights that these innovations have redefined how we face lung cancer.

“Because of new surgical techniques and targeted drug therapies and immunotherapies, the success rates of treatments for lung cancer have skyrocketed,” he states. “What once used to be a death sentence has been transformed into a chronic disease, in many cases.”

Prevention remains critical, primarily through tobacco cessation, which has helped reduce lung cancer incidence, and early detection through screening has proven effective in preventing lung cancer fatalities. 

Health disparities: Lung cancer screenings for non-smokers 

The current standard screening criteria focused on smoking history disqualifies light smokers and never-smokers who may have other substantial risk factors for lung cancer, dramatically reducing the likelihood of early detection in these individuals, something that Shrager and his group are attempting to address. These exclusions dramatically restrict early detection opportunities, particularly among high-risk groups such as women of Asian descent.

Although smoking remains the leading risk factor for developing this disease, the rise in non-smokers developing lung cancer, especially among Asian-American women, is notable. 

 “We’ve really ramped up our screening program,” Shrager says, “but right now, the guidelines and the payments from insurers are only for people with a certain amount of smoking history.” 

Shrager’s team is reshaping these guidelines to include racial and genetic considerations. Stanford Cancer Institute member Natalie Lui , MD, assistant professor of cardiothoracic surgery (thoracic surgery), is raising funds to conduct a screening trial focused on Asian women.

Epidermal growth factor receptors

Addressing these disparities from a genetic perspective, Shrager’s team is investigating the role of epidermal growth factor receptor (EGFR) mutations, which are often linked to lung cancer in non-smokers. Shrager’s lab has explicitly focused on EGFR mutations in this population, exploring CRISPR gene-editing technology to modify these mutations as a potential treatment. While current targeted drugs work well initially, resistance typically develops after several years. CRISPR could offer a more customized alternative.

“Right now, we have targeted drugs that work pretty well,” says Shrager, “but [these patients] usually develop a resistance to it after a few years of treatment, so this would be another alternative customizable to each mutation.”

Early in-vitro studies show promise, with CRISPR treatments significantly reducing tumor cell growth rates. 

These advancements contribute to reshaping lung cancer care. They provide better outcomes for individual patients and address the broader challenges of genetic risk factors and health disparities. By focusing on personalized and early intervention, Shrager and his colleagues are transforming lung cancer from a terminal diagnosis to a manageable condition.

By Kai Zheng

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