Approximately 20%-35% of patients newly diagnosed with non-small cell lung cancer (NSCLC) will have locally advanced disease, sometimes referred to as stage III NSCLC. The definitions of locally advanced disease can be complex. Generally, in these cases, the tumor may have grown into other areas close to the lung, such as the diaphragm or esophagus, or spread to nearby lymph nodes. However, the disease would not have spread to distant parts of the body.
The standard treatments of locally advanced lung cancer have been surgery, chemotherapy, and radiation for many decades, but recently, immunotherapy has been added as a treatment option for some patients.
In 2022, LUNGevity awarded the VA Research Scholar Award to Alex Bryant, MD, assistant professor of Radiation Oncology at the University of Michigan who practices at VA Ann Arbor Healthcare System. Dr. Bryant plans to leverage the VA’s nationwide electronic healthcare records database to understand the treatment journey and outcomes of veterans diagnosed with locally advanced NSCLC. LUNGevity spoke with Dr. Bryant to learn about how this research project came about and how it can help the lung cancer community.
LUNGevity Foundation: Why is it important to support lung cancer research?
Dr. Alex Bryant: It’s critically important. Unfortunately, lung cancer is still one of the most common cancers and also one of the most deadly cancers. And that is despite decades of incredible research progress. We've had a revolution in targeted therapy over the last 10 years. We've had a revolution in immunotherapy from 2015 onward. And then, not to be overlooked, are major improvements in therapies for early-stage lung cancer. We now have the ability to use very focused radiation beams and improvements in surgical procedures to cure early lung cancers. These advances have proven that our investments in lung cancer research have been paying off.
Despite all these advancements, it’s a deadly cancer for too many patients. There is still an incredible amount of work to be done to make local therapies better, to make targeted therapies and immunotherapies work better, and to make treatments less toxic for patients to improve not just the quantity of their years, but the quality of their lives.
LF: Why are you interested in working with veterans?
AB: Veterans have been a special population to me for a very long time. It is a privilege to serve our veterans who have served our country.
Veterans are at a higher risk of developing lung cancer because of tobacco exposure and environmental risk factors. Also, the population of veterans within the VA system tends to be racially and ethnically diverse and more representative of the general population as a whole.
These demographic groups also tend to be medically underserved. My ultimate goal is to help by providing them with excellent medical care and by conducting research to improve treatment for the cancers that most affect them.
LF: Tell us about how this research project came about?
AB: My research project came from clinical observations that I made during my training.
My project focuses on patients with locally advanced lung cancer, the lung cancer that has often spread to the lymph nodes in the chest but not yet to other organs. It is still contained within the chest and often it’s still potentially curable. But these patients have a high risk of recurrence.
For many years, the primary treatment for these patients was the combination of chemotherapy and radiation. In 2017, there was a practice-changing research study, the PACIFIC study, that showed that adding a year of immunotherapy onto the end of chemo-radiation resulted in a big improvement in survival outcomes.
This treatment approach has worked well for many patients. But I noticed that some patients, despite getting the immunotherapy, were having one of two things happen. Either their tumor progressed in the first year and they needed additional treatment, or they had severe treatment-related side effects.
So, there were two clear questions that came to mind for me.
- Now, in the era of immunotherapy, are severe side effects more prevalent?
- Can we do a better job of predicting which patients will benefit from immunotherapy?
I wanted to predict which patients are likely to have a good tumor response to immunotherapy versus those who don’t benefit. It would also be useful to identify which patients are likely to have severe toxicities from immunotherapy. If we identify these patients up front, we can potentially make smarter treatment decisions. We could control their tumors better and improve their quality of life.
LF: Why should the lung cancer community be excited about your work?
AB: The VA is very large. It's the largest integrated healthcare system in the US and so it really gives us unprecedented ability to ask these sorts of questions and build a computational model to predict patient outcomes.
We’re using the VA’s impressive database of electronic medical records to look for new clinical factors (such as certain classes of medications or other health conditions) that could increase the effectiveness of immunotherapy for patients or point to a good cancer outcome. Of course, it's equally possible that some of these factors could be encouraging an overactive immune response and leading to severe side effects.
To answer these questions, we need to study the health records of many, many patients and that's what this project offers.
LF: How has LUNGevity’s VA Research Scholar Award been important for your work?
AB: The research award from LUNGevity has been transformational for me. It has directly allowed me to grow my team as a new faculty member of my university hospital system. I’m hiring data analysts and program managers, and really starting to build my team. LUNGevity support has allowed that. I really can’t express my gratitude enough.