Online Health Chat with Peter Mazzone, MD, MPH and Sudish Murthy, MD, PhD

March 25, 2014


Lung cancer is a very challenging cancer to treat. The most critical factor in determining the survival rate is the stage at the time of diagnosis. Lung cancer is of various pathologies, including small and large cell lung cancer, mesothelioma and rare tumors of the chest wall and mediastinum. Using a multidisciplinary approach to lung cancer care is vital to managing the disease. Various options to treat lung cancer are available to improve function and decrease pain.

About the Speakers

Peter Mazzone, MD, MPH, is staff physician and Director of Education at Cleveland Clinic's Respiratory Institute. Dr. Mazzone is also Director of the Lung Cancer Program for the Respiratory Institute and Director of the Pulmonary Rehabilitation Program. He is board-certified in internal medicine, pulmonary medicine and critical care medicine. His specialty interests include lung nodules, lung cancer and intensive care unit medicine. His research interests focus on breath analysis, lung cancer diagnostics, lung nodule evaluation, lung physiology assessment and lung cancer screening.

Sudish Murthy, MD, PhD, is the Surgical Director of the Center of Major Airway Disease and a staff thoracic surgeon in the Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart & Vascular Institute. He holds joint appointments with the Transplant Center and the Taussig Cancer Institute. Currently, Dr. Murthy is the NetWork Chair of the Interventional Chest/Diagnostic Procedure NetWork. He is board-certified in general surgery and thoracic surgery. His specialty interests include esophageal surgery; minimally invasive surgery including Robotics, bronchoscopic, laparoscopic and thorascopic procedures; general thoracic surgery and lung transplantation.

A dedicated researcher and prolific writer, Dr. Murthy has authored or co-authored more than 100 scientific articles in leading peer-reviewed medical journals and more than a dozen chapters in medical textbooks. His research interests include lung cancer, lung transplant and emphysema.

Let’s Chat About Lung Cancer: Medical and Surgical Options

Moderator: Welcome to our chat today with respiratory specialist, Dr. Peter Mazzone, and thoracic surgeon, Dr. Sudish Murthy. We are thrilled to have both of them here with us to share their knowledge about lung cancer.

Lung Cancer Diagnosis

mikeyL: How do I know if I might have lung cancer? How do you differentiate the symptoms of lung cancer from other lung diseases?

Peter_Mazzone,_MD,_MPH: The symptoms of lung cancer are similar to symptoms of many other conditions—cough, shortness of breath, and chest pain—so it is hard to determine if the symptoms is related to cancer or not. If one of these symptoms is new and otherwise unexplained, cancer should be considered in the evaluation of the symptom. More serious symptoms, such as coughing up blood or unintentional weight loss in a smoker, should lead to immediate testing to see if cancer is present.
Another option to find lung cancer is screening with a low-dose CT in a person at high risk for developing lung cancer.

Lung Nodules

ssomel: My mother was diagnosed with several lung nodules. We are so worried, but her doctors doesn’t seem that concerned and ordered a follow up in one year! Is that normal? Shouldn’t it be checked more regularly? 

Peter_Mazzone,_MD,_MPH: The risk that a lung nodule is cancerous depends on several things—your mother's age, smoking history and other medical problems, as well as features of the nodule, including size, number and location. Very small nodules (<6 mm or <1/4 inch) can be followed in a year with imaging if someone has no risks for having lung cancer. If risks are present, nodules < 4 mm or 1/6 inch can be followed in a year. Larger nodules should be followed more closely. Older scans are usually reviewed if available. If the nodules were present in the past and have not grown, we are also reassured that cancer is unlikely.

Concerning Symptoms

epicrail: I have a lot of tightness in my chest and heavy coughing fits. I am 64-year-old male and smoke about a pack a day. I think I want to get checked out and make sure that nothing is seriously wrong, but I’m not sure where to go first? Do I start with my primary care physician or make an appointment with a specialist?

Peter_Mazzone,_MD,_MPH: I agree with you that you should get checked. It doesn't matter as much where you are checked first, only that you start the process. If you have a primary care doctor that you trust, he or she would be a great place to start. If they feel that your problem requires a specialist they should refer you on.
Moderator: Additionally, please consider a smoking cessation program to improve your health.

gillam56: I am 19 years old and I feel like I can’t breathe when I wake up and after I smoke. My heart is also beating really fast during these spells and it’s impossible to get a good breath. After a few hours it goes away, but sometimes it doesn’t. Do you have any ideas what this is?

Sudish_Murthy,_MD,_PhD: What exactly are you smoking—cigarettes, e-cigarettes or a recreational drug? Regardless of this, these are concerning symptoms and you should arrange a follow-up appointment with your general practitioner. 
Moderator: Additionally, please consider a smoking cessation program to improve your health.

Stage 2a Lung Cancer

VeronicaM: My 75-year-old mother was diagnosed with stage 2A lung cancer with some positive lymph nodes in the hilar area. What type of surgery would be done? She is otherwise healthy.

Sudish_Murthy,_MD,_PhD: Stage 2a is traditionally handled with an operation, followed by some combination of chemotherapy and/or radiation to give the highest cure rate. Patient fitness is critical and you should get you mother walking the block daily for 45 minutes or so. The treatment will depend on how robust the patient is, since the most aggressive treatment (which yields the highest cure rate) of combining multiple therapies (surgery, chemotherapy and/or radiation) demands that the patient has good remaining lung function as well as a strong heart. The operation usually involves removing the affected segment of lung (up to the entire lung depending upon where the cancer is) and then trying to peel out the involved lymph nodes. The mistake made by most physicians is underestimating the actually stage of disease, as very few people actually have stage 2a disease. Most who are thought to have stage 2a are ultimately found to have stage 3a disease, which has a slightly different treatment plan. Consequently, prior to simply forging ahead with an operation, often it is important to hit the pause button and really make sure you have the correct treatment for the correct stage. This often entails sampling the lymph nodes in the central chest, which is often not done. Most places simply rely on the results of the PET scan, which is erroneous in 20 to 30 percent of patients, unfortunately. Statistically, stage 2 lung cancer represents less than 10 percent of diagnosed cancers and must always be thoroughly reviewed and examined.

Bronchioloalveolar Carcinoma (BAC)

dms201: I was followed for eight years for a lung nodule. This past fall the CT scan showed that the nodule was 1.1 cm. It was a pulmonary ground glass opacity (GGO)ound incidentally in May 2006. A comparison from 2006 to this fall showed an increase in size, and a biopsy was suggested. In December I had thoracic surgery for the lung. If the preliminary biopsy showed cancer, I was to have 20 percent of my left lung removed with a lymph gland biopsy done. During surgery when the preliminary biopsy was done, the preliminary results came back benign with only scar tissue and inflammation. The surgeon—based his surgical decision on this result—took only five percent of the left upper lobe and did no lymph gland biopsy. Within three days after surgery, I got ill. I had liver damage  from surgery. The final biopsy on the eighth day showed non-small cell BAC (bronchioloalveolar carcinoma) in situ, well differentiated with clear margins. The surgeon said if I didn't have liver damage, he would take 15 percent more lung and do lymph gland biopsy. I go in July for a CT scan. I was told the surgery risks outweigh the benefits.

Sudish_Murthy,_MD,_PhD: You have had very bad luck. There is no such diagnosis as BAC anymore, and, unfortunately, most pathologists aren’t experts in lung pathology.  There is adenocarcinoma in situ and adenocarcinoma with lipidic type growth, which now represent the old diagnosis of BAC. Your diagnosis is hard to sort out because of the outdated wording. Perhaps the pathology could be forwarded to us by your hospital and our specialty lung pathologists can lend some insight. If you truly had in situ cancer, there would be little reason to have another surgery to remove the rest of the lobe—just watchful waiting.

dms201: My wedge resection biopsy was bronchioloalveolar carcinoma (adenocarcinoma in situ, 1.1 cm, well differentiated, no lymph nodes were submitted, five percent of lung removed. Margins uninvolved by carcinoma. Additional pathologic findings included subpleural fibrosis and meningothelial-like nodules). Do I need additional surgery to remove more lung or just continue to be observed with CT scans? Should I have a PET scan? I had stage 0 breast cancer four years ago and opted for the bilateral mastectomy, so that I wouldn't have to worry about the breast tissue or radiation effects on my bones, heart and lungs.

Sudish_Murthy,_MD,_PhD: To address this question, I think that a clarification on the specific pathology needs to be made. As I stated previously, the pathologic diagnosis that you were given is outdated based on the most recent revision of the cancer staging manual. So it is difficult to fully understand what your pathology is. Adenocarcinoma in situ is not an invasive diagnosis and what you had done should have been curative. If that is truly the diagnosis that you have, I doubt that a PET scan would be of any utility and in my practice and Dr. Mazzone's, you would likely be followed with CT scans anywhere between six months and one year depending on your risks for cancer and your smoking history status

Sarcoma with Lung Metastasis

BAL23: I have sarcoma with metastasis to the lungs. I have one lesion left that is the size of an orange. Would you consider removing it?

Sudish_Murthy,_MD,_PhD: Removal of metastases to the lung from elsewhere is based on complete control of the original cancer and the likelihood of being able to remove all of the disease in the lungs. We would need to organize a visit with us (our sarcoma oncologists as well) and I would have to see your chest scans before I could render a decision.  However, it might be possible.

Smoking and Lung Cancer Risk

Yoshi: If you have smoked for 19 years but quit 32 years ago, are you still considered high risk?

Peter_Mazzone,_MD,_MPH: You are at higher risk than someone who never smoked, but at lower risk than we would consider for lung cancer screening. Lung cancer screening can lower the deaths from lung cancer in the high-risk group outlined by nearly 20 percent. If you quit smoking at age 50, you lower your risk by more than 50 percent. Congratulations for doing what many people can't!

Phyllis: What are your thoughts on electronic cigarettes? Are they also dangerous?

Peter_Mazzone,_MD,_MPH: Our knowledge about electronic cigarettes is not strong enough to recommend them. They contain nicotine just like cigarettes—the chemical that makes people crave the cigarette. So using the e-cigarette may allow the cravings to decrease. The other chemicals in cigarettes put people at risk for many diseases such as lung cancer. There are also other chemicals in e-cigarettes. Less is known about their long-term consequences. We also don't know if the use of e-cigarettes leads more people to quit smoking. A concerning trend has been for young people to start using e-cigarettes. More control over their use and a better understanding of their benefits and harms will help us know whether they should be used in the future.

Yoshi: How much does secondhand smoke play in developing lung cancer?

Peter_Mazzone,_MD,_MPH: Secondhand smoke is a known risk factor for developing lung cancer. The risk has been difficult to estimate because it is difficult to quantify the amount of secondhand smoke that one is exposed to. The risk is definitely less than being a smoker yourself, but it is still an important risk factor. This is one of the reasons that laws to limit the public’s exposure to secondhand smoke are so welcomed by the medical community. It is estimated that up to half of never smokers who develop lung cancer have significant secondhand smoke exposure, but this is just an estimate.

Lung Cancer Risk and Associated Lung Conditions

bdg5: Do other diseases put you at a higher risk for lung cancer? I have chronic obstructive pulmonary disease (COPD), and I am worried that I am high risk. 

Peter_Mazzone,_MD,_MPH: Other lung diseases do add to the risk of developing lung cancer, particularly COPD. Depending on your smoking history and age, you may be considered at high enough risk to consider CT screening. There are also risk calculators available that can estimate your risk of developing lung cancer over time, based on your age, smoking history, family history, presence of COPD and a few other factors. A well run cancer screening program should be able to guide you about your risks and whether or not you should consider screening.

Genetic Risk of Lung Cancer

AdamCF: Both my father and uncle had lung cancer. They both smoked about a pack a day, but my father did quit for about 10 years, but then started again. Is lung cancer genetic? Should I be getting tested regularly? I am 45 years old and only smoked casually in my early 20s.

Peter_Mazzone,_MD,_MPH: There is a genetic connection to developing lung cancer, but the risk to you of having a parent or sibling with lung cancer is much, much lower than the risk from smoking cigarettes. You did the best thing to minimize your risk by not becoming a smoker. I would not recommend regular testing.

Squamous Cell Lung Cancer Survival

LUCILLEMARIE: I would like to know the estimated longevity of a non-small cell, squamous cell lung cancer in a 74-year-old woman with emphysema and interstitial lung disease. When would you know when the end is near? What would be symptoms that would alert a caregiver? She has only been known to have this for 18 months.

Peter_Mazzone,_MD,_MPH: The longevity for a squamous cell carcinoma of the lung is related to the stage of the disease (how far has the cancer spread). A squamous cell cancer that has not spread can be treated for a cure, and her other medical problems may be more important in terms of how long she will live. If the cancer has spread to the lymph nodes or areas outside of the chest then the chance of survival is much lower, perhaps in the one-year range.

Sudish_Murthy,_MD,_PhD: That is unfortunately a question for a far higher authority. However, there are several ways to predict this crudely. I think understanding the stage of the disease (lung cancer) would be of prognostic use. In addition, simply having COPD and interstitial lung disease is not enough for me to get a mental picture of your mom. Very advanced lung disease (in the absence of any cancer) can be a terminal event on its own and measurements of lung function and oxygen use can be used for life projections. Your local physician should have much of this information and should be able to give you reasonable expectations.

Non-Small Cell Lung Cancer Survival

jray31961: How comfortable can you be if your oncologist says your stage 4 non-small cell lung cancer (NSCLC) is in remission? How long can that last? I know this is a slow growing cancer, so are we talking years or months before it rears its ugly head again? I realize you can't be precise and everyone is different, but a general idea would be appreciated

Peter_Mazzone,_MD,_MPH: Lung cancer can be rather slow moving or rather aggressive. Remission would usually mean the cancer has no signs of being present. This would be unusual for a stage IV lung cancer but it is very nice to hear that from your oncologist. Hopefully this means the cancer is rather slow growing and you will have a significant amount of time—months to even years—before it becomes a problem again. Following with your oncologist and imaging over time is the best way to gauge how fast the tumor will return.

Leptomeningeal Carcinoma Survival

Aware: Have any patients survived leptomeningeal carcinoma?

Sudish_Murthy,_MD,_PhD: This is clearly a poor prognostic sign when cancer is advanced to the point of central nervous system involvement, regardless of origin of the cancer (i.e. lung cancer, breast cancer, melanoma, etc). Survival revolves around patient vigor and vitality, which have the largest impact when trying to assess how a patient will do with cancer. Typically, most patients with leptomeningeal spread will have lost weight, lost muscle mass, have poor appetites and have become very sedentary. Patients in these states are at risk for terminal events that occur in end-stage cancer (e.g. pneumonia). Leptomeningeal cancer is not in itself an indication of an end of life, but it is a late finding in many advanced cancers. Response of cancer in the central nervous system to chemotherapy tends to be lower because of the blood/brain barrier which often reduces the concentration of chemotherapeutic agents in cerebral spinal fluid. 


towhom: If CT scans are beneficial for early diagnoses, why are they only available to very heavy smokers over 50 years old? 

Peter_Mazzone,_MD,_MPH: There are potential harms to using CT scans to screen for lung cancer. They deliver a small dose of radiation to the patient with the potential for long-term consequences. They frequently identify lung nodules—small spots in the lung—that are almost always little scars in the lung, but the small chance of cancer leads to additional scans and sometimes biopsy with potential harm to an otherwise healthy patient. Finding lung nodules also leads to considerable anxiety for our patients. In a high-risk group we must screen more than 300 people to cure one lung cancer. In lower risk groups this number explodes into the thousands while the risks remain the same. We therefore only recommend screening with CT when the risks are high enough so that the benefits can outweigh the harms. Hopefully other options will become available for the lower risk group in time.

lmartin: My mother who never smoked was diagnosed with stage 4 non-small cell lung cancer last summer, and is doing well with her therapy. However, her father also had lung cancer. (He was a smoker). There has been little research and/or conclusions on causes of lung cancer and it seems virtually no early detection. Often lung cancer is not diagnosed until after it has metastasized and is found somewhat coincidentally. Recently the NCI/NIH began recommending regular CT scans for early detection, but only for people with a 30-pack-year smoking history. However, more and more lung cancer diagnoses are in people who never smoked or quit years ago. Are there any recommendations for people with a family history or other factors other than smoking—or do you just wait and hope?

Peter_Mazzone,_MD,_MPH: This is a very good question and one that we all struggle with. Please refer to my prior answer about the benefits and harms of CT screening and the reasons that we only recommend high risk people be screened. Recently, reasonably good risk predictors have been developed that include family history and other non-smoking related issues to develop an estimate of your lung cancer risk. A lung cancer risk that is equal to the high-risk group included in the screening programs may be enough to justify screening. A well run large screening program can help you decide. Future advances in blood, breath and urine testing may also be helpful.

Time from Diagnosis to Treatment

MFroj: My husband was just diagnosed with stage 4 lung cancer and we are not due for another appointment for several weeks. Is it dangerous to wait that long? How fast is it spreading?

Sudish_Murthy,_MD,_PhD: While you are waiting, and I'm sure that there are a variety of tests probably scheduled, it is of critical importance to optimize nutrition and vitality. There are no medications for these elements and quite frankly, I suspect that they are just as important as any therapy that your oncology team will construct. I would suggest focusing on optimization of the diet and some form of daily low impact exercise in the interim while you wait for a treatment plan to be developed. In reality, the cancer probably began a few years ago and waiting one or two additional weeks for an appropriate treatment plan is probably worth it if you use those few weeks constructively to fortify vitality. 


Yoshi: What are the best first- and second line chemotherapy for small cell lung cancer?

Sudish_Murthy,_MD,_PhD: All effective treatments revolve around use of a platinum-containing chemotherapeutic agent (cisplatin and carbaplatin). In addition to these agents, etoposide and irinotecan are added in combination. Any other therapies for small cell would have to be given in the setting of a clinical trial at this point. 

Side Effects of Chemotherapy

skluff: How much shortness of breath is common with chemotherapy?

Peter_Mazzone,_MD,_MPH: Shortness of breath can be due to many things in people with lung cancer. The tumor can push on or enter the breathing passageways making it difficult to breath. The tumor may lead to fluid surrounding the lung which can result in breathing difficulties. Our treatments may also lead to breathing difficulties. Chemotherapy can lower our blood counts which can add to someone's breathing difficulties. Inflammation in the lungs is a rare side effect of commonly used chemotherapies. This could also lead to breathing difficulties.

Treatment for Coughing

Walace: What can be done to help coughing with lung cancer that is being treated by chemotherapy? My coughing can be really bad with lots of mucus.

Peter_Mazzone,_MD,_MPH: Coughing can be a difficult problem in people with lung cancer. The best treatment is one that helps shrink the tumor in the lungs such as chemotherapy or radiation therapy. At times a tumor can block a breathing tube leading to pneumonia behind the tumor. Antibiotics can be helpful. There are procedures available that may be able to open up the breathing tube and help with the cough as well. Breathing medications can also be helpful if there is also asthma or COPD. When all else fails, cough suppressants—usually containing narcotic medications—may be helpful.

Surgical Selection

Kitty: When is surgery an option for lung cancer? Does it cure it? Or would someone also need radiation and such? 

Sudish_Murthy,_MD,_PhD: Surgery for lung cancer has long been considered the best chance and the gold standard therapy for the disease. However, there are certain presentations for which surgery is effective as well as certain conditions where it is ineffective. Commonly, surgery is used in the management of early stage lung cancer (stages 1 and 2) in patients who have preserved lung function and are otherwise in reasonably decent health. For these same patients, who are debilitated by co-existing emphysema, heart disease, severe obesity or other severe systemic illnesses, new techniques in radiation delivery are useful. For patients for more advanced cancers (stage 4) surgery is seldom utilized because it adds very little to treatment. For patients who have regionally advanced cancer (stage 3) occasionally surgery is utilized as an important component of multimodality treatment, and is combined with both chemotherapy and radiation quite often in this setting. 

Small Cell Lung Cancer Screening and Treatment

Yoshi: What is the best treatment for extensive small cell lung cancer.  Being it is so aggressive and usually advanced by the time of detection, is there any type of screening for people who are at high risk?

Sudish_Murthy,_MD,_PhD: Currently the best treatment for extensive small cell is chemotherapy with prophylactic cranial irradiation. The systemic nature of advanced small cell lung cancer usually precludes surgery or radiation therapy, leaving chemotherapy as the most important treatment. Statistically, patients with this disease curiously benefit from preventative radiation to their brain as this site often serves as a sanctuary for cancer spread even in the presence of negative head scans. 

Peter_Mazzone,_MD,_MPH:. The only currently accepted method of screening for lung cancer is a test called a low-dose CT scan of the chest. Low-dose refers to a low radiation dose. This test can be helpful in a high-risk population, which is defined as people who are between the ages from 55 to 77 who have smoked at least 30 pack-years (one pack per day for 30 years) and have been a smoker within the past 15 years. The test is not without potential  harms—particularly the identification of many small lung nodules that are nothing more than small scars, but can lead additional testing and worry. The benefit of testing only outweighs the potential harms for the high risk group listed. A lower-risk group should not be screened as the harms will outweigh the benefits. Research is looking for other ways to identify early lung cancer and those at risk of lung cancer, but this remains a few years off.

Yoshi: Is surgery ever considered with extensive small cell lung cancer?    

Sudish_Murthy,_MD,_PhD: By definition, extensive small cell is just that—extensive. Surgery and to some extent, radiation therapy, are best utilized as local therapies as they cover a very narrow portion of a patient's body. The main therapy for extensive small cell as stated previously is chemotherapy and PCI (prophylactic cranial irradiation). 

Lung Volume Reduction Surgery

JohnP: My diagnosis is pulmonary fibrosis. What exactly is lung volume reduction surgery?

Sudish_Murthy,_MD,_PhD: Lung volume reduction surgery is designed for patients with the exact opposite problem as you have, chronic obstructive pulmonary disease (COPD).  They have enormously inflated lungs and some will benefit from reducing the lung volumes. Your disease causes the lung to contract and become very much smaller than normal. This operation would not benefit you.

Upper Lobectomy

ConcernedWife: My husband needs an upper lobectomy of his left lung due to metastases from a sarcoma 15 years ago. What does that surgery involve? How does he get evaluated for surgery? Can we make one trip ?

Sudish_Murthy,_MD,_PhD: I am happy to review the scans and tell you what I think over the phone. We would probably assess lung function as well as the location of where the sarcoma implant is. If your husband is otherwise healthy, it is quite conceivable that we could offer him an operation. At 15 years after removal of his sarcoma, it is quite conceivable that any operation to remove a metastatic implant from the lungs would be with curative intent. 

Treatment for Secondary Lung Cancer

PH874: My father’s kidney cancer spread to his lungs. Is there still an option for surgery?

Sudish_Murthy,_MD,_PhD: Removal of cancer spread from other organs to lung is often a very reasonable treatment for metastatic cancer. Specifically, the most common cancers that migrate to the lung from other organ origins include colon, breast, lung cancer, sarcoma and kidney cancer. Of these cancers, the most commonly cured cancer by removing these implants in the lung are sarcoma, colon and kidney cancers. There are certain features that predict whether removal of metastatic cancer to lung is in the patient's best interest. These center around complete control of the origin of the cancer (in this case your father's kidney cancer, and I suspect he had his kidney removed some time ago), as well as the sense that all of the cancer that is in the lung can be removed. Consequently, to render an opinion regarding whether surgery might be an option for your father, I would need to view the scans. Interestingly, there are some unique targeted agents that are active in metastatic kidney cancer. Some of these, such as Sutent® (sunitinib), have actually become the standard of care for widespread kidney cancer. Surgery is an important adjunct in this setting for selected patients. I suspect your father's care is under the guidance of an oncologist and I'm sure that these targeted therapies have come up, either as part of the discussion or in his treatment. For more information, I had published a paper called, "Can We Predict Long-Term Survival After Pulmonary Metastasectomy for Renal Cell Carcinoma?" in Annals of Thoracic Surgery 79: 996-1003, 2005.

Stage 4 Lung Cancer and Mutational Analyses

vren: My brother was diagnosed the stage 4 lung cancer two years ago. Now the cancer has spread to the bone and peritoneum with ascites. The second chemotherapy reduced the cancer in lung and bone, but had no effect on the peritoneum. Are there any other options he can be given?

Sudish_Murthy,_MD,_PhD: Hopefully the oncology team have examined your brother's cancer for the presence of unique mutations that subsequently render the cancer susceptible to some of the targeted agents that are now being used. Unfortunately, these unique mutations in regards to lung cancer are found in the vast minority of patients (approximately 15 percent), but that still 15 people in 100 who seemingly have no other option that might be effectively treated by these unique therapies. I would suggest that your brother ask his oncology team whether mutational analyses have been performed. If the analysis was completed and demonstrated no activating mutations, then unfortunately your only option at this point is palliative (traditional), second- and third- line chemotherapy. 

Targeted Therapies

Aware: What is the status of Yervoy® (ipilimumab) for all cancers?

Sudish_Murthy,_MD,_PhD: Targeted therapies for lung cancer are clearly the future. There are a variety of agents that are being trialed. There are, at present, no one agent that would span the entire spectrum of all cancers. There are certain targeted treatments, for example Xalkori® (crizotinib), that are highly effective for a small percent of lung cancers with a unique genetic mutation. We will likely have more use of these targeted therapies as more unique mutations are found as causative events in specific cancers. So to get around to your original question, the answer is no, not yet. 

Clinical Trials

Yoshi: How can you become involved in a clinical trial?                        

Peter_Mazzone,_MD,_MPH: There are clinical trials that are trying to develop new ways to find lung cancer—hopefully early in its course, and others that are testing new treatments for lung cancer. Each trial will have criteria for entry, e.g. age, smoking history, type of cancer, stage of cancer and criteria that exclude you from participating. Most major cancer programs have open clinical trials. To find one you can check with their website, or search for a more complete list of trials available around the country. Your doctor can also point you towards the right trials.

MarKar: How do we go about enrolling in clinical trials for lung cancer? Are they safe? 

Sudish_Murthy,_MD,_PhD: Clinical trials are typically reserved for patients who have exhausted standard therapies. Most often, these trials are managed through larger cancer centers and academic medical institutes. Each large institute will often have a list of trials that they are currently participating in. There is usually a cancer hotline where inquiries and visits can be arranged. If you lived in northeast Ohio, we have a Cleveland Clinic Cancer Answer Line (866.223.8100) that you would be welcome to call and would be quickly directed to a list of trials and meet with an oncologist that could explain enrollment requirements. 


Moderator: I am sorry to say that our time with Peter Mazzone, MD, MPH and Sudish Murthy, MD, PhD is now over.  Thank you for sharing your expertise and time to answer questions today.

For Appointments

To make an appointment with Peter Mazzone MD, MPH, or any of the specialists in the Respiratory Institute, please call 216.444.6503 or toll-free 800.223.2273, ext. 46503. You can also visit us online at

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