Treating lung cancer, case by case

Suresh Ramalingam has treated hundreds, if not thousands, of lung cancer patients. He knows that lung cancer is a particularly cruel disease.

The five-year survival rate is only 15%. But in the past three years, he has seen the realm of possible treatments for lung cancer grow. “It has never looked so promising,” he says.

For example, oncologists now can offer individualized treatments to many lung cancer patients who fail to respond to chemotherapy.

“Lung cancer is not one disease,” says Ramalingam, an oncologist at Emory’s Winship Cancer Institute. “Eight-five percent of lung cancer cases are due to smoking, and how carcinogens affect one person versus another varies. As a result, one person may have DNA damage in one molecular pathway and another person in a different molecular pathway. So one approach doesn’t work.”

At Winship, a patient’s tumor tissue can be tested for one of 13 known molecular abnormalities. Treatments exist for two abnormalities, and clinical trials are under way for the others.

For some patients, new treatments are able to make a vast improvement on their quality of life. One of Ramalingam’s wheelchair-bound patients was able to walk on her own after participating in a clinical trial for patients with an anaplastic lymphoma kinase (ALK) inhibitor. The ALK inhibitor is a gene that stops the normal growth of cells and encourages cancer cells to grow. Only 3% of patients with lung cancer have an ALK inhibitor.

This particular clinical trial illustrates the challenges of lung cancer research, Ramalingam says. Some molecular abnormalities exist in such a small percentage of patients that enrolling many of them in a clinical trial can be challenging. Moreover, some patients are embarrassed about their years of smoking and don’t pursue participation in clinical trials. Ramalingam hopes that one day there will be more survivors of lung cancer to talk about the disease and advocate for more volunteers.—Kay Torrance


Web Connection: To see a video about individualized lung cancer care, see For clinical trials, visit or call 404-778-1900. 


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