HJBR Nov/Dec 2020

HEALTHCARE JOURNAL OF BATON ROUGE I  NOV / DEC 2020 47 Emily E. Cassidy, MD Thoracic Surgery Specialist Mary Bird Perkins - Our Lady of the Lake Cancer Center operable patients with early stage lung cancer. Historically, the pain and compli- cations associated with an open thoracot- omy approach to lung resection made the procedure an option for a limited number of patients. A thoracotomy is an 8- to 10- inch incision along the side and back of the chest, deep between the ribs. Histori- cally, this approach was associated with a prolonged hospital stay, increased blood loss and long-term post-thoracotomy pain. Over the past decade, surgical prac- tices have evolved to minimally invasive techniques, namely VATS (video-assisted thoracic surgery) and robotic advances in lung cancer surgery. Minimally invasive in- cisions are 1/3- to 1/2-inch-long and help patients achieve a faster recovery with less postoperative pain. These improvements in surgical technique have impacted the mortality and morbidity associated with lung cancer. TARGETED THERAPIES AND IMMUNOTHERAPIES The outlook for advanced stage NSCLC has also improved significantly over the past decade thanks to new targeted thera- pies and immunotherapies. The identifica- tion of specific mutated oncogenes, such as eGFR (estimated glomerular filtration rate) and ALK (anaplastic lymphoma ki- nase), have been identified in some lung cancers. These mutations allow the tumor cell to grow and divide, leading to cancer progression. In patients whose tumor cells have these specific mutations, effective treatment options have been developed that target those cancer cells. Based on the success of these medications, the NCCN recommended in 2012 that all patients with nonsquamous type NSCLC undergo ge- netic testing for eGFR mutations and ALK rearrangements. Additionally, immunotherapies have substantially impacted survival in ad- vanced stage lung cancers. PD-1 and PDL-1 are proteins that that are found on some immune cells and tumor cells. In tumors that express these proteins on their sur- face, medications have been developed that bind specifically to these proteins and increase the body’s natural immune response against cancer cells. In 2015, single-agent PD-1 pathway inhibitors (nivolumab, pembrolizumab and atezoli- zumab) were approved as second line treatments. Research has demonstrated that each of these drugs provides an im- proved overall survival compared to single agent chemotherapy in patients without EGFR and ALK mutations. In conclusion, it is a truly exciting time to be a clinician specializing in thoracic oncology. Our healthcare community con- tinues to recognize lung cancer as a major problem, and innovative solutions have been implemented to move the needle to- ward a better outcome for these patients. From prevention to detection to treatment, the enthusiasm for progress is palpable. Given the advances that have been made over the past 10 years, the opportunities for new and improved treatments that may be available to us in the next decade will cer- tainly propel the evolution of lung cancer to a more survivable disease. n Emily E. Cassidy, MD, is a thoracic surgery spe- cialist. She graduated from Louisiana State Uni- versity School of Medicine in New Orleans and has more than 10 years of diverse experience, especially in thoracic surgery. Cassidy currently serves on the Hepatobiliary/Upper GI and Lung Multidisciplinary Care Team and leads the Me- sothelioma Specialty Team at Mary Bird Perkins - Our Lady of the Lake Cancer Center. “Our healthcare community continues to recognize lung cancer as a major problem, and innovative solutions have been implemented tomove the needle toward a better outcome for these patients.”