In November 2012, when Ian McAlpine’s wife, Cathy, told him he was breathing strangely, he had no idea that his whole life was about to change. “I didn’t think anything of it,” says Ian. “I was involved with kickboxing at the time. I was in excellent shape.”
But a few months later, when a pain in his shoulder sent him to the doctor, Ian and his family’s worst fears were realized: he was diagnosed with stage 4, non-small cell lung cancer. The fact that Ian had never smoked and appeared to be in physically good health made the diagnosis all the more shocking.
Lung cancer statistics are shocking in and of themselves: 20,000 Canadians die from the disease each year — more than from breast, colorectal, and prostate cancer combined.
Many patients with advanced lung cancer are given less than a year to live. Ian received a similar prognosis, but refused to give in. His wife, Cathy, recalls: “Ian said to me, ‘I’m not giving up on this. I’m fighting this, I’m going to have a long life. I’m going to see my granddaughters become mature adults.’”
Ian was initially treated with chemotherapy. Sadly, despite the support of his family and doctors, he did not respond to treatment, and his cancer continued to spread.
Innovative treatment: making it personal
Personalized medicine — which means tailoring specific treatments according to an individual patient’s unique needs and responses — is changing the face of treatment for many patients with cancer. Instead of using a one-size-fits-all approach, doctors are now seeking to understand a patient’s genetic makeup and their specific type of tumour. Armed with this new knowledge, they’re better able to select the most appropriate form of treatment. Targeted therapies are leading to better results and fewer side effects, all by customizing their treatment path to each individual’s unique genetics.
This customized approach made all the difference for Ian. In August 2013, his doctors decided to test him for a genetic variation called an EGFR mutation. They told Ian that if he did have the mutation, he could receive an innovative therapy that targets specific molecules inside cancer cells, significantly slowing their growth.
“Lung cancer is not one disease. It’s actually a whole bunch of little diseases, and we need to learn as much about the patient and their tumour to try to put people into the right treatment path,” explains Dr. Rosalyn Juergens, Associate Professor at McMaster University. Testing for specific genetic mutations has completely changed cancer treatment, allowing doctors to target treatments much more specifically.
“When I started in practice a decade ago, I had three treatment options for metastatic disease. And on average, if you were fit enough to get those treatments you lived about a year,” says Dr. Juergens. “Thanks to mutation testing, things are very different. I need to know people’s molecular profile so that I can be more precise in picking the appropriate treatment.”
Fortunately, Ian did have the mutation, making him eligible for targeted therapy that began to help almost immediately. “When Ian was found to have the mutation, it was like winning the lung cancer lottery,” says Cathy.
Nearly four years later, Ian is managing his condition well and is hopeful about the future. “Right now, we’re looking at his cancer like it’s a chronic disease,” explains Cathy. “He will always have lung cancer, but Ian says that he has to stay strong and carry on, and hope that medical innovations are six months ahead of him all the time.”
These new targeted treatments, as well as genetic and mutation testing, are now being used not only for lung cancer but for other forms of cancer as well. Informed patients should ask if mutation testing and targeted treatments are an option for them.