Why early detection matters: Transforming lung cancer care

Welcome to the podcast by Kevin MD, the only daily medical podcast where we share the

stories of the many who intersect with our healthcare system but are rarely heard from.

Now here's your host, Dr. Kevin Poe.

Hi and welcome to the show where we share the stories of the many who intersect with our

healthcare system but are rarely heard from.

Subscribe at KevinMD.com slash podcast.

Today we have a special sponsored episode from Lilly.

Dr. Lee James will join Lilly as a senior vice president, oncology medical affairs, bringing

extensive leadership experience from Brissomire Squibb and Pfizer across oncology development

and medical affairs.

Train at Cornell, the University of Washington, Fred Hutch, the University of Chicago and

Memorial Stools and Memorial Sloan Kettering, Lee is also a former practicing oncologist

serving high needs communities in Queens, New York.

Today we'll be discussing why early detection matters, transforming lung cancer care.

Find out more at lily.com.

L-I-L-L-Y dot com.

The link will be in the show notes.

Lee, welcome to the show.

Great, thanks Kevin, thanks so much for having me.

It's great to be here and a chance to talk to your audience.

Alright, so let's start by briefly sharing your background and role at Lilly.

Yeah, great.

As you mentioned, I have an extensive academic background, but the short form of it is really

that I'm a medical oncologist by training.

So I did that training at Sloan Kettering, but I didn't just do sort of general oncology.

In addition to that, I really had a focus in lung cancer.

So I have been passionate about this space for 20 years.

After that academic training, I went into a private practice in a community group in Queens

and then about 15 years ago I joined Pharma.

So as you said, I've been at some different companies.

I have the privilege and honor here at Lilly to lead our medical affairs group for oncology.

And so I lead a pretty large team of people who think about the safe and effective use of

medicines and how we can educate doctors and patients.

And what makes you passionate specifically about lung cancer research and working into

lung cancer space?

Yeah, I think there's two parts to that.

One is that sort of like nerdy scientific interest.

You know, when we understand that cancer is a molecular disease, and over the years

as we've come to understand the real drivers of lung cancer, the brain part of me is just

fascinated by our ability to take our understanding of biology, understand how it leads to disease,

and then come up with treatments to treat that disease based on our understanding.

That's amazing.

But I've also had very personal stories with cancer.

As many of us have, I have an aunt who was never married, no kids, non-smoker, and in her

70s developed lung cancer.

And so I was then not on a white coat side of the bed, but really sitting with her through

the diagnosis journey, the treatment journey, some difficult end of life conversations.

And it's very personal for me as well.

I think we've come a long way, but it really highlighted for me how much there is yet

to do.

Can you talk a little bit more about who can be affected by lung cancer and which groups

are more at risk?

Yeah, you know, I think there's a lot of misunderstanding around lung cancer.

So I'm happy for the opportunity to talk about that.

I think certainly we know that tobacco is a risk factor, and people can reduce their

risk by not smoking.

But 20% of patients with lung cancer are never smokers or kind of smoking less than 100

cigarettes in their life.

So understanding that basically anybody with lungs could potentially get lung cancer is

an important reset.

And like for me personally with my aunt, that was a firsthand experience about that.

So we have a lot of work to do to educate people about the prevalence of lung cancer,

but also how it really can be a disease that affects anyone.

You've emphasized the importance several times about early detection and access to screening.

Because someone is diagnosed with non-small cell lung cancer, are there specific tests beyond

imaging that could help guide treatment decisions?

Yeah, absolutely.

So when we think about a diagnosis, we want to know like what is it?

What is this cancer?

And where is it?

How far has it spread from where it started?

And those two pieces of information really help us understand what's likely to happen for

that patient with that cancer.

And we talk about early detection of lung cancer.

That's really finding it before it is spread throughout the body.

But when we say what it is, that word, lung cancer, it's really not enough.

It's the beginning of a diagnosis, but it's not the full story.

So when we say lung cancer, the next step is really the genetic information about the

mutations that might be associated with that lung cancer.

So when I was in training, there were sort of two or three.

Now there's upwards of 20.

And it is amazing how many different kinds of lung cancer there are.

The molecular mutations become so important.

Because if they are present, it really guides treatment.

And so step one is finding the cancer as early as possible.

And the next step is really not stopping with the diagnosis until you know exactly what

the molecular profile of that cancer is.

Not before talking about the molecular profile, as you know of a primary care physician,

tell me what kind of options I have to screen for lung cancer and when should I be thinking

about it when I have a patient in front of me in the exam room?

Yeah.

So the screening recommendations from like the USPSTF, the United States Preventative Services

Task Force, those recommendations are people who are between 50 and 80 and have a substantial

smoking history.

And maybe I'll take a moment and talk about what that means by substantial smoking history.

The guidelines talk about 20 pack years, you know, but maybe your audience might not.

So when we say 20 pack years, that could be somebody who smoked one pack a day for 20

years, two packs a day for 10 years, four packs a day for five years, that's how we get

to that like pack year exposure.

So the screening recommendations are not going to cover everybody who might get lung cancer,

but it certainly does focus on that higher risk population.

So if you're in your office and you're talking to a patient, you may say, do you smoke and

they might say no, but that's not the end of the conversation.

You really want to understand their smoking history to see if they meet the risk criteria

to go for lung cancer screening.

That's important to understand the screening is a low dose CT scan and usually people are

followed closely.

So if there's a nodule or something that's found, it doesn't necessarily mean it is cancer,

but everything that's found should probably be followed up.

People who are in a lower risk category, if they're less than 50, they might not qualify,

but this is really where a conversation between the physician and the patient is so important.

And I know as a primary care doctor, you're also thinking about colon cancer screening and

breast cancer screening.

Amazingly for lung cancer screening, the rates are much less.

We find probably there's only about 13% of eligible patients who are actually getting lung

cancer screening as opposed to well over 50 or 60% for other tumors.

So it's an important part of the primary care conversation to really go through somebody's

history and understand what the right kind of treatment is for them.

You're listening to a special sponsored episode from Lily.

We're discussing why early detection matters, transforming lung cancer care.

Find out more at lily.com.

That's L-I-L-L-Y dot com.

The link will be in the show notes.

See how has the use of comprehensive genomic profiling changed treatment options?

Yeah.

So that's a complicated word.

So we'll break it down with comprehensive.

What does that mean?

In the past, when we only had two or three mutations to look for, you might order just two

or three tests.

And so if there was like an example like EGFR, you might order just an EGFR test and that

might be enough.

But as I said, now we have so much deep understanding about how many different kinds of

mutations there could be.

There are tests that can be done on the tumor itself or on blood that are comprehensive.

So they look throughout the genome.

They look throughout all of the expressed genes and find any abnormalities that are

there.

So you can find things that maybe you had top of mind, but there are other rarer things

that might be discovered through comprehensive genomic testing.

So it's very important, as I said, if you really want to understand the full picture of

somebody's cancer.

It's important to understand the totality of it.

And that means comprehensive testing.

It's one test, but it looks for many, many things.

Despite the progress we've discussed with early detection and precision medicine, what

challenges do physicians still face in getting patients diagnosed and treated?

Yeah.

So I think, if we think about the lived experience of a patient, right, the patient journey,

it starts off with somebody who might have no symptoms or might have symptoms that lead

them to a diagnosis.

Getting a timely diagnosis is important because the earlier you find a cancer, the better

the outcomes are.

We talk about early stage disease as catching something so early that surgery or surgery

in some other treatment options might be enough for that cancer to go away and not come back.

And when we think about a cancer going away and not come back, that begins to feel like,

you know, a potential cure for that patient, because they had something they don't have

it anymore.

Once the cancer has spread, cure may not be an option, but the goal is to really maximize

the amount of time that they have and the quality of that time.

And this is where genomic testing is so important.

If you look at patients with a mutation and they have comprehensive testing and they get

that diagnosis and they go on an appropriate treatment, their five year survival could

be over 80%.

Those same patients without that information, their five year survival less than 10%.

So I think that's really an important take-home, it's not just that this is guiding treatment,

but it's guiding treatment in a way that has a huge impact potentially for patients.

So I think, like I said, the early detection is important, the diagnosis is important,

but I think for all patients, it's really that understanding about their disease, understanding

that some people have stigma about lung cancer, but in a way nobody should.

It just happened to everybody and it's important to really just treat it as a disease, understand

and acknowledge that there might be like some emotion that goes around that, but not letting

that get in the way of making the best treatment choices.

Could you tell us about some of the challenges we still face regarding genomic testing and

how can clinicians work to address these challenges?

Yeah, so most times the person who might be ordering that genetic testing is not necessarily

the oncologist.

So in your practice, I'm sure you have a pulmonologist that you work with.

That pulmonologist might be the one who's obtaining a tissue sample to send for testing.

So when we talk about education, it's certainly like primary care doctors, but also the doctors

who are obtaining tissue, because they are going to be ordering the testing in a timely way,

either on the blood or the tissue that they get in order to get the right diagnosis.

That's one challenge, is like having the people obtaining the tissue know what they need to do with

it. I think another key part of the challenge is our healthcare system is complex, it's fragmented,

and it's easy for people to kind of fall through the cracks.

If you're sending them to one doctor to get the tissue and another doctor for the radiology and

another doctor to talk about the results, there's a chance that like not all the information flows

through or that patients are lost in the system, and so I think there is a lot of work to be done

to making sure that things happen in a timely way. I think the other real challenge is just educating

people. Some people hear that word lung cancer and they think that's the end and they shouldn't

even do anything about it. So I also think this is like educating physicians and patients about

all the progress that's been made in this disease. When we look at the numbers,

when I was in training, the sort of five-year survival rates for lung cancer in general was like

2% and recent data from like 2026 numbers on the prevalence of cancer and survival show us that

that has increased dramatically. And so we have to really change our mindset from like an outdated

way of thinking that there's no hope to really understanding the current landscape and that there

are a lot of effect to treat. So how do we clarify where in the diagnostic pathway to genomic testing

would play? Would it be after you get a tissue diagnosis and how can clinicians best communicate

the value of comprehensive genomic profiling to newly diagnosed patients? Yeah, so the sooner it happens,

the better off it is, right? So if that pulmonologist or that radiologist is getting tissue,

that's the best time to worry, right? If a really well-informed primary care doctor says,

oh, like this is diagnosis, I don't see all the information, you know, really following up while

that tissue is still available and sending it for testing. But the next step would be even if that

patient doesn't have the testing up front, they can go to their medical oncologist who can access

that tissue that has already been taken and send it for testing. Now that requires sufficient tissue.

So this is also where education is important. If a pulmonologist goes in and just gets a little

bit of tissue enough that they think to establish lung cancer or no, that might not be enough to do

the comprehensive genomic testing. And so it's incumbent on anybody who's getting the tissue

to get enough so that all the appropriate testing can be done. Can you share maybe an anonymized case

study where genomic testing really changed that treatment course of a patient? I know putting you

on a spot here, but is there a case study that you could share with us to really illustrate some of

these tenets in action? Yeah, sure. So I'll tell a story about a patient that I have known actually

now for many years. So you know, the story kind of has a nice outcome. But this person was a medical

student and passed out on rounds. They were found to have a huge amount of fluid around their heart

and ended up in ICU. They took some of that fluid. It saw that the student had lung cancer. They took

that fluid and sent it for testing and found a brand new mutation for which there was an available

treatment. Within days of getting that treatment, the patients started to feel better and they were

able to walk out of the hospital two weeks later after being in the ICU. That person then decided

not to pursue medicine, but a PhD. And still on treatment was able to complete their PhD work

and is now married and has kids. And so it is an amazing story about the value of understanding,

even in a person, never smoker young medical student, but cancer that's driven by a mutation when

you know the right information, you can have a really substantial impact. I think the parts of

that story that really resonate with me also is all the other people in someone's life who are

impacted by a cancer diagnosis and how when you can have the right treatment, you're also kind of

like extending the sphere of impact of a beneficial treatment because of the quality of life and

amount of time that somebody has available. You're listening to a special sponsored episode

from Lily. We're discussing why early detection matters, transforming lung cancer care.

Find out more at lily.com.ly.com. The link will be in the show notes.

Lee, how would you describe the role Lily plays in the lung cancer treatment space and its commitment

to patients? Yeah. So Lily has been in the lung cancer space for a long time. Even when I was in

fellowship and practice, I was very excited about the lung cancer medicines that Lily had. And that

kind of like long-standing commitment to the disease and the space and the patients has really

borne out because today, Lily has very exciting treatments that are being developed, many of which

are like molecularly targeted treatments, which can impact patients with a particular rotation

or some of the treatments we have on our pipeline could impact people with a more broad profile

and not necessarily one particular mutation. So I think that the commitment of Lily is beyond just

like one disease or one narrow part, right? It's really a commitment to patient education,

working with advocacy partners, working with established societies to really make sure that

the information is out there and available. Make sure doctors and patients are talking,

really sort of like hopefully lifting the time for all boats so that there's more patients

who are getting treated appropriately, who are being screened appropriately and are being tested

appropriately. So I'm very excited and very proud to work for a company that has such a long

standing commitment and has so many different approaches to helping patients. And what message would

you like to give to patients with non-small, soft lung cancer and what message would you like to

give to clinicians? Yeah. So the message to patients is very clear like there is hope and a good part

of that hope is based on the science that we have developed and their diagnosis is not complete

until they know they're full genomic profile. That's the message to patients. There is hope

and you need all the information. I think the message to clinicians is similar in a way, right?

There is hope. There's not a reason to sort of like have a narrow kind of like dark view of the

prognosis and the diagnosis is not complete until you have comprehensive testing. And importantly,

for physicians screening because the earlier you find a tumor, the better the outcomes can be.

And before we end, Lee, any last thoughts or take-all messages they want to share with the

Kevin and the audience? Yeah. I just think we are at such an exciting time in oncology in general

and lung cancer in particular. Always be on the lookout for like the latest treatment advances.

I do want to put a plug in for clinical trials because many of the like most exciting or innovative

therapies are actually through a clinical trial. And so in addition to thinking about standard

of care, all of this guidelines talk about consideration for a clinical trial. There's a great

need to sort of understand what patients, how patients might benefit from a new treatment.

And the only way to do that is enrollment. So in addition to all the great work that your

audience is doing in standard of care, I always also want them to thinking about clinical trials

as another option for patients. You've listened to a special sponsored episode from Lily,

discussing why early detection matters, transforming lung cancer care, find out more at lily.com.

That's L-I-L-L-Y.com. The link will be in the show notes. Lee, thank you so much for sharing

your perspective and insight. Thanks for coming on the show. Great, Kevin. Thank you so much.

Really pleasure to be here. Thank you for listening to the podcast by Kevin MD. To share your story

and appear on the show, visit KevinMD.com.