Lung Cancer Program
INCIDENCE AND PREVALENCE
Lung cancer is the leading cause of cancer death in both men and women,
including those who live in California. It is the second most common cancer
in the United States and accounts for about 14% of all new cancers.1
PROGRAM OVERVIEW
For over two decades, Hoag’s Lung Cancer Program has remained the
highest volume provider of lung cancer care in Orange County. The program offers comprehensive care that includes screening and early
detection, advanced diagnostic and treatment capabilities, and a complement
of supportive services. A coordinated approach among a team of specialists
in thoracic surgery, medical oncology, radiation oncology, palliative
care, interventional pulmonology, radiology, and pathology ensures multidisciplinary
treatment plans are personalized to each patient.
Daryl Pearlstein, M.D., is Hoag’s Lung Cancer Program director. Dr.
Pearlstein is board-certified in cardiothoracic surgery and completed
subspecialty fellowship training in minimally invasive thoracic surgery.
DIAGNOSTICS
Hoag offers the full spectrum of advanced imaging technologies for the
diagnosis of lung cancer including CT, PET, Bronchoscopic Ultrasound,
and electromagnetic navigation bronchoscopy (Hoag uses SuperDimension™),
a minimally invasive technology that can reach lesions deep in the lungs
as well as the mediastinal lymph nodes. It is beneficial for obtaining
lung biopsies and marking pulmonary lesions in the periphery of the lung
and is particularly useful for patients who are not candidates for percutaneous
radiologic procedures due to the fragility of their lungs. The technology
can also assist in identifying small lesions that might be difficult to
see and feel during minimally invasive and robotic lung resection. Hoag’s
team is experienced in the use of electromagnetic navigation bronchoscopy
to diagnose and treat tiny lesions that otherwise might be inaccessible.
Comprehensive tumor profiling is available for all advanced lung cancer
patients at the time of diagnosis. Tumor samples are sent to Caris Life
Sciences for molecular testing of the patient’s DNA, RNA, and proteins
and bioinformatic analysis. Caris provides a detailed report of each patient’s
results, which are used in treatment plan selection.
Hoag was an early adopter of lung cancer screening, starting a program
for the community in 2006. Hoag’s Lung Cancer Screening Program provides low-dose CT scans
to patients ages 55-77 with a history of smoking to detect lung cancer
when it is most treatable. Patients can access the program with a referral
from their physician. In many cases, a patient’s insurance may cover
the cost of screening, based on specific criteria.
TREATMENT
Tumor Board
The multidisciplinary Lung Cancer Tumor Board joins thoracic surgeons,
medical oncologists, radiation oncologists, pathologists, radiologists,
pulmonologists, and the nurse navigator to discuss patient cases.
The Lung Cancer Tumor Board meets weekly at the Patty & George Hoag
Cancer Center Newport Beach and via videoconferencing at Hoag Cancer Center
Irvine. It is moderated by Daryl Pearlstein, M.D.
To submit a case for the Lung Cancer Tumor Board, contact the Lung Cancer
Nurse Navigator, Lilian Reed, R.N.C., at 949-764-6889 or [email protected]
or Rosana Figueroa at 949-764-7044 or [email protected]
Surgery
When it comes to thoracic surgical oncology, minimally invasive surgery,
including robotic-assisted surgery, is the benchmark.
90-95% of lung cancer surgery cases are performed at Hoag using robotic-assisted
surgery or video assisted surgery (VATS). Hoag has invested in six state-of-the-art Da Vinci® Xi robots between
its Newport Beach and Irvine campuses, and the Lung Cancer Program’s
thoracic surgeons are national leaders in robotic-assisted surgery. Hoag’s
program is one of two in the Western U.S. and just 15 in the nation to
be named a Mentorship Site by Intuitive Surgical, which provides surgeons
from other hospitals the opportunity to learn thoracic robotic-assisted
surgery from Hoag’s team.
Hoag’s lung cancer surgeons are committed to continuous improvement.
In 2017, the Enhanced Recovery After Surgery (ERAS) protocol* was implemented,
which contributed to a decrease in average length of stay from 170 hours
in 2016 to 108 hours in 2017 while also reducing complications and enhancing
the patient experience. The effort involves the active participation and
collaboration among surgeons, anesthesia providers and nurses across the
continuum of care.
Medical Oncology
Recent advances in the genomic characterization of lung cancer, identification
of novel therapeutic targets, and improved targeted and immune boosting
drugs position lung cancer for a precision medicine approach. Beginning
in 2016, the Lung Cancer Pr ogram was the first of Hoag Family Cancer
Institute’s site-specific programs to implement reflex tumor genomic
profiling through the Institute’s partnership with Caris Life Sciences.
The team worked with Hoag Family Cancer Institute leadership to select
a comprehensive panel that gives physicians the most useful genomic information possible.
PET/MR post Yttrium 90 radioembolization to
evaluate precise targeted treatment
Radiation Oncology
Patients whose treatment includes 3-D conformal radiation therapy have
access to TomoTherapy® and Elekta Versa HD™ at Hoag’s
Radiation Oncology department. The Versa is one of the newest and most
advanced linear accelerators on the market. Its high dose rate means treatment
times are typically under ten minutes and the added precision allows the
radiation oncologist to give more dose to the tumor while limiting exposure
to healthy tissues.
A beneficial radiation treatment modality for many patients with inoperable
non-small cell lung cancer is stereotactic body radiotherapy using Hoag’s
advanced radiation modalities. The systems adjust for respiratory motion,
which allows precise and tightly focused radiation, minimizing damage
to surrounding healthy tissue and limiting side effects. The course is
typically delivered in three to five treatments.
CLINICAL RESEARCH
Through Hoag Family Cancer Institute’s Developmental Therapeutics
Program, in alliance with USC Norris Comprehensive Cancer Center, a range
of phase I and II clinical trials with lung cancer applications have opened
at Hoag, some of which are only available at Hoag and USC Norris Comprehensive
Cancer Center. This gives patients, especially those with advanced disease,
more options in their treatment. The following clinical trials have opened
for patients with lung cancer. For a list of trials currently open, please
contact Leila Andres, M.S., at 888-862-5318.
(106-16) 0S-15-5: A Pilot Multi-Arm Study of sEphB4-HAS In Combination
with Different Chemotherapy Regimens in Patients with Specific Advanced
or Metastatic Solid Tumors (Phase 1)
(109-17) 2N-16-3: A Phase 2, Fast Real Time Assessment of Combination Therapies
in Immuno-Oncology Study in Subjects with Advanced Non-small Cell Lung
Cancer (FRACTION-Lung)
(134-17) 0S-16-8: A Phase 2a trial of sEphB4-HSA in combination with Anti
PD-1 Antibody (Pembrolizumab, MK- 3475) in patients with non-small cell
lung cancer and head/ neck cancer
(151-17) 0C-14-11: A Phase 1, Open-Label, Dose Escalation Study of Pf-04518600
as a Single Agent and In Combination with PF-05082566 in Patients with
Selected Locally Advanced or Metastatic Carcinomas
155-17 0C 17-1: Phase 1 Multi-center Study of the Safety Pharmacokinetics
and Preliminary Efficacy of CBT- 101 in Subjects with Advanced Solid Tumors
and C-Met Dysregulation
187-17/0C-17-11 Phase 1 Trial of ZW25 in patients with locally advanced
(unresectable) and/or metastatic HER2- expressing cancers
208-17/0C-17-15: A multicenter, open-label, phase 1b/2 study to evaluate
safety and efficacy of Avelumab (MSB0010718C) in combination with chemotherapy
with or without other anti-cancer immunotherapies as first-line treatment
in patients with advanced malignancies.
214-17/0C-17-17: “A Phase 1/2 First-in-human Study of BMS-986258
Alone and in Combination with Nivolumab in Advanced Malignant Tumors”
157-17/0C-18-2: A Phase I Study of FID-007 in Patients with Advanced Solid Tumors
SCREENING AND HIGH RISK SERVICES
Hoag does more lung cancer screenings than any hospital in Orange County.
The Lung Cancer Screening Program, which has been in place since 2006,
is led by board-certified radiologist, Winston Whitney, M.D. The program
aligns with the results of the National Cancer Institute’s 2011
National Lung Screening Trial and National Comprehensive Cancer Network
guidelines in recommending annual low-dose chest helical CT screenings
in patients 55-77 years old with a history of heavy smoking. A physician
referral is required, and for some patients, insurance may cover screening.
SUPPORT AND EDUCATION
Nurse Navigator Lilian Reed, R.N.C., is available to every lung cancer
patient from the time they are diagnosed through treatment and into survivorship
to guide them through the healthcare system and serve as a knowledgeable
and supportive resource. The Lung Cancer Support group meets monthly at
both the Patty & George Hoag Cancer Center and Irvine Cancer Center.
The Palliative Care team, CARES, is integral component of the Lung Cancer
Program. The team collaborates with patients’ treating physicians
at all stages to minimize pain and suffering and improve quality of life
through symptom management, emotional support, and advance care planning.
Patients also have access to a range of support services including education
classes, workshops, and side effect management through Hoag’s Integrated
Cancer Support Services.
Hoag also offers a Smoking Cessation Program that is free to the community.
1 American Cancer Society. Facts & Figures 2018. American Cancer Society.
Atlanta, Ga. 2018.
* The Enhanced Recovery After Surgery Protocol consists of standardized
perioperative interventions designed to help patients achieve early recovery
after surgery.
For more information call:
949-722-6237