As he put it in a recent address, “not that long ago, and still for many with lung cancer, their new diagnosis feels like looking down the barrel of a gun. Yet at the same time we can now also fill a room with select long-term survivors of the disease.”
Camidge delivered that speech, titled “Evolving Expectations,” in Singapore in September at the annual World Conference on Lung Cancer. The event is hosted each year by the International Association for the Study of Lung Cancer, which this year honored Camidge with its Daniel C. Ihde Lectureship Award for Medical Oncology. The award is named for the influential lung cancer researcher and former longtime deputy director of the National Cancer Institute.
“I’m just now finishing a labor of love, writing a book about the discovery of targeted therapy in lung cancer, and Daniel Ihde plays a role in that,” says Camidge, the Joyce Zeff Chair in Lung Cancer Research in the CU School of Medicine. “To get an award named after a person who did such important work in the field felt very special.”
In his acceptance speech, Camidge focused on the ways in which evolving treatments have extended life for some lung cancer patients.
“There are patients who are still doing very badly — it’s still a very serious disease. But we’ve also got this group of patients who are doing incredibly well,” he says. “Now we have long-term survivors with advanced-stage disease, sometimes for a decade or more. Maybe we haven’t figured out how to make everyone a long-term survivor, but in theory, it’s possible.”
Camidge pointed to a few ways in which the field can begin to think differently about lung cancer treatment to achieve that goal, including improving methods for assessing a cure for early-stage disease, opening clinical trials to a wider population of patients, and getting the balance right between treatment benefit and toxicity.
“To give you an idea of how much management of the disease has changed for some people, one of the crazy things that’s emerged in recent years is young lung cancer patients saying, ‘I’m not dying any time soon; can I have kids?’ Before, you couldn’t even have that conversation in regard to lung cancer – there was almost no point,” he says. “Now we actually have patients who have conceived and carried children. We have to start to think in those terms to inspire us with the goal of creating perfect control of cancer and perfect quality of life for our patients.”
Born in England, where he received his medical training at the University of Oxford and began his research career at the University of Cambridge, Camidge arrived at the CU Cancer Center in 2005. In the years that followed, he saw lung cancer treatment transformed by genetic testing.
“We’re fortunate that in Colorado, we were one of the early adopters of doing routine molecular testing of our lung cancer patients, to put them into different buckets based on the mutations in their cancer,” he says. “That allowed us to say, ‘OK, there are five people in front of us, and they all have lung cancer, but really, they have different subtypes of lung cancer, and they need different treatments.’ When you personalize that treatment, you start to really get transformative control of the cancer.”
Camidge then saw the immunotherapy revolution in all of cancer care, which had an immediate dramatic impact on around 10%-20% of lung cancer patients. However, which patients will respond to the treatment remains obscure. For this reason, Camidge argues, the field has still not been able to build on those early immunotherapy successes in lung cancer over the past decade.
“In contrast to immunotherapy, the advantage of the personalized medicine revolution was that benefit was highly predictable once you knew which mutation was there. With some people, you do a test and they just have to take a pill once a day, every day,” he says. “With the best pills, there are almost no side effects; it’s entirely compatible with leading a normal life. You can carry on working, running, cycling — whatever you want to do. And you might control that cancer for years before the cancer evolves and you have to switch to some other treatment.”
Making it personal
Camidge is now interested in the growing field of personalized immunotherapy, which he describes as a middle ground between personalized medicine and immunotherapy. The therapy targets markers specific to an individual’s lung cancer, activating the patient’s immune system to go in and attack the cancer cells.
“I think we’re just scratching the surface of what that can do,” he says.
No matter the treatment, Camidge is happy to see how advances in lung cancer research have evolved expectations not just for oncologists, but for their patients as well.
“The classic lung cancer patient, to put it bluntly, would get diagnosed and then wait to die,” he says. “Now, inspired by these successes, other people with lung cancer are getting off the couch and saying, ‘I’m not going to be satisfied with this. I’m going to seek a second opinion. I’m going to enter a clinical trial.’ We are starting to engender hope in the hopeless.”