vrum Spira, M.D., had just finished medical school when he had a personal experience that would define his career to this day.
“My aunt, who was in her 40s and a nonsmoker, died of lung cancer. Watching how quickly it overtook her was terrifying,” recounts Dr. Spira, who went on to become a pulmonary and critical care physician, and soon found himself caring for patients who, just like his aunt, were diagnosed too late with lung cancer to benefit from lifesaving treatment.
For Lung Cancer Awareness Month, we sat down with Dr. Spira—Global Head of the Johnson & Johnson Lung Cancer Initiative, which is aimed at preventing, intercepting and detecting early-stage lung cancer, and Professor of Medicine, Pathology and Bioinformatics at Boston University—to learn more about the challenges of diagnosing and treating lung cancer, and how he’s determined to make a difference in the lives of people affected by the devastating disease.
Lung cancer is the leading cause of cancer deaths worldwide. Why is it such a threat?
The main reason is that lung cancer is almost always detected at a late stage, when the disease has already spread outside of the lungs to other organs and is no longer possible to cure. Generally speaking, lung cancer doesn’t cause symptoms until the disease is fairly advanced. We do have drugs that can extend a patient’s life, but it's difficult to cure late-stage lung cancer. That’s why it’s so important to find it early.
In the United States, we can use CT scans of the chest to screen high-risk smokers without symptoms to catch lung cancer at its earliest and most curable stage. But only a very small fraction of eligible people are getting screened, and there is a high rate of false positives among those who are screened, which can lead to unnecessary invasive procedures among people who don't have lung cancer.
Outside of the U.S., there is no accepted screening modality for lung cancer, although that may change in the near future given the recent positive findings from a large European screening trial involving chest CT scans.
Despite its seriousness, lung cancer doesn’t seem to be on as many people’s radars as, say, breast or prostate cancer. Why do you think that is?
One reason is that there are fewer long-term survivors. Strong advocacy usually starts with survivors—they are the ones who make it a lifelong mission to advocate for a cure.
There's also a stigma associated with lung cancer: that it only occurs in people who smoke and “brought the disease upon themselves.” But the majority of people who are diagnosed with lung cancer today don't smoke. They are either former smokers who quit, or they never smoked at all.
Why is lung cancer such an important focus area for Johnson & Johnson, and what is the goal of the new Lung Cancer Initiative?
Most companies working in lung cancer today are focused on treating late-stage disease. There's a huge burden there and it's an important area, but Johnson & Johnson’s vision of a "World Without Disease" focuses on prevention, interception and cures—preventing disease from happening in the first place, intercepting the process among patients who are already incubating disease to block its full-blown development and diagnosing the disease at an early, curable stage.
That really resonates in lung cancer because we almost never diagnose it early, let alone prevent it before it develops. We're in desperate need of a paradigm shift, and prevention and interception is really the only way forward.
Johnson & Johnson is uniquely positioned as a company that has assets across the entire spectrum of human health: medical devices, pharmaceuticals and consumer products. If we are really going to intercept a disease as complicated and deadly as lung cancer, one pill or product won’t do it—we need all three of these sectors to work together.
Lung cancer touches more lives than any other cancer. It kills more people in the U.S. than the next three most-deadly cancers combined—and most people who get lung cancer today are either nonsmokers or never smoked. But there is hope.Share
The idea is to think about the entire life cycle of a lung cancer patient. At certain points on the journey, it may be with a consumer-based product—for example, something to protect their lungs from carcinogens in the air or to help them stop smoking.
Further along, for someone who has a precancer growing in their airway or lung, we might develop a device or a drug to block it from becoming a full-blown invasive cancer, diagnose it at a curable stage and use sophisticated medical devices for the cure. We will holistically use all three sectors along this entire journey to find more appropriate and effective solutions.
It’s one reason we’ve partnered with Boston University on the Lung Cancer Initiative. BU researchers have access to exceptionally unique and large cohorts of patients, which will help with targeting that entire life cycle. They also have expertise in biomarkers that can be used to develop strategies for early detection, such as a cholesterol-like test for lung cancer.
Meanwhile, Johnson & Johnson brings deep expertise in large-scale development programs, global clinical trials and regulatory submissions, as well as the ability to bring discoveries, tests and other products to patients quickly.
A recent Lung Cancer Innovation QuickFire Challenge held by Johnson & Johnson Innovation, JLABS, awarded the winner a residency to study the disease at the JLABS @ Shanghai facility when it launches in 2019. Why Shanghai, specifically?
Lung cancer is the #1 cancer killer in the world—and ground zero for that epidemic is China. Of the 2 million people worldwide who were diagnosed with lung cancer in 2018, more than 700,000 of them are in China.
That's because China faces unique challenges when it comes to air pollution and smoking rates: More than 50% of men there smoke, compared to less than 20% of all adults in the United States. There are more than 300 million people who currently smoke cigarettes in China—that’s equivalent to the entire population of the United States.
So if we want to eradicate lung cancer, we have to start where we can make the biggest impact.
What is one thing you wish everyone knew about lung cancer?
It’s important for people to understand lung cancer touches more lives than any other cancer. It kills more people in the U.S. than the next three most-deadly cancers (colon, pancreas and breast) combined—and most people who get lung cancer today are either nonsmokers or never smoked.
But there is hope.
There is exciting science and technology emerging for preventing, intercepting and potentially curing lung cancer, and there is a path forward. If we can catch lung cancer early, we can cure it. And we also have the potential to stop this disease before it starts.