The treatment landscape for lung cancer has changed dramatically in the six years since Navy Lt. Cmdr. (Dr.) Karen Zeman began her lung cancer training.

Just a decade ago, little was known about the leading cause of cancer deaths among both men and women. A newly diagnosed patient coming into her clinic would have a tumor checked for, at most, four genetic mutations. In comparison, now every lung cancer tumor is sent for next generation genetic sequencing to check for over 100 different markers to help identify the most effective treatment to combat the patient’s unique cancer.

“In my clinic, I have more survivors today than I had years ago,” said Zeman, an oncologist at Walter Reed National Military Medical Center or WRNMMC in Bethesda, Maryland. “The lung cancer patients are doing significantly better in 2020 than they were doing in 2014.”

Within the last two years, the Food and Drug Administration approved nearly two dozen new drugs to treat lung cancer. Among those was a new drug for a fast-growing and deadly lung cancer common among smokers, the first in over a decade, according to Zeman.

New treatment advances are made by understanding the disease itself, through analyzing the mutations and proteins that drive lung cancer, said Matthew Wilkerson, Ph.D., director of the Data Science Core of the Center for Precision Medicine for Military Medical Education and Research at the Uniformed Services University in Bethesda, Maryland.

Three ongoing lung cancer research projects within the Department of Defense aim to do just that by investigating the building blocks of lung cancers to find effective treatments and perhaps even prevent lung cancer one day. The Applied Proteogenomics OrganizationaL Learning and Outcomes network, or APOLLO, is a tri-federal initiative between the National Institutes of Health, the Department of Veterans Affairs, and DoD that resulted from the Cancer Moonshot. Spearheaded by retired Army Col. (Dr.) Craig Shriver, director of the Murtha Cancer Center Research Program, Department of Surgery, School of Medicine, USU, and director of the Murtha Cancer Center at WRNMMC, APOLLO leverages the technology and expertise in the tri-federal initiative to accelerate a cure for cancer, including lung cancer, said retired Navy Capt. (Dr.) Robert Browning, medical director of interventional pulmonary at WRNMMC.

“It’s really important because the APOLLO project is mainly focused on active duty military service members in the DoD and veterans,” said Browning, noting that 10 different military medical treatment facilities are collecting and testing lung cancer specimens as part of the project. “We’re going to find some answers about lung cancer in the military and the DoD, among other cancers, that just were not possible before this project.”

In addition to APOLLO, the Detection of Early Lung Cancer Among Military Personnel, or DECAMP, and the Genomics of Early Lung Cancer Among Military, or GELCAMP, both hold ramifications for why certain people get lung cancer and some don’t among military service members. Cigarette smoking contributes to 80% to 90% of lung cancer deaths, according to the Centers for Disease Control and Prevention. Smoking cessation remains a priority for preventing lung cancer, but not all lung cancers are a result of smoking, said Browning. “Some smokers don’t get lung cancer and there are people who have never smoked who do,” he said. “All of these DoD studies have some component where we are looking for biomarkers to detect early- or high-risk patients, and even looking for precancerous markers.”

Wilkerson agreed, adding that quitting smoking is one way to prevent lung cancer, but with the advances in molecular imaging and genetic sequencing of tumors, lung cancer prevention can also mean preventing the cancer on a whole new level. “The DECAMP project is another way to look at lung cancer prevention as we learn more about these lesions that occur in individuals who smoked, differentiating growths that are cancerous versus noncancerous,” he said.

By understanding who is more likely to develop lung cancer and why, scientists could develop a test to screen for lung cancer based on genetic markers, not just smoking history. Today lung cancer screening is limited to a low-dose CT scan in people ages 55 to 80 who have a history of heavy smoking. But in the future, Browning imagines lung cancer screening could be more prescriptive.

“In cardiology, you give a statin to prevent cholesterol buildup so a patient doesn’t have a heart attack,” he said. “We’re not there yet, but that is where we are headed in lung cancer prevention.”

Advances in treatment, including therapies that train the immune system to detect and kill cancer cells, are already changing the lives of Zeman’s lung cancer patients. “We have patients who can have better quality of life with therapies that are less toxic. And for patients fit enough, even more effective therapies are available,” she said.

“Lung cancer. When you hear that term, there’s a lot of fear,” she added. “We’ve come a long way and we’re going much farther.”

Browning agreed: “Lung cancer is a terrible diagnosis, but if there’s any message to get to lung cancer patients diagnosed now, it’s to hang on because there are treatments coming at a pace we have never seen in our lives or in history,” he said. “We all were trained in treating lung cancer that had the same death rate for the past 50 years. And then in the past five years, things have exploded and we’ve made tremendous progress.”