SINGAPORE, April 29 – When he learned he had fourth lung cancer, the first thing Jeffrey Leong was thrilled with was to divide the news into his daughters.
“We're a close family. If anything happened to their father, I knew it would be difficult for them to accept, "said Leong, 57, who is self-employed.
His daughters were 17 and 21 years old, when in July 2016 the MRI muscle tendon injury accidentally revealed three huge tumors in the lungs.
The largest, within his right lungs, was 10 cm in length.
Lung cancer is one of the most deadly cancers, and late diagnosis is considered a rapid death penalty.
"My wife and I decided to present our diagnosis as a" business plan "and how we could go from there. Not only do you have to stay positive with cancer, but you also need to instill a sense of positivity in the people around you, ”Leong said.
Despite his positive attitude and two exhausting rounds of chemotherapy, cancer continues to spread. As she grew and blocked one of the key arteries leading to his heart, breathing became a challenge.
Four months after diagnosis, Leong was offered immunotherapy as the last lifeline. The relatively new cancer treatment that was combined with chemotherapy in his case used the immune system to fight cancer.
“I knew lung cancer would not be a miracle cure. The biggest challenge at the time was whether I should continue my efforts (standard treatment) or go for something new, ”he said.
The new treatment worked, diminishing large tumors drastically within a few months. Since mid-2017, scanning has shown it to be free of cancer.
In Singapore, lung cancer is the second and third most common cancer in men and women. But it is a major cause of cancer death.
Between 2011 and 2015, approximately 930 new cases of lung cancer were diagnosed annually in men and approximately 500 new cases in women per year, Dr. Dr. Kong Hwai Loong, a medical oncologist at Icon SOC Singapore at the Paragon Medical Center that treated Leong.
Lung cancer accounts for 27.1% of cancer deaths in males and 16.6% in females, according to Dr. Lars. Shang Yeap, another Icon SOC oncologist.
Non-smokers are not immune
Smokers have a higher risk of lung cancer, but non-smokers are not exempted, experts said.
Evolving evidence suggests that environmental factors such as passive tobacco smoke may contribute to risk. Non-smoking lung cancer is more likely to contain a specific mutation that will allow patients to be treated with an orally targeted drug, Dr Kong said.
“No one is immune to lung cancer. Life-long non-smokers can also be affected by lung cancer, especially non-mammalian non-small cell lung cancer, ”Dr Kong said.
Non-squamous non-small cell lung cancer – which Leong, a former smoker – had most of all lung cancers. Mostly, these are adenocarcinomas or cancers that form in the glands that secrete mucus throughout the body, said Dr. Yeap.
Stage Four cases are usually considered incurable, Dr Kong said.
Within two to three years, these patients would be treated with either orally targeted drugs or chemotherapy, Dr Kong said. Targeted cancer therapy blocks the growth and spread of cancer by interfering with specific molecules that control the spread and progression of cancer.
The goal of treatment is to manage symptoms and to keep the patient living longer, he said.
On average, patients who respond to initial treatment could live anywhere between one and three years, but those who do not live live for months to a year, Dr Kong said.
"While a significant proportion of treated patients would initially show treatment responses, shrinking tumors would always be reflected," Dr Kong said.
Using the immune system
Newer treatments that use the immune system to fight cancer are intended to extend the time for patients whose lung cancer has spread.
"Immunotherapy, especially pembrolizumab, has significantly and positively changed the landscape of lung cancer treatment," Dr Kong said.
In November last year, Health Sciences Authority approved pembrolizumab in combination with chemotherapy as a first-line treatment for patients with metastatic non-small cell non-small cell lung cancer who do not have certain mutations that drive cancer.
The approval was based on promising data from a randomized multi-center clinical trial.
The treatment that saved Leong's life is also used in other cancers such as melanoma (skin cancer), bladder cancer, and classical Hodgkin's lymphoma.
If pembrolizumab is used with chemotherapy, the likelihood of death of these patients would be halved compared to those receiving chemotherapy alone. He was also more likely to enjoy a longer period of stability than patients treated with chemotherapy alone, he added.
Treatment is relatively well tolerated, although some patients may result in significant organ injuries due to an overactive immune system that attacks their own body, Dr Kong said.
Other drugs for cancer treatment, nivolumab and atezolizumab, are also available in Singapore for the treatment of lung cancer, said Dr. Wong Seng Weng, Medical Director and Consultant for The Cancer Center.
All three therapies report prolonged control of advanced stages of lung cancer, he said. Wong.
"Some patients who have entered the first phase of one clinical trial, before the treatment is approved, are still doing well and remain on it for more than seven years," he said. Wong.
There are also new targeted therapies for the treatment of patients with non-small cell lung cancer who have become resistant to prior treatment. Yeap.
Cost can be "headache"
Immunotherapy is not cheap, but long-term treatment costs are a major factor in many patients.
“Immunotherapy can sometimes achieve a very long period of cancer control, even in advanced lung cancer. This is good news in terms of prolonging life, but clearly headaches in terms of cumulative treatment costs, "said Dr. Kurt. Wong.
According to him, the cost of treatment for immunotherapy ranges from $ 7,000 (RM21,000) to $ 15,000 every three weeks in a dose-dependent manner. If chemotherapy is added, additional costs will be incurred.
The cost of chemotherapy ranges from $ 3,000 to $ 7,000 in three weeks, depending on the drug selection, he said.
The current expert opinion is to continue treatment with immunotherapy for two years or more if the disease does not have treatment resistance and patients do not have any significant side effects, said Dr. Wagner. Wong.
Immunotherapy is usually referred to in the chemotherapy category for Medisave and Medishield, subject to limitations on individual plans, said Dr. Wong. Basic Medishield Life and Medisave may not be sufficient to cover the total cost, he said.
Dr. Wong said that some patients who achieve remission after several months of treatment will decide to stop treatment early because of its cost. But he also observed several patients who did not show cancer progression after some time.
"It seems that for some patients, once their immune system is mobilized to attack cancer, momentum can be sustained without the continued use of the drug," said Dr. Wong.
However, the best bet on good treatment outcome would be early detection. In early stages, surgery may be curative, Dr Kong said.
Dr. Kong has recommended that smokers talk to their doctors about participating in a periodic lung cancer screening program.
Smokers and non-smokers who have persistent pulmonary symptoms, such as coughing or dyspnea, for more than two weeks, should see their doctor for further examination. Other symptoms include unexplained weight loss and loss of appetite.
Live a lot
Leong's biggest challenge during his journey to cancer was his psychological impact, but he found ways to cope. During cancer treatment he tried to continue exercising. Makes a 45-minute walk on the treadmill and lifts weights.
"I was so weak that I couldn't even make a 1kg bicep curl when I lift 10 to 12kg." But I didn't want to rest in bed, stay home – that's when people give up life. I wanted to live life as usual. Even though I went slower, I could still move, ”he said.
In addition to being optimistic, Leong advised cancer patients to find a doctor they trust.
"People gave me a lot of advice, from the boiling of a certain root to eating a particular leaf." I didn't do any of this. All I did was listen to my doctor, ”he said.
Currently still on immunotherapy, Leong's thyroid gland has been damaged as a side effect of the treatment, but is contemplated.
He stopped smoking two packs of cigarettes a day and now includes a healthier lifestyle consisting of more fresh whole foods, less processed foods, and regular exercise. He has also taken a "step back" in his career and is now working on a contract basis.
“I used to be the first person to enter the office and the last one to leave. No longer pursuing materialistic goals. There is too much to live in life, ”he said. – TODAY