Biology Professor Teaches Stage 4 Lung Cancer a Lesson

While some relish the idea of slowing down as they age, Brian Spooner, PhD, isn’t one of them. For Brian, slowing down has zero appeal. It’s not surprising when you consider his lengthy tenure at Kansas State University   ̶   he joined the faculty in 1971  ̶   and his ascent through the ranks to become a University Distinguished Professor and director of the Division of Biology.

In addition to his professional accomplishments, Brian has been a lifelong athlete, including time as a collegiate basketball player. In fact, he still jogged up to 3 miles a day until spring 2016 when life hit an unexpected speed bump.

A grim lung cancer prognosis

On the drive home to Manhattan, Kansas, from a vacation in Florida, Brian had trouble breathing. Once home, he went to an urgent care clinic, where he had a chest X-ray, and was then sent to the local hospital emergency department.

At the hospital, pulmonologist Avinash Singh, MD, performed additional tests that confirmed Brian’s right lung had collapsed. He also discovered pleural effusion  ̶   a buildup of fluids between the lung and chest wall   ̶   had caused his lung to collapse. But the underlying reason remained a mystery.

Dr. Singh referred Brian to cardiothoracic surgeon and lung cancer specialist Nirmal Veeramachaneni, MD, at The University of Kansas Cancer Center. At the cancer center, Dr. Veeramachaneni performed a lung biopsy that revealed stage 4 lung cancer. The prognosis was grim, with a life expectancy of approximately 6 months. Chemotherapy was an option, but Brian and his wife, Mary-Rita, chose to explore alternatives that might offer fewer side effects and a better quality of life.

Meanwhile, Brian’s condition continued to deteriorate. He required oxygen and eventually was confined to a wheel chair. He became listless and lost 50 pounds   ̶   a dramatic contrast from his once healthy and active lifestyle.

Unmasking the cancer cells

Dr. Veeramachaneni referred Brian to Chao Huang, MD, medical oncologist and lung cancer specialist at the cancer center. Dr. Huang examined the molecular makeup of Brian’s tumor, which showed that it expressed a high level of PD-L1. PD-L1 is a tumor marker that indicated Brian’s cancer might respond well to immune checkpoint inhibitors, a class of immunotherapy drugs that help the immune system fight cancer.

Immunotherapy is a form of treatment that harnesses an individual’s own immune system to recognize and destroy cancer cells. Immunotherapy is highly targeted and precisely destroys cancer cells without harming healthy cells. It offers the potential to deliver more targeted treatment with fewer harsh side effects.

The immunotherapy Brian received blocks a protective mechanism of his lung cancer cells and allows his immune system to destroy them. As Brian describes it, “It removes the cancer cells’ ‘cloak of invisibility.’”

“Recent studies indicate patients with the PD-L1 marker respond better to immunotherapy than chemotherapy, so Brian was a good candidate for the treatment,” explains Dr. Huang. “At the time, the drug was approved by the Food and Drug Administration but had not been approved as a first-line treatment. We presented Brian’s case to our cancer center’s pharmacy and therapeutics committee to use as a first-line therapy. After receiving committee approval, we then submitted the request to the pharmaceutical company, and it was approved.”

Brian began immunotherapy in August 2016, visiting The University of Kansas Hospital every 3 weeks for intravenous treatment. During this time, he also received chest and brain CT scans to monitor his progress every 12 weeks.

An unexpected complication

Simultaneously, and related to his lung cancer diagnosis, from September through early November, Brian experienced a series of falls and a confused mental state. An MRI showed bleeding in his brain from a bilateral subdural hematoma. Brian had neurosurgery to stem the bleeding in his brain and was taken off blood thinners, which he had been prescribed when he was first diagnosed with lung cancer. The purpose of the blood thinners is to counteract any potential blood clots that might travel to his heart and/or lungs. Fortunately, Dr. Veeramachaneni had inserted a medical device during Brian’s biopsy surgery to capture and crush blood clots so they are reabsorbed by the body, in the hopes of preventing any life-threatening events.

“Brian completed his therapy in August 2018 and his cancer has remained controlled, thus far,” says Dr. Huang. “He no longer requires oxygen and there is no fluid in his chest. He was able to return to work a few months after starting therapy. Before immunotherapy, with his advanced diagnosis, most patients had a life expectancy of 11 to 12 months. So, Brian’s results have been incredible.”

Brian says he experienced no severe side effects during the treatment and is back to fully enjoying life with his wife, 4 children and 8 grandchildren   ̶   as well as walking 2-3 miles daily.

“I’ve been very pleased with my treatment and the doctors at The University of Kansas Cancer Center,” says Brian, who turns 81 in December. “Dr. Huang cares about his patients. I have developed a good rapport with him. He’s an excellent physician who does quality work.”

Lung cancer screening saves lives

According to the American Cancer Society, approximately 156,000 men and women die annually from lung cancer   ̶  more than breast, prostate and colon cancers combined.

“Society doesn’t talk as much about lung cancer or screening,” suggests Dr. Huang. “From ages 55-77, you can receive low-dose CT lung cancer screening if you meet the guidelines   ̶   smoking a pack of cigarettes a day for 30 years or 2 packs a day for 15 years. This screening, which we offer, can catch the disease early and greatly reduce lung cancer-related deaths.

“Immunotherapy has dramatically changed the story for lung cancer patients and represents a major shift in how we treat cancer,” he adds. “Instead of just chemotherapy, we now have this alternate therapy or a chemotherapy/immunotherapy combination   ̶   and we are seeing patients live much longer with this approach.”

For Brian, the outcome has been nothing short of amazing. Lung cancer may have slowed him down, but immunotherapy made sure it wasn’t for long. “I feel very good about the future. I still haven’t retired from my university responsibilities, in research, teaching, outreach and administration,” he says. “In fact, a year ago I accepted reappointment for another 5 years.”