Stage IV lung cancer survivor: Targeted therapy and surgery left me cancer-free

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Stage 4 Lung Cancer Patient Out Of Hospice, Resumes Life Of Hiking And Traveling

MADISON, Wis. (WTVO) – November is Lung Cancer Awareness Month, and thanks to genetic testing and new, cutting edge treatment, a 68-year-lung cancer patient with a grim diagnosis is out of hospice care and is back to her passions of hiking and traveling the world.

From hiking in national parks to just walking their dog in the morning, Diane and Scott Althaus enjoy spending time in nature. That all changed in December 2019, when Diane was diagnosed with Stage 4 lung cancer.

"I've had many steps to this, many unfortunate steps," Diane said. "I had heart failure in 2020 and in 2022 I was placed in hospice."

Diane's cancer had also spread to other parts of her body.

"My oncologist at the time said, 'There's nothing more we can do for you.' Devastating. Absolutely devastating."

Still in hospice, Diane was then re-evaluated by Dr. Nataliya Uboha, an oncologist involved in cancer research at UW Health. What the re-evaluation found was that Diane's cancer carried a genetic mutation, one that could be manipulated to slow the spread of the disease.

"The good thing about this mutation is that there are drugs that can go after this mutation and turn this mutation off," Uboha said. "And I realized when I looked at Diane's case, she never truly received therapy that went after that mutation effectively."

Diane is now taking an oral medication that targets a mutation in a gene called B-RAF, which can cause normal cells to become cancerous. She has occasional pain but for the most part, she's back to traveling and enjoying time with Scott and their children.

"Last fall, a year ago, we took a two-week trip, a Mediterranean cruise from Italy to Spain," she said. "And then, last May, we went to Yosemite with our two daughters."

Diane and Scott have also taken trips to Canada and New York.

"At times, you're thinking, 'Oh, I'm going to have a quiet weekend.' And then all the sudden she wants to go somewhere, and away we go," Scott said. "We are doing it while we can."

Dr. Uboha can't be sure what will happen in Diane's case in the future but she hopes her current treatment will stop the cancer from mutating.

"Her quality of life has been great," Uboha said. "She isn't dealing with difficult side effects anymore, and now she has more time and energy to do what she loves."

Diane says she's never lost hope that an effective treatment would give her a new chance at life.

"Don't ever give up," Diane said. "You never know who's around the next corner to help you."

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How MSK Cares For A Young Woman Living With Stage 4 EGFR Lung Cancer

The diagnosis was earth-shattering, especially for someone who had never smoked.. 

Jhalene Mundin, a 35-year-old mother of two young children, was told in July 2023 that she had stage 4 (metastatic) non-small cell lung cancer. It had spread beyond her lungs and was considered inoperable.

At the time, she was a nurse working at another hospital in Manhattan. A colleague suggested she go straight to Memorial Sloan Kettering Cancer Center (MSK), specifically to see thoracic medical oncologist Alexander Drilon, MD, Chief of MSK's Early Drug Development Service. 

"To me, stage 4 cancer sounded like a death sentence," Jhalene says. "But from the beginning, Dr. Drilon said I shouldn't focus on my prognosis. He told me he had patients with the same kind of cancer who had been doing well for more than 10 years. That gave me hope and switched my focus from dying to living." 

Thanks to the treatments she received from Dr. Drilon, Jhalene's tumors shrank enough for her to have them surgically removed. Today her scans show no substantial evidence of cancer. She is currently receiving chemotherapy to stop her cancer from growing back. 

The Symptoms That Led to Stage 4 Lung Cancer Diagnosis   

Jhalene's first symptom of non-small cell lung cancer was a persistent cough that lasted for months. She initially blamed it on the constant colds her children were bringing home from school and, later, on allergies. When a friend finally persuaded her to get a chest X-ray, the image showed a large mass. Follow-up CT and PET scans at the hospital where she works revealed that she had a tumor about the size of a grapefruit on her left lung, as well as smaller tumors in both lungs.   

Increasing Lung Cancer in Women and Never-Smokers

While cases of lung cancers have declined overall, there is a disturbing trend among women and people who have never smoked.

Lung cancer is more common in women aged 35 to 54 than it is among men in the same age group, according to a recent study.

What's more, as the number of smoking-related cancers continues to go down, the overall proportion of lung cancers in nonsmokers is increasing.

"Some 20% of lung cancers that are diagnosed this year and more recently are in never-smokers – and that equates to like 40,000 cases a year," MSK thoracic oncologist Helena Yu, MD, told CNN in an article about the trend. "About 1 out of 5 people who die of lung cancer now are never-smokers, too."

How Tumor Genetic Testing Revealed EGFR Mutation and Options for Treatment 

Molecular testing of Jhalene's tumor revealed a mutation in the gene EGFR — one of the most common genetic mutations in non-small cell lung cancer. It's found in about one-third of cases. It is most frequent in younger women who have never smoked, like Jhalene, and especially in women of Asian descent. Jhalene is from the Philippines and moved to the United States for college.

Thankfully, there are treatment options for EGFR lung cancer. 

Easy Access to MSK's Many Clinical Trials and Other Treatment Options 

Jhalene's story is an example of why where cancer patients are treated first matters. She says she had no trouble making an appointment at MSK. 

In their very first meeting, Dr. Drilon told her that, based on the results of the molecular testing, she qualified for two different clinical trials. If she didn't want to enroll in a trial, there were also standard treatments with targeted therapies that were likely to control her cancer for a long time.  

Getting Guidance on the Best Treatment

Dr. Alexander Drilon, an expert in lung cancer, has taken care of Jhalene throughout her treatment.

"The best thing about coming to MSK was that I felt like I had lung cancer treatment options I wasn't going to get anywhere else," Jhalene says. Dr. Drilon and his team — especially nurses Erica Stumpf, MSN, NP, RN, and Jamie Gibson, RN — always provide helpful guidance, she says, while also giving her the space to make her own decisions about her care. "Erica was amazing, compassionate, and really helped me feel comfortable about being in a trial," she says.

"The whole thing happened so fast," Jhalene adds. "I went from being diagnosed to starting treatment in a clinical trial in less than a month." 

Choosing a Lung Cancer Clinical Trial 

Jhalene chose to enroll in a trial that combined a pill called osimertinib (Tagrisso®) with an experimental antibody treatment called patritumab deruxtecan. Unfortunately, the side effects from the combination were too difficult for her. Dr. Drilon told her she could switch to taking osimertinib alone. It had far fewer side effects. The most common are gastrointestinal problems and rashes. 

As the Tumor Shrank, Lung Cancer Surgery Became an Option 

Less than a year after Jhalene's metastatic lung cancer diagnosis, scans revealed her main tumor had shrunk enough to be surgically removed. 

"I was crying because I was so happy when I found out," Jhalene remembers. "I really wanted the surgery." 

In August 2024, MSK thoracic surgeon David Jones, MD, Executive Vice-Chair of the Department of Surgery, performed the operation, removing the upper lobe of her left lung. "The surgery went well and Jhalene's subsequent recovery has been quick and complete," Dr. Jones says.

After Cancer Developed Drug Resistance, Another Treatment Option 

 After the surgery, a pathology review of her tumor revealed a surprising and unfortunate twist: Some of the cells had changed and were no longer responsive to EGFR drugs.

 But Dr. Drilon had another treatment option for her. He told her she could have chemotherapy to help prevent the cancer from coming back. Jhalene expects to finish her fourth and final round soon. She also continues to take the osimertinib pills every day. 

Embraced by a Community of Friends, Family, and Her MSK Team for Support 

Thankfully, Jhalene is surrounded by support. Her mother, who lives across the street from her home in New Jersey, helps take care of her two children, now 5 and 6. Her brother and her many friends have also been by her side, including going to appointments with her.  

She says the MSK team has gone beyond caring for her cancer — they care for her as a person, too. Heather Hightower, MSEd, RN, a nurse in the Lisa and Scott Stuart Center for Adolescent and Young Adult Cancers, checks in with Jhalene periodically to see how she's doing. This center supports teenagers and adults up to age 40 who have been diagnosed with cancer. 

MSK's financial services team also has made it easier to cope with the bills and the paperwork that can overwhelm patients when they are already at their most vulnerable. 

"I know that whenever I have a question about co-pays or something on one of my statements, I can call them," Jhalene says. "When I was recovering from surgery and mentally preparing to start chemotherapy, they relieved a large amount of the stress I had." 

She is exceptionally grateful for Dr. Drilon and nurse Jamie Gibson. "When I started my chemotherapy, I was in constant communication with Jamie," she says. "Whenever something comes up, I always know she will be there to answer my questions and make me feel better." 

In The US, Young And Middle-aged Women Are Being Diagnosed With Lung Cancer At Higher Rates Than Men

CNN —

Susan Wojcicki, the late CEO of YouTube, had a message for the world just weeks before she passed.

"Although lung cancer overall is decreasing because of declines in tobacco use, lung cancer among people who have never smoked has been rising significantly," Wojcicki wrote in a YouTube blog that was posted Monday.

Wojcicki, a tech pioneer who was one of Google's earliest employees, died in August after living with lung cancer for two years. She was 56.

In her YouTube blog, she calls for more resources investing in lung cancer research, especially in women and nonsmokers. The blog was written in the weeks before her death, according to YouTube, which posted it with the permission of her family.

"At the end of 2022, I was diagnosed with lung cancer. I had almost no symptoms and was running a few miles a day at the time. I had never smoked so I was totally shocked with this diagnosis," Wojcicki wrote.

"Having cancer hasn't been easy. As a person I have changed a lot, and probably the most important lesson I have learned is just to focus and enjoy the present," she wrote. "Life is unpredictable for everyone, with many unknowns, but there is a lot of beauty in everyday life. My goals going forward are to enjoy the present as much as possible and fight for better understanding and cures for this disease."

Wojcicki was not alone in her lung cancer journey.

A trend has emerged in the United States of more young and middle-age women being diagnosed with lung cancer at higher rates than men.

And although cigarette smoking is the No. 1 risk factor for lung cancer, many of these young women being diagnosed have never smoked. It's estimated that about two-thirds of lung cancer cases in never-smokers are in women.

Jhalene Mundin, a 36-year-old nurse based in New Jersey, has never smoked, and her doctor described her as otherwise healthy, with no risk factors. Yet last year, the mother of two received the shock of her life.

She was diagnosed with stage IV lung cancer, an advanced stage of disease in which it had spread outside her lungs.

Her eyes still fill with tears when she thinks about that day.

"I remember I was crying," Mundin said of her diagnosis.

"I thought it was maybe stage II or III. But when she said it was stage IV, I felt like the room was closing in on me. And I remember saying 'No, no,' because I was thinking about my kids," she said. "I was like, 'No, I can't die yet, because I have two kids that I need to raise. They still need me.'"

Before Mundin's diagnosis, she had had a persistent cough that was getting worse – but she thought it may have been a lingering symptom from a case of Covid-19.

However, she had an appointment on her calendar to get an X-ray of her hip due to hip pain.

"My friend, who is also my co-worker, she was like, 'You're already getting an X-ray of your hip. Why don't you get a chest X-ray?'" Mundin said.

"And so the doctor gave me a script for both," she said. "Then the chest X-ray showed a big mass. The persistent cough was from the lung cancer."

Most people with lung cancer don't have symptoms until the disease is advanced, but some common symptoms of lung cancer may include a persistent cough that gets worse or doesn't go away, chest pain, shortness of breath, wheezing, coughing up blood, fatigue or weight loss.

Research suggests that lung cancer diagnoses have risen 84% among women in the US over the past 42 years while dropping 36% in men. Women who have never smoked are more than twice as likely as male never-smokers to get lung cancer.

"Lung cancer is clearly increasing in never-smokers," said Dr. Helena Yu, a thoracic medical oncologist and early drug development specialist at Memorial Sloan Kettering Cancer Center.

"So 20% of lung cancers that are diagnosed this year and more recently are in never-smokers – and that equates to like 40,000 cases a year," she said. "Then 1 out of 5 people who die of lung cancer now are never-smokers, too. So we're seeing an increased diagnosis but also a death rate that's keeping up with that."

She added that the youngest lung cancer patient she has treated was diagnosed at 26. That person also did not have a history of smoking.

Although it remains unclear what exactly is driving this rise in lung cancer among young women, Yu has some ideas.

"I think that there are two ways or reasons that never-smokers get lung cancer. I think that there are exposure issues – which are like air pollution, asbestos, secondhand smoke, radon – and those are kind of rare and maybe make up a small portion," she said. "And then there are mutations that cause lung cancer, and we are also seeing a really significant increase in these mutations that cause lung cancer, and those are enriched in women."

Mundin said her doctor was "95% sure" that a genetic mutation was behind her lung cancer diagnosis. She grew angry that she had never been told about this mutation, even though she is a nurse.

"If I had known, I would have been on top of it," she said. "I was mad that no one was talking about it. That – why wasn't there a screening like colon cancer or breast cancer?"

A mutation in the gene that codes for the epidermal growth factor receptor, or EGFR, has been associated with an increased risk of lung cancer. It is just one of several genetic mutations that are tied to an increased risk of the disease.

The EGFR protein can help cells grow too much, which can cause cancer.

Like Mundin, 38-year-old Kara was diagnosed with EGFR lung cancer and said that, as a patient, she sees a considerable need for more research. Kara is one of Yu's patients.

"My hope for the future is that there will be momentum around the EGFR and so that they can continue to research to find a cure, because it is impacting a lot of individuals that are healthy, and it's just kind of sideswiping us," Kara said.

Kara began noticing pain in her right arm and shoulder in February. Eventually, an MRI revealed a roughly 6-inch malignant tumor in her arm, she said, and she had reconstructive surgery because the tumor grew extremely large.

But doctors determined that the cancer did not originate in Kara's arm, and they raced to find its origin. In June, Kara was diagnosed with stage IV lung cancer. She had no history of smoking and no risk factors and was otherwise healthy.

"It was very shocking to get this news and totally unexpected," said Kara, who has requested that CNN not use her last name for privacy reasons.

With help from her care team at Memorial Sloan Kettering Cancer Center, she has been able to continue living an otherwise normal life while undergoing treatment, she says. She leans on her friends, boyfriend, family and faith.

"I'm living my life normally. I run marathons, and I'm still able to do that," Kara said.

"I ran the Chicago Marathon in October," she said. "I'm still traveling. I'm still spending time with my family. I feel great. I don't feel sick, so I'm very blessed to feel good and have such great quality of life."

Research suggests that EGFR mutations are more prevalent among tumors from women than from men, appearing in about 59% of tumors from women versus 26% of tumors from men.

Some studies also suggest that EGFR mutations occur at a significantly higher frequency in tumors among East Asians compared with non-Asian people, appearing in one study in about 30% of tumors from East Asians versus 8% of tumors from non-Asians.

"There are certain mutations like EGFR that are more common in Asian women," Yu said.

Mundin said she "basically fit the bill," as she is young and Asian and has never smoked.

She later connected with two friends in her social circle who also were diagnosed with lung cancer associated with a genetic mutation. They both also are Asian, she said.

Dr. Alexander Drilon, who has been treating Mundin for lung cancer, said he treats many people whose cancers have targets, such as EGFR mutations.

"These patients tend to be, like Jhalene, younger at diagnosis compared to patients who get smoking-related lung cancers, and many of them are women," Drilon, a thoracic medical oncologist and early drug development specialist at Memorial Sloan Kettering Cancer Center, wrote in an email.

"In the earliest stages of our learning about the EGFR target, young women who never smoked was a demographic that was strongly associated with EGFR+ lung cancer," Drilon said, adding that there are also many lung cancers that have other targets that are diagnosed in young women who never smoked.

"While I am not surprised that this trend has been observed in lung cancers with targets, it still remains a mystery as to why these cancers develop in young women," he said. "Scientists in the field have hypothesized the potential contribution of environmental factors or genetics, but this far, no one has made an extremely strong connection with one particular factor."

Lung cancer can be treated with surgery, chemotherapy or radiation therapy, but Drilon said that many of the cancers associated with genetic mutations can also be treated with targeted therapies, drugs that target genetic mutations found in a tumor to block the growth and spread of cancer cells.

"Because of these new therapies, patients that receive them may survive for much longer than those that do not," Drilon said.

This ongoing mystery around the biological differences in lung cancer has led some lawmakers to call for more research into these differences.

Last year, US representatives introduced the Women and Lung Cancer Research and Preventative Services Act, which aims to commission more lung cancer research and would require the US Department of Health and Human Services to conduct an interagency review of the status of lung cancer in women, including identifying new opportunities for screening, diagnosis and treatment.

Historically, women were not represented in some large lung cancer studies, and before 1993, many clinical trials omitted women.

Lung cancer is the leading cause of cancer death in the US, but it appears to be among the least-funded of the major cancers in terms of research dollars, suggesting that lung cancer research is underfunded relative to its burden on society. In 2019, only 15% of the National Institutes of Health's $267 million lung cancer budget went to women-focused research, according to the nonprofit Women's Health Access Matters. Yet lung cancer kills more women in the US than breast, ovarian and cervical cancer combined.

Lung cancer is so deadly in part because it's often diagnosed late, when it's harder to treat.

Mundin said that she hopes more awareness is raised around this increase in lung cancer among young women and that it leads to the development of targeted screening, such as for people with a genetic mutation.

She hopes there is greater understanding around how to diagnose some of these lung cancer cases early – especially for her two young children, and their future.

The only recommended screening test for lung cancer in the US is a low-dose computed tomography or CT scan. In this scan, a patient lies on a table while an X-ray machine uses a low dose of radiation to capture images of their lungs.

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Current guidelines from the American Cancer Society recommend annual lung cancer screening for current or past smokers starting at age 50. The US Preventive Services Task Force, a group of independent medical experts whose recommendations help guide doctors' decisions and influence insurance plans, has similar recommendations.

"But we have a lot of patients who never smoked," Mundin said. "A lot of us were diagnosed at stage IV, which is already late, very late."

However, there have been efforts internationally to identify never-smokers who may benefit from screening, Yu said.

One of these studies, the TALENT study, conducted in Taiwan, enrolled about 12,000 people who didn't have a history of smoking and gave each low-dose CT scans.

"They found lung cancers in about 2.5%," said Yu, who was not involved in the research. The study also found that the prevalence of invasive lung cancer was higher among participants with a family history of the disease than in those without.

When looking at the global landscape of medicine, "this is not a forgotten area, and we are trying to figure out if we can select out high-risk people and try to screen them for lung cancer," Yu said. "Because early detection for all cancers is really correlated with survival."

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