The Thoracic Surgery team at Montefiore Einstein is conducting two clinical trials to explore how the use of precision medicine and innovative technologies may improve outcomes for patients with lung cancer. The trials employ targeted therapeutic strategies designed to address treatment challenges across different patient populations, from patients with high-risk, early-stage disease to locally advanced tumors. 

'Historically, stage 1 lung cancer has been viewed as curable with surgery alone. But recurrence rates-up to 30%-remain higher than for other early- stage cancers like breast or prostate, explains Dr. Brendon M. Stiles, Chief, Thoracic Surgery and Surgical Oncology and Associate Director, Surgical Oncology at Montefiore Einstein Comprehensive Cancer Center. 

To address this challenge, an upcoming trial called TROPION-Lung12 will employ a two-part approach for high-risk stage 1 patients: targeted chemotherapy directed at specific proteins expressed by cancer cells, coupled with novel immunotherapy agent. Risk stratification will use liquid biopsies that detect circulating tumor DNA (ctDNA) in blood, a novel method for identifying high-risk patients. Combined with traditional pathologic features, this screening identifies approximately 20-30% of stage 1 patients as high-risk candidates for targeted interventions. This includes using antibody-drug conjugates (ADCs), which deliver chemotherapy specifically to cancer cells, to better target the cancer and to reduce toxicity for patients. 

Another ongoing trial addresses locally advanced stage 2 and 3 patients who have received neoadjuvant therapy but still have residual cancer after surgery. While patients achieving complete pathological response to neoadjuvant treatment were recently shown to have five-year survival rates as high as 95%, those patients with residual cancer removed at the time of surgical resection might need more enhanced interventions. 

This trial combines postsurgical immunotherapy with individualized neoantigen therapy (INT). Remarkably, the INT process involves analyzing the patient's resected tumor to identify antigens (proteins that the body recognizes as foreign), and then developing personalized treatment bespoke to that patient's specific tumor characteristics. This approach, the ultimate personalized therapy, has been previously tested in patients with melanoma where it showed promising results. It aims to help those patients who didn't achieve a complete response to chemotherapy and immunotherapy alone. 

Working in close partnership with lead medical oncologist, Dr. Balazs Halmos, and his team, the thoracic surgeons at Montefiore Einstein prioritize patient- centered, collaborative care throughout the treatment continuum. "The surgeons are heavily involved and play a lead role. We talk to patients about the whole treatment spectrum from the get-go, 'Dr. Stiles notes. This integrated model, supported by Dr. Tamar B. Nobel's grant funding for the Building Reliable Oncology Navigation to Ensure Adjuvant Management (BRONX-TEAM) project, ensures comprehensive adjuvant management. "The surgeon has to have a stake in this; we can't just do surgery and hand our patients off to the medical oncologist.' 

Both trials emphasize the importance of avoiding overtreatment while identifying patients who would benefit from intensified therapy. The Program accepts new patients for trials, with surgery performed at Montefiore Einstein to ensure coordinated care. For referring physicians, these trials offer access to state-of-the-art surgical therapy combined with leading-edge oncological interventions across all disease stages, using liquid biopsy technology, individualized neoantigen therapy and integrated collaborative care. 

To refer a patient, call 718-920-5732. Learn more about Thoracic and Lung Surgery at Montefiore Einstein.