Can immunotherapy cure stage 4 lung cancer in a 40-year-old?

Question

Hello doctor,

My husband is 40, and last month we found out that his lung cancer has spread to both lungs and that he also has two small spots on his liver. He was a very occasional smoker, maybe five cigarettes a week for a few years in his twenties, and we are still shocked because he was the healthiest person we knew.

His PD-L1 expression came back at 80 percent, which his oncologist said is very high and makes him a good candidate for Pembrolizumab (Keytruda) monotherapy. However, the oncologist was very careful with his words and never used the word “cure,” and I need to ask someone directly: Can immunotherapy cure stage 4 lung cancer in both lungs at age 40, or is “cure” not even a word used in this situation?

His KRAS mutation was also found, and they said immunotherapy is still the preferred first-line treatment here. He had his first infusion last week and already has some joint stiffness, which they said might be immune-related. His oxygen saturation has been dropping to 93 to 94 during walks, and he is using an inhaler now.

We have two kids, aged eight and 11, and I am trying to figure out how to plan everything without knowing what to expect. Can this actually be beaten, or at minimum controlled for many years?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

I can understand how frightening and confusing this situation must be for you. When lung cancer is diagnosed at a relatively young age and has already spread to other organs, it can be extremely overwhelming for the entire family, especially when you have children and many practical things to think about.

When lung cancer has spread to places such as the liver, doctors usually describe treatment with the aim of controlling the disease rather than curing it completely. That is why your oncologist may have avoided using the word cure. However, treatments for advanced lung cancer have improved a lot in recent years, and immunotherapy has changed the outlook for many patients.

A PD-L1 (programmed death-ligand 1) level of around 80 percent is considered high, and this is the reason Pembrolizumab was recommended. Tumors with high PD-L1 expression often respond better to immunotherapy because the medicine helps the body’s immune system recognize and attack the cancer cells. In some patients, the tumors shrink significantly, and the disease can remain stable for long periods.

While cure is not commonly used as the expected outcome in stage 4 lung cancer, long-term control is possible in some patients receiving immunotherapy. In clinical practice, we do see patients who remain stable for several years on medicines like Pembrolizumab, particularly when PD-L1 levels are high, and the patient is otherwise physically well.

The KRAS (Kirsten rat sarcoma virus oncogene homolog) mutation does not prevent immunotherapy from working, and many patients with this mutation are still treated with immunotherapy as the first option when PD-L1 levels are high. Doctors will monitor the response with repeat scans over the coming months to see how the cancer is reacting to the treatment.

Joint stiffness can sometimes happen with immunotherapy because the medication activates the immune system. Doctors usually monitor these symptoms carefully and treat them if they become significant. Oxygen levels around 93 to 94 percent during exertion should also be followed by his treating team, especially while they evaluate how the lungs respond to treatment.

Hope I have addressed all of your queries and concerns. Do follow up whenever needed.

Thank you.