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David Madtes, pulmonary researcher

Improving the odds for lung cancer patients

Lung cancer is the leading cause of cancer death in the U.S., and the five-year survival rate—just 15 percent, a number that hasn’t budged for three decades—reflects the slim odds. By comparison, survival rates for breast and prostate cancers over the same span have improved to 87 percent and 99 percent, respectively.

Dr. David Madtes, a pulmonary researcher at Fred Hutch and director of Seattle Cancer Care Alliance’s Lung Cancer Early Detection and Prevention Clinic, wants to change the odds for lung cancer patients.

Madtes’ specialized, multidisciplinary clinic is one of only a few in the country that assesses people’s risk of lung cancer and expedites evaluations of suspicious findings, using state-of-the-art diagnostic techniques. The clinic’s emphasis on early detection—including a CT screening program—and prevention through smoking cessation help make the clinic a unique resource in the region.

In an effort to identify biomarkers in the blood that could aid in lung cancer treatment, Madtes and his Fred Hutch colleague, Dr. Mandy Paulovich, are evaluating the blood of late-stage lung cancer patients receiving the chemotherapy drug cisplatin. The treatment shrinks tumors in some patients but not others. They are looking for markers that could identify which patients will benefit from cisplatin. The goal, Madtes said, is precision medicine.

“We want to be able to profile a patient’s tumor so the chemotherapy received is better tailored for a high probability of success. It will help expedite the best treatment for the patient and minimize side effects and toxicities,” said Madtes, who also directs SCCA’s Critical Care Medicine program and its pulmonary function laboratory.

Madtes and his early-detection colleagues are at the forefront of sorting out the best use of the low-dose CT scan screening program—one of only a handful in the country linked to a multidisciplinary team for lung cancer diagnosis and treatment. Detecting lung cancer at its earliest stage, and having it surgically removed, means a person can expect a five-year survival rate close to 70 percent.

The promising direction of lung cancer screening doesn’t mean everyone should line up for a scan. The exam’s radiation can have serious downsides, including false alarms that could lead to unnecessary surgery. Madtes said a balance must be struck. “Nobody has really worked out the ideal algorithm yet,” he said. “It’s part of our mission to sort that out.”

Saving lives is the bottom line, Madtes said. “We need to improve outcomes. It’s been a real push to improve outcomes in advanced stage disease. With better early detection, we’ll be able to surgically remove tumors before they advance. That’s where the cure is.”

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