The Duke Cancer Institute Center for Cancer Immunotherapy connects physicians, scientists, and researchers to discover immunotherapies for every cancer type. Immunotherapies boost the immune system's ability to kill cancer. The Center’s mission is to develop and test new immunotherapies, new indications for immunotherapies, and new combinations of drugs that include immunotherapies. They hope to accelerate the journey from animal and cell studies to human clinical trials, and drug manufacturing, when possible.
Chimeric antigen receptor (CAR) T-cell therapy is one example of an immunotherapy that is offering new hope to some lymphoma patients. CAR T-cell therapy involves removing white blood cells called T cells from a patient’s body, genetically modifying the cells in a lab, and then infusing them back into the patient. Unlike a pharmaceutical with a defined chemical formulation, each batch is made from living cells of an individual patient.
This therapy is approved for people who have failed at least two lines of treatment for several kinds of non-Hodgkin’s lymphoma: diffuse large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma (PMBCL), high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma. Duke Cancer Institute was one of the earliest treatment centers certified to administer CAR T-Cell therapy when it was approved by the FDA in October of 2017.
Many Studies Underway
CAR-T therapies for some solid tumors are in clinical trials. The Preston Robert Tisch Brain Tumor Center is studying a CAR-T therapy for glioblastomas, a type of brain cancer.
Duke investigators also have several studies under development to learn how to use immunotherapies to target cancer and to the ramp up the immune system to fight cancer.
The Duke Cancer Institute Center for Cancer Immunotherapy is interested in potential opportunities for collaboration from the bench to the bedside across the entire spectrum of cancer types. We are actively looking for the development of strategic research partnerships to generate scientific synergy. Whether there is interest in translating a concept into a different scientific field or building research teams for future grant proposals, the Duke Center for Cancer Immunotherapy is interested in helping investigators through the process.
The Duke Cancer Institute Center for Cancer Immunotherapy is the nexus for physician-scientists and researchers across DCI who are focused on developing new immunotherapies as well as testing, in clinical trials, new immunotherapies, new combinations of drugs that include immunotherapies, and current immunotherapies for new indications. The center is comprised of known thought leaders in their respective fields who look for cancer immunotherapy discoveries that show promise, no matter the cancer type.
The DCI Center for Cancer Immunotherapy aims to speed up the process that brings immunotherapies for cancer from the bench to the bedside. We’ve been able to accomplish in six months what might take years at another institution by drawing on the collaborative talent of Duke investigators. Our investigators are engaged in every step of the process, from conducting lab studies to designing clinical trials and manufacturing a drug. We are open to collaborating with research partners across the world to broaden the scope of cancer patients who may benefit from immunotherapy treatment.
More research efforts are under development at our center, including new lung cancer immunotherapies and immunotherapies that will fight head and neck cancer, upper gastrointestinal cancer, colorectal cancer with metastasis to the liver, melanoma, and bladder cancer.
The Hanks Lab, run by Brent Hanks, MD, PhD, immunotherapy resistance. Understanding why some patients respond to immunotherapy and others don’t may guide the development of novel strategies to overcome resistance and expand the number of patients who can respond to immunotherapy.
Ongoing research in the Hanks Lab focuses on understanding how malignancies develop their own strategies for evading anti-tumor immunity and becoming resistant to currently available immuno-therapeutics. The lab utilizes both genetically engineered tumor models as well as clinical specimens from patients undergoing immunotherapy to guide their research. The group is currently conducting studies in melanoma, non-small cell lung cancer, and colorectal cancer.
This area of investigation holds great promise for using immunotherapies to treat people with cancer.
Brent Hanks, MD, Ph.D, Andrew Nixon, Ph.D., and Jennifer Choe, MD, Ph.D., are collaborating on a biobank to understand why some patients develop autoimmune responses that inflame the gastrointestinal tract, lungs, and liver, or lead to the destruction of endocrine glands, including the thyroid and pituitary. The biobank collects blood and tissue samples, and data on reactions, from Duke cancer patients treated with immunotherapy for various cancer types. Data from this project will help predict which patients are at risk for side effects so they can be proactively managed or even prevented.
Disease-Specific Research Projects
Several projects are underway to study immunotherapies in breast cancer, gastrointestinal cancers, genitourinary cancers, lung cancer, and melanoma.
Novel Therapeutics Development
The Hanks Lab is working to develop drugs that target and manipulate dendritic cells to boost immune responses to checkpoint inhibitor therapy.
Georgia Beasley, MD, a surgical oncologist, is conducting clinical trials evaluating intra-lesional therapeutics such as oncolytic viral vectors to help manage patients with advanced melanoma. She is conducting clinical studies evaluating these agents that have been developed by other biotech companies.
April K.S. Salama, MD, leads ongoing clinical efforts to improve the management of patients with melanoma that has spread to the brain.
In the summer of 2016, three-time leukemia patient Connor McMahon, then 15, enrolled in a clinical trial at Duke of a novel immunotherapy using his own disease-fighting T-cells. While there was a significant risk of life-threatening complications, the Atlanta teen — under the care of Duke pediatric bone marrow transplant specialists Tim Driscoll, MD, and Paul Martin, MD —came through the trial with flying colors and was declared cancer free. In sworn testimony before a U.S. Food and Drug Administration (FDA) panel the following summer, Connor’s father Don McMahon urged the regulatory body to approve the customized investigational therapy Connor received, a chimeric antigen receptor (CAR) T-cell therapy called Kymriah (tisagenlecleucel). Weeks later, Kymriah became the first commercially available gene therapy in the U.S. when it received accelerated approval from the FDA to treat children and young adult patients (through age 25) with relapsed/refractory B-cell acute lymphoblastic leukemia.Natural human T-cells, which help orchestrate the body’s immune response, are often fooled by cancer’s disguises. CAR T-cell therapy gives them the boost they need. Unlike a pharmaceutical with a defined chemical formulation, CAR T-cell therapy is made from a patient’s own T-cells (a type of white blood cell called lymphocytes), which are re-engineered in a lab to produce proteins on their surface called chimeric antigen receptors (CARs). These CARs enable the T-cells, once infused back into the body, to recognize and bind to a specific overexpressed antigen (either CD19 or BCMA) on the surface of cancer cells that’s driving their out-of-control growth. The CARs bind with the antigens — like keys into a lock —deactivating those cancer cells.
Duke Cancer Institute physician scientist Brent Hanks, MD, PhD, has been elected to the American Society for Clinical Investigation (ASCI), one of the nation's oldest medical honor societies. The ASCIsupports the scientific efforts, educational needs, and clinical aspirations of physician-scientists to improve health.In 2019, Hanks was first recognized by ASCI with a Young Physician-Scientist Awardin 2019 — one of 35 “outstanding physician-scientists” named that year by the society.“This is a great honor demonstrating the value that Dr. Hanks’ physician-scientist colleagues place on the high quality of his laboratory work designed to understand the mechanisms of resistance to immunotherapy,” said then-Chief of the Division of Medical Oncology James L. Abbruzzese, MD FACP FASCO DSc (hon) at the time. “Dr. Hanks’ work has the potential to extend the impact of immunotherapy to diseases that have not yet been able to take advantage of this new treatment modality.” “I have a ton of respect for the mission of the ASCI and their support for the development and training of future physician scientists,” Hanks said upon receiving the Young Physician-Scientist Award. “I believe the role of the physician scientist to be critical for advancing medicine and healthcare into the future and this type of support is vital for making sure this challenging career path remains viable.” A DCI member since 2013, Hanks is an associate professor in the Department of Medicine and an assistant professor in the Department of Pharmacology and Cancer Biology.He has dedicated more than 20 years of his career to research in the fields of tumor immunology and immunotherapy. In his lab, he explores how cancers have evolved to suppress the generation of tumor antigen-specific immune responses and how to exploit that knowledge to develop more effective cancer immunotherapy strategies. He is working to develop new pharmacologic and genetic strategies to overcome immunotherapy resistance and investigating the mechanisms that contribute to some immunotherapy-associated toxicities. (READ:School of Medicine Faculty Elected to American Society for Clinical Investigation) In addition to managing an independent research lab, Hanks sees gastroesophageal and gastric cancer patients in DCI's Gastrointestinal Cancer clinic. He made the clinical shift to GI towards the end of 2023 after several years of treating patients with skin cancers, particularly melanoma and Merkel cell carcinoma, in order to address the prevalent problem of immunotherapy resistance in these patient populations.Hanks serves as associate director of Basic/Translational Research in DCI's Center of Cancer Immunotherapy.He's currently an investigator on 16 different grant projects — including in melanoma, gastroesophageal cancer, gastric cancer, immunotherapy-associated toxicities, immunotherapy resistance, immune evasion, non-small cell lung cancer, and prostate cancer — including six grants funded by the National Institutes of Health (he's PI on three, and a mentor or preceptor on the other three), one by the U.S. Department of Defense (he's PI), four by pharmaceutical companies (he's the PI on all four),and one each bythe Conquer Cancer Foundation (he's PI), American Association for Cancer Research (he's PI), Cancer Research Institute (he's PI), and Melanoma Research Foundation (he's PI).Hanks received his PhD (2004) and MD (2006) from Baylor College of Medicine, and completed both his residency in Internal Medicine (2008) and fellowship in Hematology/Oncology (2012) at Duke University School of Medicine.
DCI member Jose Ramon Conejo-Garcia, MD, PhD, (left), worked with co-authors Mostafa Eysha, PhD; Luis Bailon, PhD; and co-senior author Carmen Anadon, PhD, on an antibody approach for precision cancer treatment. (Photo by Les Todd)
Duke Cancer Institute Executive Director Michael B. Kastan, MD, PhD, presents medical student Priya Alagesan, BS, with the Robert and Barbara Bell Award For Basic Science Cancer Research at the 2022 DCI Scientific Retreat.
For the first time since 2019, the Duke Cancer Institute Scientific Retreat was held in person with a full program followed by a poster session and mingling. Held on December 2, 2022, the retreat attracted around 90 faculty, staff, and trainees (students, residents, fellows, postdocs, etc.).There was also a virtual option, which an additional 184 individuals took advantage of — whether out of convenience or caution during a season of rising Covid-19, Flu, and RSV infections.“Good afternoon, everybody. It's a pleasure to welcome you to the ninth annual Duke Cancer Institute Scientific Retreat. It's wonderful to be able to be in person again. I know this is a hybrid meeting, so we don't have everyone here. Maybe 15% of the audience is in person — but this is better than zero," said Executive Director of Duke Cancer Institute and host of the event Michael B. Kastan, MD, PhD. "We have a wonderful afternoon planned with selections of the top abstracts from each of the Cancer Center programs, a faculty presentation by Dr. Epplein that we're very much looking forward to, and then our keynote speaker for the Colvin lecture, Peggy Goodell from Baylor will be wrapping up the afternoon prior to the poster session.”Commemorations of DCI's 50th Anniversary as a National Cancer Institute-designated Comprehensive Cancer Center were in evidence in nearly every presenter’s PowerPoint — emphasizing their pride in the tremendous impact of current and former DCI investigators and clinicians on cancer research and patient care in the U.S. and around the world.Seven DCI Trainee Members — one from each of DCI's seven basic, clinical, and translational National Cancer Institute-Designated Research Programs — were selected by program leaders and the scientific review committee to present their research at the retreat. (Previous to the retreat all trainees were invited to submit, for oral-presentation consideration, an abstract on their research project).Six of the trainees received a $1,000 award from the DCI and the trainee with the most innovative basic-science research project, as is customary at the annual retreat, received the Robert and Barbara Bell Basic Science Cancer Research Award in the amount of $5,000.Each trainee was introduced by either their mentor or a research-program faculty leader and took questions after their presentation. Between affirmations, friendly critiques, probing questions, and ideas for further exploration, there was no debating that the learning was infectious.In three presentations, the learnings were literally “infectious.”Meira Epplein, PhD, MS, MA—co-leader with Katherine Garman, MD,of the National Cancer Institute-designated DCI Cancer Risk, Detection and Interception Research Program (CRDI) — plus two of seven top trainees addressed, each from different angles, the bacterial and viral associations with and molecular drivers of gastric cancer, and potential strategies for both treating it and stopping its development before it starts.Other topics of the afternoon included:a patient experience study on barriers and facilitators to care in Black patients with newly diagnosed leukemia (specifically AML);a pathology/immunochemistry computational mapping study — deep learning — to characterize the features of the immune micro-environment landscape;novel approaches for: targeting fusion-driven rhabdomyosarcomas; targeting glioblastoma stem cells, otherwise known as brain-tumor initiating cells; and making breast cancer more receptive to treatment with immunotherapies by using targeted therapy/vaccinationand a review, by the keynote speaker, of the mechanisms that regulate hematopoietic stem cells and how they go awry in blood cancersGastric Cancer in Focus
Part of a Special Report by Duke Cancer Institute & the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual Report (pdf)Oncologists today have a wider range of anti-cancer drugs to reach for, many of which target the molecular alterations believed to contribute to the cancer’s development.Comprehensive genomic profiling, also known as next-generation sequencing (NGS), is used to identify these molecular alterations. Duke Cancer Institute (DCI) oncologists partner with Duke University Health System (DUHS) Clinical Labs and private diagnostics companies to test patients at diagnosis and/or after the cancer grows or spreads.While it can vary across cancer types, increasingly, targeted therapies that can save patients from needing toxic chemotherapy are becoming available at multiple points in a patient’s cancer treatment, from first line standard of care to subsequent treatment after progression on conventional therapies.Test results are entered into a Molecular Registry of Tumors known as Frameshift MRT. This centralized informatics tool — designed, built, and coded at Duke byMichael Datto, MD, PhD, (currently the medical director of DUHS Clinical Labs and vice chair for Clinical Pathology) and Christopher Hubbard (DUHS clinical informatics architect) — helps oncologists identify if anything in their patient’s mutational profile, even extremely rare targets, can be treated with any existing targeted therapies or immunotherapies.Duke Cancer Institute has been offering its patients NGS testing since 2014. Developing Frameshift MRT three years later to organize and optimize the growing volume and complexity of data, and the subsequent formation, in early 2018, of a weekly multidisciplinary Molecular Tumor Board to review complex patient cases was a perfectly timed great leap forward.The Precision Cancer Medicine Initiative — launched in 2017 by DCI, the BioRepository & Precision Pathology Center (BRPC), and the Clinical Labs — was the critical push behind it.“It had become increasingly clear that the needs of sophisticated cancer researchers were changing across all cancer types; moving away from generic, archived, cancer-tissue samples, to fresh samples, to samples with a specific molecular abnormality,” explains Shannon McCall, MD, director of the BRPC, a DCI and Duke University School of Medicine Shared Resource housed in the Department of Pathology. “This coincided with clinical advances. Providers, including at DCI, were utilizing these broad molecular profiling assays to direct the care of cancer patients. There was a need to harness all this molecular profiling data to support both cancer research and treatment. I was totally on fire to get this started. We have so many big thinkers at Duke who said, ‘Let’s think about data and what’s possible.’”In mid-2018, Executive Director of DCI Michael Kastan, MD, PhD, a noted cancer biologist, and Chair of the Department of Pathology Jiaoti Huang, MD, PhD, a prostate cancer researcher, signed a memorandum of understanding to co-fund the staffing necessary to further support the Molecular Tumor Board — co-directed by oncologists John Strickler, MD (for solid tumor cancers), and Matthew McKinney, MD (for blood cancers) — and to manage the Frameshift MRT database. This included hiring a bioinformatician/ data analyst (Jonathan Bell, PhD) and a savvy genetics scientist (Michelle Green, PhD).Green, fresh from a position in the molecular diagnostic testing industry, joined the Duke Pathology (with salary support from DCI) in the spring of 2019 as senior research program leader of the Molecular Tumor Board and main user and manager of Frameshift MRT. She tracks promising clinical trials and new FDA drug approvals and has configured Frameshift MRT to automatically send therapy alerts to providers when their patients' molecular profiles match any known anti-cancer drug(s). This match could include drugs that are already FDA-approved, drugs that are “emerging” with strong clinical evidence, drugs that are being tested in clinical trials, or drugs that are approved or being trialed in another cancer type.Over the course of the COVID-19 pandemic, Green has made several significant changes to Frameshift MRT that make it more user-friendly, interactive, and accessible for clinicians and researchers, who can access the Frameshift MRT dashboard when logged into the Duke VPN. Green is available to train and advise.
When Joseph O. Moore, MD, came to Duke as a fellow in 1975, he and his mentors treated chronic myeloid leukemia (CML) with a chemotherapy regimen that was like a “wet blanket.” It suppressed the cancer for a few years. “But it didn’t change the trajectory of the disease,” Moore said. Patients developed acute leukemia, which was almost always fatal.
By the early 1990s, younger patients could achieve a cure with a bone marrow transplant, though complications were common. By 1999, Moore was the Duke investigator for a national study of a targeted drug, imatinib, which stops leukemia cells from growing by shutting down a key protein.
When imatinib was approved by the Food and Drug Administration (FDA) in 2001, it transformed CML into a disease easily treated by taking a pill.
When Moore retired from clinical practice in 2019, he was involved in a study following people with CML who had been taking imatinib long term, which showed they could safely stop therapy.
The CML example provides a snapshot of just how far cancer treatment has come in the last 50 years. For many patients, “There’s an expectation of success and people living normal lives,” said Moore, professor emeritus of medicine.
Much of that progress can be traced to research funded by the “war on cancer,” which launched in 1971 when congress passed the National Cancer Act. The act gave the National Cancer Institute (NCI) the authority and funds to create a national cancer program. The backbone is a network of comprehensive cancer centers that provide patient care and conduct rigorous research to find new and better ways to prevent, diagnose, and treat cancer.
The Duke Cancer Institute 8th Annual Scientific Retreat, held on December 3, 2021, attracted a broad array of faculty, trainees (students, residents, fellows, postdocs, etc.) and staff.For a second year, the retreat was entirely virtual and there were no poster presentations owing to the ongoing Covid-19 pandemic.“Hopefully, this will be the last time that we have to do it this way,” said executive director of DCI, Michael Kastan, MD, PhD, welcoming participants over Zoom.That it was virtual didn't stop a series of lively discussions from moving full-steam ahead on a full Friday afternoon on topics such as DCI cancer health equity and engagement strategies, viral lymphomas, bone loss as a CLL co-morbidity, ways around immune system evasion, cardio-protective cancer therapy, new approaches for treating head and neck squamous cell carcinoma, clues as to how cystic lesions progress to pancreatic cancer, unlocking immune dysfunction in glioblastoma, cholesterol-control drugs and cancer, and the PARP revolution.“We have a very full agenda today with great science from Duke trainees and faculty and are also celebrating several different anniversaries. First, it's my 10th anniversary as director of the Duke Cancer Institute and I have to say it's been a real privilege of my life to be in this role and to be able to work with such extraordinary people here. And I couldn't be more proud of everything that all the staff and all the faculty have done during the time that I've been here," said Kastan. "We're also celebrating the 50th anniversary of the National Cancer Act, which was signed in 1971, and put us down the path to NCI-designated cancer centers. The Duke Comprehensive Cancer Center (now DCI) was one of the original eight."Kastan also noted that DCI's own 50th was on the horizon."This year we begin celebrating our 50th anniversary. We've made a tremendous impact on cancer research and patient care in the U.S. and around the world.”
The North Carolina non-profit Lung Cancer Initiative has awarded Duke Cancer Institute member Chuan-Yuan Li, DSc, a professor in the Duke University School of Medicine Departments of Pharmacology and Cancer Biology and Dermatology, the Vicky Amidon Innovation in Lung Cancer Research Award.The $50,000 grant will support Li's ongoing investigations into whether specific FDA-approved cholesterol control drugs may be repurposed in the treatment of LKB1/STK11-mutated advanced non-small cell lung cancer (NSCLC) to help these patients overcome immunotherapy drug resistance.The importance of cholesterol in transforming normal cells into cancer cells, the role of cholesterol in cancer spread, and the utility of cholesterol control in cancer control, are topics of current study and debate in a number of cancer types and by a number of cancer researchers.Based on work published last year (Liu et al, Nature, 2020), Li suspects that PCSK9 — a protein that regulates the amount of cholesterol in the bloodstream and that’s found in high amounts in LKB1/STK11- mutated advanced NSCLC tumors — is driving the immune evasion of this type of lung cancer and that the protein may play a key role in these patients' known resistance to immune checkpoint inhibitor drugs, a type of immunotherapy that’s shown great promise in many but not most patients with advanced lung cancer. (Numerous factors, including drug resistance, have limited their efficacy)“Our hypothesis is that using certain FDA-approved cholesterol control drugs — specifically evolocumab (Repatha) or alirocumab (Praluent), which are designed to inhibit the functioning of PCSK9 proteins — may also work in advanced LKB1/STK11-mutated tumors,” Li explained. “Inhibiting the functioning of PCSK9 may help these particular non-small cell lung cancer patients — which represent 25 to 30% of all cases of advanced NSCLC — overcome their resistance to immune checkpoint inhibitor drugs and thus receive a greater benefit from these drugs.”Li noted that the cholesterol control drugs evolocumab and alirocumab have shown minimal toxicity in human cardiology patients, which makes him hopeful about the potential side effects of these drugs if used in cancer patients. (Statins, a popular, but different kind of cholesterol control drug, limit the liver’s production of cholesterol by blocking a protein that the body needs to produce cholesterol — HMG-CoA-Reductase — and help the body reabsorb existing cholesterol. Statins are not part of Li’s LCI-funded research project.)In addition to lab studies to further understand the role PCSK9 in LKB1/STK11-mutant lung cancer, Li hopes to collaborate with DCI immunotherapy researchers Scott Antonia, MD, PhD (director of the DCI Center for Cancer Immunotherapy), Neal Ready, MD, PhD and James Isaacs, MD, to evaluate evolocumab through phase I and II clinical trials.Lung cancer claims more lives in North Carolina and the US, annually, than any other cancer and more than breast, colon, and prostate cancers combined. According to LCI, an estimated 8,830 individuals in North Carolina were diagnosed with lung cancer in 2021.Since 2008, LCI has funded more than $2.8 million in lung cancer research through programs like theResearch Fellows Program, the Health Disparities in Lung Cancer Grant (in partnership with the V Foundation for Cancer Research), an annual Career Development Grant, and research innovation grants. Duke Cancer Institute has been a direct recipient of about $875,000 of these grants.Li’s grant award from LCI — the Vicky Amidon Innovation in Lung Cancer Research Award— is named in memory of Vicky Amidon a beloved wife, mother, and friend who lost her battle with lung cancer at the age of 46 and whose memory is furthered through her family’s advocacy and support for the advancement of lung cancer research and awareness. The award, first given in 2019, recognizes and supports researchers who are developing innovative lung cancer projects that will improve the lives of those at risk of or living with lung cancer.
Duke Cancer Institute Blog
Lung Cancer survivor Henrietta Carr presents a cancer ribbon-themed wall hanging to physician assistant Susan Blackwell, October 2021. (photo by Les Todd)
On October 12, just before her 66th birthday, Henrietta Carr surprised her care team with a cancer ribbon-themed wall hanging she’d embroidered.
“When I was diagnosed with stage 4 lung cancer, I moved from Greensboro to Durham so I could get treatment at Duke; I just wanted to come to Duke because I think they’re better,” says Carr. “I was feeling hopeless and as I was being treated by Dr. Crawford and Susan Blackwell, I started feeling hopeful of a future. They would share in my happiness, as the cancer would shrink. I am so grateful to my cancer team and wanted to show this gratitude.”
Carr, a mother of two adult children, began embroidering cancer-ribbon-themed wall hangings to support individuals with cancer — friends, friends of friends, family, and friends of family — after she retired from nearly 30 years of service as a clerk and IT specialist for the Social Security Administration. This was well before she was diagnosed with cancer.
“I did about 30 individual pieces and sent them out across the United States,” says Carr, who continued to embroider after her cancer diagnosis. It took about 25 hours to create the 36 by 56 (inches) piece she made for her cancer care team.
To be diagnosed with cancer after bringing so much joy to other individuals with cancer was an unfair turn of events, Carr agrees. “But it is, what it is,” she says.
It’s been nearly two years since Carr’s diagnosis. She’d gone to the Emergency Department at a hospital in Greensboro feeling a little fatigued and hoarse and came out of the ED with a diagnosis of pneumonia, which she was subsequently treated for. However, within a few weeks, she’d lost her voice and was hurting in her chest. Her second trip to the same ED resulted in a diagnosis, by an oncologist there, of lung cancer and pneumonia.
“It was in both lungs and in between my lungs,” says Carr, noting that she wasn’t coughing or experiencing any breathing problems at the time. “I was kind of surprised. Because they kept saying it was (only) pneumonia.”
Not Too Late
In April 2020, she began radiation treatments to her right lung under the care of DCI radiation oncologist Christopher Kelsey, MD. She would also receive various combinations of chemotherapy and immunotherapy. There were promising clinical trial results at the time that indicated that chemotherapy and immunotherapy taken in combination might be more effective than either alone, Crawford explained.
In December 2020, she underwent radiation to her left lung. Since then, she has been on immunotherapy (Keytruda, pembrolizumab) alone.
Carr's specific diagnosis was lung adenocarcinoma, the most common primary lung cancer in America. This particular type of non-small cell lung cancer (NSCLC) has a strong association with previous smoking.
Carr smoked cigarettes. As soon as she learned she had lung cancer, she tried to quit. With the aid of DCI physician assistant and trained tobacco cessation specialist Kelly M. Young, PA-C, she “cut way back.”
“Quitting smoking can be extremely difficult and at times patients may not even know where to start,” said Young. “I value being able to help patient accomplish their goal of quitting smoking by offering medications and counseling based on the most current research.”
People who currently smoke or have ever smoked make up more than 80% of lung cancer diagnoses. Quitting smoking can reduce your chance of developing lung cancer. Even after developing cancer, Young explained, quitting smoking can make cancer treatment more effective and prevent recurrence of cancer or new cancers from developing.
By the end of this year, more than 235,000 new cases of lung cancer will have been diagnosed in the U.S. While the number of annual lung cancer deaths is decreasing, it remains the leading cause of cancer death in the U.S. (not including skin cancer). Lung cancer will take the lives of roughly 132,000 people in the U.S. this year — including about 5,000 in North Carolina — estimates the American Cancer Society.
A Path to Home
More than 75% of lung cancers are diagnosed in people over the age of 65. Carr, 66, has been on treatment for more than a year and a half and is still going strong.
She’s even cheery. She says she feels “much, much, better,” though she admits she doesn’t have a lot of energy.
In September 2021, Carr and her sister Sharlene were able to settle into a new house back in their hometown where they have extended family — in an area down towards Wilmington, not far from the Duplin Winery.
Her treatments have now been extended to once every 6 weeks. She drives an hour-and-a-half to her immunotherapy infusion appointments and clinic visits at Duke Cancer Center in Durham, her sister by her side, and at the end of the day they drive right back home.
“It’s going good. I feel pretty good,” said Carr, who describes herself as a homebody who avoids crowds. “We are just enjoying our house. And staying away from the Delta COVID.”
Susan Blackwell, MHS, PA-C, and Jeffrey Crawford, MD, have been caring for patients with lung cancer at the Duke Cancer clinic for more than 30 years and are more excited than ever about the many treatment options now available.
They work especially closely with primary clinical nurse, Mallory Tassone, BSN, RN, thoracic oncology fellow, Hilary Dietz, MD (who's training in medical oncology), and radiation oncologist Christopher Kelsey, MD, in a team approach for the benefit of their patients.
Susan noted, “Ms. Carr is a wonderful person, always thinking of the needs of others. She is a true lung cancer survivor, living well and living longer.”