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Breathing in Life with Stage IV Lung Cancer

Molecular testing, precision medicine can help patients manage cancer as a chronic disease

By Yadira Galindo   |   November 26, 2019

In December 2015, Gina Dietzer, a nurse, was experiencing pain midway down her back, where the kidneys are located. Suspecting a kidney infection, she sought medical attention. A computed tomography (CT) scan confirmed she had kidney stones, but it also revealed a mass indicative of lung cancer.

“Imaging showed lesions along my spine,” said Dietzer. “My doctors said it might already have metastasized and it was likely stage IV. That was quite the shock. Although I’m a nurse, I didn’t have oncology experience, so when I heard stage IV, I immediately thought ‘this is the end.’”

Bazhenova and Gina

A stage IV cancer diagnosis is the most advanced stage of the disease. It means the cancer has spread, or metastasized, beyond where it originated.

Stage IV lung cancer is incurable.

Like most people, Dietzer looked up the statistics online. According to the National Cancer Institute, 5.2 percent of people with metastatic lung cancer are alive five years after diagnosis.

However, those survival statistics do not take into account molecular subtypes of lung cancer. With precision medicine, some people are living longer. Some patients with stage IV lung cancer are doing well, living with cancer as a chronic disease for an extended period, said Lyudmila A. Bazhenova, MD, a physician-researcher with Moores Cancer Center at UC San Diego Health.

“Molecular testing helps us understand what makes each person’s cancer unique,” said Bazhenova, who used results of these tests to guide Dietzer’s treatment plan when she arrived at Moores Cancer Center for a second opinion.

“Every patient should have molecular testing, but many patients don’t undergo it. If Gina was not tested, we would not have known that she has an EGFR mutation. We have effective targeted therapies for this molecular abnormality, which are well tolerated and work longer than chemotherapy.”

Dietzer’s cancer is not a result of smoking. She does not consume tobacco products. Her disease is a result of an acquired genetic mutation of a key cell signaling protein, called epidermal growth factor receptor (EGFR) that is crucial for tumor growth.

At the time of her diagnosis at another medical facility, Dietzer’s tumor was molecularly tested but her doctor prescribed standard chemotherapy.

“That’s the worst part about it. They tested the tumor but didn’t tell me or share the results with me. I could have been on a targeted therapy from the start,” said Dietzer. “The heavy duty chemo was awful. But I’m inquisitive and advocate for myself. I did my research and found that we have an NCI-Designated Comprehensive Cancer Center here in San Diego, so I sought a second opinion at Moores Cancer Center.”

Bazhenova believes in a multidisciplinary approach to lung cancer and works closely with colleagues — physicians and scientists from several specialties — to develop the best possible individualized treatment plan.

Dietzer’s cancer responded well to a first generation kinase inhibitor, initially keeping her disease at bay, but recent tests show her cancer is progressing.

Bazhenova and lung cancer team

Unfortunately, for patients with stage IV lung cancer, even targeted therapies eventually fail. Cancer cells that do not die can adapt and can change. That’s what happened to Dietzer.

With new treatment options, clinical trials and a better understanding of how cancer works, Bazhenova is going back to the drawing board to find a treatment that might help Dietzer.

“Gina is now receiving another type of treatment. We do not know yet if she’s responding, but we have other options down the line if needed,” said Bazhenova.

Dietzer is staying positive thanks in part to her faith. The initial shock of a stage IV diagnosis has subsided. She joined a support group and found people living with late stage metastatic disease for five years, 10 years and even someone who has lived with it for 14 years.

Since her diagnosis in 2015, Dietzer’s youngest daughter has graduated from high school and her oldest daughter married and had her first child — both life events she had not expected to see.

“I experience life each day,” Dietzer said. “The first thing I tell someone newly diagnosed with cancer is: ‘There is hope.’”

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