Lung Cancer in the Era of Modern Treatment Approaches — Podcast with Dr. Irina Stefansky

Dr. Stefansky:

This is one of the most common questions I hear.

And it makes complete sense.

Patients are suddenly faced with several treatment options, and it’s not always clear how they differ or how decisions are made.

One important point: these treatments don’t compete with each other.

Each has its own role.

• Chemotherapy is a more traditional approach. It targets rapidly dividing cells
  and remains very effective in many situations.
• Targeted therapy is based on identifying specific mutations. If we find something like EGFR or ALK, we can use drugs that act directly on that mechanism. That makes treatment much more precise.
• Immunotherapy works differently. Instead of attacking the tumor directly,
  it helps the immune system recognize it. Some tumors “hide” from the immune system. Immunotherapy helps remove that shield.

How do we decide?

We don’t choose the “strongest” treatment.

We choose the one that fits the patient.

Even with the same diagnosis, treatment can be different.

Because:

— tumor biology is different
— the body responds differently
— and treatment goals may vary

Sometimes we combine approaches or adjust treatment over time.

I often tell patients: there is no single “best” treatment.

There is the right treatment for you.

And once that makes sense, the fear becomes a bit more manageable.

Dr. Stefansky:

“Personalized treatment” can sound a bit abstract, sometimes even like a buzzword.

But in reality, it’s the foundation of how we treat lung cancer today.

Because lung cancer is not one disease.

It’s a group of different conditions that behave in very different ways.

So when a patient comes in, I don’t just see “lung cancer.”

I’m looking at a specific biological picture that we need to understand.

We start by asking:

— where exactly is the tumor
— what stage are we dealing with
— is surgery an option
— would radiation be effective
— are there targetable mutations
— how might the immune system respond

Each of these factors can completely change the treatment plan.

For example: if the tumor is localized and can be removed — surgery may be the best option.

Today, many lung surgeries are minimally invasive, and recovery is often easier than patients expect.

If surgery isn’t possible, we may use focused radiation like SBRT.

In some cases, it can be very close to surgical results.

On the other hand, if we identify a mutation — such as EGFR, ALK, ROS1, or KRAS — the whole approach changes.

In that situation, targeted therapy may become the first step.

And often, we see a strong response with less overall burden on the body.

If there are no mutations, but PD-L1 is high — we may consider immunotherapy.

Sometimes alone, sometimes combined with chemotherapy.

In more advanced disease, we often combine treatments: chemotherapy, immunotherapy, and sometimes local approaches like radiation.

And it’s important to say: combination is not a “second choice.”

It’s part of a planned strategy.

But personalization is not only about the tumor.

It’s also about the person.

Age, other medical conditions, lifestyle, and how someone tolerates treatment —
all of this matters.

For example: if surgery isn’t an option, we look for alternatives.

If maintaining daily function is a priority, we may choose a more balanced approach.

We also have tools like ctDNA — a blood test that helps us track changes in the tumor.

Sometimes we see the tumor evolving over time, and we can adjust treatment earlier because of that.

So personalized medicine is not about making one decision and sticking to it.

It’s about continuously reassessing and adapting.

At the end of the day, it’s not just about choosing a drug.

It’s about finding the most accurate pathnfor that specific patient at that specific moment.

And when patients understand that, they usually feel more at ease.

Because they see that treatment is tailored to them — not applied as a standard template.

Dr. Stefansky:

This is one of the most important questions.

Because many patients come in already feeling that there’s no way out.

They hear “lung cancer” and assume the worst.

But the reality is more nuanced — and in some cases, much more hopeful.

When we talk about early-stage disease, we mean a situation where the tumor is still confined to the lung.

At that point, we’re not just talking about control.

We’re talking about a real chance of cure.

With modern imaging, we’re detecting more of these cases earlier.

Sometimes it’s a small finding on a CT scan that the patient didn’t even feel.

And that’s where timing becomes critical.

In many cases, surgery is the first option.

Lung surgery today is very different from what it used to be.

Often minimally invasive, with faster recovery.

And in some patients, we truly see complete remission.

It’s not guaranteed for everyone.

But it is a real possibility.

If surgery isn’t an option, we can use focused radiation like SBRT.

In selected cases, it can achieve outcomes very close to surgery.

Another important development: we increasingly use systemic treatments even in early stages.

This can include immunotherapy or targeted therapy — before or after surgery.

In certain situations, this reduces the risk of recurrence.

So when patients ask, “Is there a chance?” — the answer is yes.

When cancer is detected early and treated appropriately, some patients live many years without the disease returning.

And I always emphasize: it’s not only what we find — it’s when we find it.

Early-stage disease is where we can truly change outcomes.

Dr. Stefansky:

This is a topic I’m personally very involved in.

A significant part of my work is with patients participating in clinical research.

So I’m not just reading about new treatments — I’m seeing how they work in real life.

And one thing is very clear: this field is moving forward quickly.

In the past, options were limited.

Today, we often tailor treatment based on tumor biology, not just size or stage.

There are newer generations of targeted therapies that can address mutations that used to be considered untreatable.

For example, KRAS G12C. A few years ago, we had almost nothing for it.

Today, we have drugs that directly target this mutation.

In EGFR-positive disease, newer agents have better penetration to the brain, which helps control even brain metastases.

Immunotherapy is also evolving.

We’re not only looking at the drugs themselves, but at how to better identify who will benefit from them.

PD-L1 is part of that — but not the whole picture anymore.

We also look at broader tumor characteristics and ctDNA data.

There are ongoing studies looking at combination strategies — how to “train” the immune system to respond more effectively.

At the same time, local treatments are improving.

Techniques like SBRT allow us to target small lesions with very high precision.

In some cases, this becomes an alternative to surgery.

We also see more combination approaches: targeted therapy, immunotherapy, radiation — used together, based on how the disease behaves.

And it’s important to say: these are not “miracle solutions.” They expand our options.

They give us paths that didn’t exist before.

Another important point: in Israel, there is a strong clinical research system.

Some of these advanced treatments are available through clinical programs before they become standard elsewhere.

That doesn’t mean patients should look for something “experimental.”

It means they may have access to very up-to-date approaches.

I often explain it this way: progress in oncology is not one big breakthrough.

It’s many small steps that together change the picture.

And today, there are simply more of those steps.

Which means — more options for patients.

Dr. Stefansky:

I know the word “chemotherapy” often creates fear even before treatment starts.

Sometimes it comes from past experiences, sometimes from things people have heard over the years.

And it’s important to be honest: yes, side effects do exist.

Fatigue is common.
Sometimes nausea.
A drop in energy.

Hair loss can happen — but not in every case.

And it’s not the same for everyone.

But one thing has changed significantly: we manage these side effects much better today.

For example, anti-nausea medications are far more effective than they used to be.

Blood-related complications, which used to lead to hospitalizations, can often be prevented or controlled early.

We use supportive treatments to stay ahead of symptoms.

Another important point: chemotherapy is often combined with immunotherapy.

And that changes the side-effect profile.

Patients sometimes feel different compared to what they expected.

But maybe the most important part is not just the medication itself.

It’s the way we support the patient.

When someone understands what to expect and knows who to reach out to — the fear becomes more manageable.

I always tell my patients: don’t wait until symptoms get worse.

If something changes — say it early.

Because small issues are much easier to control when we address them in time.

And it’s also important to remember: everyone responds differently.

Some patients continue working, staying active.

Others feel more fatigue.

And both are normal.

At the end of the day: chemotherapy is not an easy phase.

But it’s not what it used to be.

And in many cases, it’s a treatment that gives us a real chance to control the disease and move forward.

Dr. Stefansky:

One of the most common fears is that breathing will get worse.

Sometimes patients feel that even before treatment begins.

But in many cases, we can actually influence that.

And sometimes more than people expect.

The first thing I explain is: the lungs don’t need rest — they need activity.

Gentle movement, walking, simple breathing exercises — all of this helps maintain lung capacity and flexibility.

Some patients worry that activity will make things worse.

But more often, movement actually helps.

It reduces tension and makes breathing easier.

Breathing exercises can also be very helpful.

Nothing complicated.

Slow inhale through the nose, a short pause, slow exhale through the mouth.

It helps engage the diaphragm and reduce the sensation of shortness of breath.

There are also supportive tools, like breathing trainers.

Not everyone needs them, but in some cases — after surgery or before radiation —
they can be useful.

But maybe the most important thing is this: don’t stay silent.

Shortness of breath is not something to hide.

Sometimes the cause is simple — anemia, a treatment side effect.

Sometimes it’s something local, like fluid that can be treated.

And quality of life can improve quite quickly.

I often say: lungs are not something you protect by avoiding effort.

They are something you work with.

And when the body keeps moving, when breathing stays active, and anxiety is reduced —

treatment becomes easier to handle.

Because in the end, this is not just about test results.

It’s about living: walking, talking, sleeping comfortably.

And our goal is to preserve that as much as possible.

Dr. Stefansky:

This is a question I hear quite often.

Especially from patients who are traveling for treatment or living abroad.

And it’s a very reasonable concern.

After diagnosis, it can feel like life is suddenly on hold.

But in reality, things are more flexible than that.

The short answer is: in most cases — yes, flying is possible.

But it depends on the patient’s condition.

First, we look at lung function.

There’s a big difference between a patient with a small lesion and no symptoms and someone with more advanced disease.

Air travel involves pressure changes, and the body needs to tolerate that.

If breathing is stable, there are usually no major issues.

The second factor is treatment type.

Targeted therapy usually doesn’t limit travel.

Many patients continue their normal routine.

Immunotherapy also typically allows travel, as long as there are no active side effects.

With chemotherapy, we need to be a bit more careful.

There are periods when the body is more vulnerable — for example, right after treatment.

There may also be temporary drops in immunity.

So we plan flights accordingly.

There are situations where it’s better to delay travel:

— significant shortness of breath
— fluid in the chest
— risk of blood clots
— overall unstable condition

This is not a strict restriction.

It’s about safety.

And one more thing: we don’t just ask “is it possible?”

We also ask “how will the patient tolerate it?”

Because flying is not just about pressure.

It’s fatigue, waiting, physical stress.

Sometimes adjusting the timing makes the experience much easier.

I usually tell patients: life doesn’t stop because of the diagnosis.

It changes — but it continues.

And with proper planning, travel is often still part of it.

The key is to make these decisions together with your doctor.

Dr. Stefansky:

I always tell patients: a second opinion is not about distrust.

It’s a normal part of the process.

In oncology, decisions are not always straightforward.

Sometimes there are several reasonable options, each with its own advantages.

Wanting to hear another perspective is completely natural.

Patients sometimes hesitate to ask.

They worry it might offend their doctor.

But in reality, it’s the opposite.

A patient who wants to understand, ask questions, and make an informed decision — is a responsible patient.

There are situations where I even suggest it myself.

For example, when there are multiple possible approaches.

In lung cancer, that happens quite often.

Targeted therapy, immunotherapy, surgery — sometimes more than one option is possible.

Another situation is when the disease behaves differently than expected.

If the response is not what we hoped for, or something changes — another perspective can be helpful.

There’s also a simpler reason: after the first consultation, patients often still have questions.

That’s completely normal.

It’s an emotional moment, and not everything can be processed at once.

A second opinion gives space to ask differently, to hear things again.

And it’s important to understand: it doesn’t always change the treatment.

Sometimes patients come back and say: “Now we feel more confident in the plan.”

And that in itself is very valuable.

I always say: if you feel the need to hear another voice — say it.

This is not about the doctor.

It’s about you.

Your right to understand what is happening and why a certain path is chosen.

And in oncology — this is completely normal.

Dr. Stefansky:

This is a question patients don’t always ask directly.

Sometimes it comes in between the lines.

“What happens next?”
“What should I expect?”

But behind it, there is usually one thing:

is it possible to live — not just months, but years?

And today, the answer is not what it used to be.

When we talk about advanced lung cancer, we are no longer talking about a single outcome.

There are tumors with mutations that we can target.

There are cases where immunotherapy works very well.

There are situations where the disease progresses slowly and can be controlled.

And most importantly: we now have more options than before.

Immunotherapy has changed a lot.

In some patients, we see long-lasting responses.

Sometimes treatment continues for years, and even after stopping — the disease remains controlled.

It doesn’t happen in every case.

But it’s no longer rare.

Targeted therapy has also changed the picture.

With the right mutation, we often see long-term disease control with good quality of life.

People continue working, traveling, living.

And that’s important to say: we’re not only talking about survival.

We’re talking about life.

Of course, everything depends on the individual situation:

— tumor biology
— response to treatment
— how quickly we can adapt

Today, we can detect changes earlier with CT and ctDNA.

And adjust treatment accordingly.

I don’t tell patients “everything will be fine.”

But I do tell the truth: more and more people are living with this disease for years.

Active.
Engaged.
Making plans.

And that is a very different reality compared to the past.

I often explain it this way: we are not always “fighting” the disease anymore.

We are learning to understand it, control it, and live alongside it.

And that is a very important shift.

Advanced lung cancer is still a serious diagnosis.

But it is not always the end point.

It can become a condition that people live with — longer and with better quality than before.