Jami Way recites a mantra out loud before swallowing a pill each morning intended to prevent a return of lung cancer.
Way takes Tagrisso, a targeted therapy for non-small cell, early-stage epidermal growth factor receptor (EGFR)-positive lung cancer, where a mutation in the tumor causes cancer to spread quickly.
UCLA Health participated in a global clinical trial that led to expanded use of the drug in 2020, the year Way was diagnosed. Early data showing a big reduction in the risk of recurrence or death among people who underwent surgical removal of their tumors led to expedited approval from the U.S. Food and Drug Administration.
With that success in mind, Way speaks her daily mantra in a quiet, reverent voice:
“I am grateful for this Tagrisso pill I am about to take, and for all the scientists and doctors who devoted their time and intellect to develop it. My body is willing to accept this medication's help!"
Way, 65, is fulfilling her desire to live a normal life. The former aerobics instructor is now chief operating officer for a winery. She walks briskly five days a week. She delights in watching her two grandchildren jump on the trampoline in her backyard.
Her UCLA Health physicians say she demonstrates the improving outcomes and new treatment options for early-stage disease.
“She’s a good example of how catching a lung cancer early can make a difference, and only within the last couple of years the results are even further improved,” said Jane Yanagawa, MD, associate professor of surgery at the David Geffen School of Medicine at UCLA, interim chief of thoracic surgery and a member of the UCLA Jonsson Comprehensive Cancer Center (JCCC). “It used to be people were diagnosed so late, it was really hard to get these kind of results.”
Way’s thoracic oncologist, Amy Cummings, MD, PhD, an assistant professor, said Tagrisso has helped usher in a new era of progress for a cancer that can produce grim outcomes.
Expanded access
Tagrisso, or the generic name osimertinib, was originally approved by the FDA in 2018 as a first-line treatment for people with metastatic non-small cell lung cancer whose tumors have EGFR genetic mutations and can’t be surgically removed.
EGFR-positive cancer is more common in people who have never smoked or have a minimal history of smoking. The cancer, which makes up roughly 15% of lung cancers, tends to come back even in early-stage disease.
Because of that tendency, a subsequent clinical trial, called ADAURA, studied Tagrisso in people with earlier stage disease who underwent surgery to remove their tumors. For instance, nearly a third of patients diagnosed at stage 1B – Way’s stage – experience recurrence within five years, according to manufacturer AstraZeneca.
Tagrisso is an EGFR inhibitor, meaning that it works by blocking the action of the abnormal protein that signals cancer cells to multiply.
“It fits into the receptor almost like a lock and key to jam up that receptor and turn it off,” Dr. Cummings said. “When you take that away from a cancer cell, it basically has no ability to perpetuate itself as a cancer cell so it dies over time.”
The mutation most often develops during the course of a person’s lifetime but rarely can be hereditary. EGFR tumor mutations are more common in women and frequently are present in cases of younger people with lung cancer.
The FDA estimates that more than 10,000 patients nationwide may be eligible for Tagrisso each year after undergoing tumor removal.
Before Tagrisso, Way would not have had a treatment to potentially ward off a recurrence.
“It was caught early at a point where upfront surgery is considered the standard of care,” Dr. Yanagawa said. “In the past, it would have been the only therapy she got for it.”
Dr. Cummings said Way wanted to do everything possible to avoid a recurrence and the trial results came just in time to give her another treatment option.
“That’s why ADAURA has changed things so dramatically for us,” Dr. Cummings said.
Dr. Cummings said the most recent four-year trial data shows that Tagrisso is reducing the risk of recurrence for early-stage patients by about half, which she described as really significant.
“I think it’s very important for people to know that when being on a medication like Tagrisso, we have every expectation that you should lead a normal life,” Dr. Cummings said. “I think Jami’s been doing fantastic this whole time. She’s very actively living her life to the fullest.”
A scary diagnosis
Way caught a bad cold in 2020. After she recovered, her cough persisted. The hacking woke her up at night and left her abdominal muscles aching. A CT scan of her lungs came back fine, but the cough remained.
“I always thought that with biopsies you are going to find out what’s going on but that’s not necessarily true,” Way said. “A biopsy can be a swing and a miss.”
Dr. Wilgus advised Way to undergo a CT guided biopsy, which has a high rate of diagnostic accuracy. This time, the cancer was found.
“I’d been a fitness instructor for 40 years – this is not what I was expecting,” Way said. “It’s one of those moments in your life that’s very scary.”
But Dr. Wilgus was reassuring, saying the cancer appeared to be early stage.
“I tried then and have tried every day to be very brave about this,” Way said. “I’m just so thankful this didn’t happen to me as a young woman. My kids are grown up and flying on their own.”
Way went to Dr. Yanagawa, who performed a surgery called a lobectomy to remove a lobe in her upper right lung. The lungs contain five lobes of different sizes and the procedure allows the rest of the lungs to function normally.
“I called her my bad ass surgeon,” Way said. “I just loved her. I had an all-female team in the operating room. It was really cool.”
The tumor in Way’s lung was 3.6 centimeters, which was small enough to be classified as stage 1B. It tested positive for an activating EGFR mutation.
While recovering, she quickly started walking with pumping arms rather than resting in her hospital bed at Ronald Reagan UCLA Medical Center.
“I was basically racing around doing my laps,” Way said. “I was determined to get back into shape. I recovered very quickly.”
Way spent four days at the hospital and was able to go home a day earlier than expected.
“Immediately after the surgery the cough went away and I felt like a new person,” Way recalled.
Dr. Yanagawa said the surgery removed about 15% of Way’s lung capacity without ill effect.
“For someone like her, who started out with good lung function, we predicted it would not impair any of her activities and she’s gone back to doing everything that she was doing previously,” Dr. Yanagawa said. “She went in a healthy person and came out a healthy person.”
Dr. Yanagawa said the surgery was considered curative and described Way’s current health status as excellent. But because there’s still a risk of developing another lung cancer, she will continue to be monitored with diagnostic CT scans every six months.
“The CT scans are such high quality now and can detect tiny lesions and very tiny changes,” Dr. Yanagawa said.
A new treatment
After surgery, Way met with Dr. Cummings, accompanied by one of her three sons. Dr. Cummings told her about Tagrisso, a tablet that Way described as “a circle of pretty pink magic.”
Way has kept her daily mantra ritual private, but agreed to share the words and the rest of her experience to help promote early detection and a sense of hopefulness.
She said when she was growing up, cancer was considered a death sentence. Her father, who smoked, died of lung cancer weeks after his diagnosis.
“It’s not like that anymore. This might shorten my life, it might not,” said Way, who graduated from UCLA. “There are so many different therapies and great doctors who want to keep you alive and get you more years.”
Way said as an adult she’s on occasion smoked in social situations but never considered herself a smoker. She is concerned about misconceptions that lung cancer is caused only by smoking, which could lead non-smokers to feel immune. She said she doesn’t want anyone to ignore potential symptoms.
Symptoms of lung cancer may include: chronic cough, chest pain, shortness of breath and coughing up blood.
“I want to reach the people who are like me, who have this gene mutation,” Way said.
Dr. Cummings said some people are scared or ashamed to tell their doctors about any smoking history, but the information is important. She said those who qualify can undergo low-dose CT screening to ideally prevent metastatic cancer. Screening services are offered at many of UCLA Health’s imaging centers across Southern California.
“I think lung cancer is particularly stigmatized because it has this public perception that people did something to bring it on – that’s completely untrue,” Dr. Cummings said. “Even if you do have a smoking history, it’s not just that that led you to a lung cancer diagnosis. Far more people smoke than ever get lung cancer. And lung cancer happens in many who never smoked. There is more to the story.”
Way said her cancer diagnosis has freed her to live on her own terms, whether that’s saying no to a social obligation that would overpack her schedule or steering clear of negativity.
“What one hears often from cancer patients is enjoy every moment of your life, don’t waste a moment,” Way said. “I don’t want to feel the pressure of having to enjoy every moment. I just want a normal life.”
For Way, that means working at a supportive job she loves, enjoying backyard dinners with her husband and a glass of wine, and reading a book or watching a documentary.
“At some point, all of us who have a cancer diagnosis have got to be able to say this cloud doesn’t have to hang over me forever,” Way said. “I honestly feel if in 10 years my time is up, if I had chosen to sulk and be scared to death every day, look what I would have wasted.”
Learn more about lung cancer treatment at UCLA Health.
Courtney Perkes is the author of this article.
