Dr. Stein Uses Molecular Testing to Inform His Patients' Cancer Treatment

In 2021, Russell (Russ) Horne and William Sibert were diagnosed with non-small cell lung cancer (NSCLC). They both benefited from molecular profiling of their cancer, known as precision oncology, which identified different and effective treatment approaches.

Matthew Stein, MD, an oncologist and hematologist on staff at Missouri Baptist Medical Center, explained that the genetic makeup of each cancer patient's disease is unique.

"Recent advances in technology enable us to test a patient's cancer for a broad panel of driver gene mutations and other biomarkers with the goal of finding an effective drug or clinical trial. Typically, this testing can be completed in several weeks."

NSCLC is a model for molecular testing, with more than 10 non-chemotherapy FDA-approved treatments for those with advanced or metastatic disease.

Receiving a Cancer Diagnosis

Twenty-nine years into retirement from McDonnell Douglas, Russ said life was good with plenty of time for family and making quilts. However, in late April 2021, he developed a cough with cream-colored
mucus that wouldn't go away. Russ tried taking sinus medication followed by two rounds of antibiotics without relief.

In December 2021, Russ made an appointment with Kiran Sarikonda, MD, a pulmonologist on staff at MoBap, who reviewed a computed tomography (CT) scan to see the condition of his lungs. The test results showed an abnormal consolidation in his lungs.

"Even though I quit smoking in 1982, cancer never entered my mind," Russ said.

Before the end of December, Russ had a biopsy to determine if cancer was present. "I learned I had advanced NSCLC in the left lower lobe of my lung which spread into my lymph nodes."

Like Russ, William Sibert's lung issues began in 2021 when he was diagnosed with COPD (chronic obstructive pulmonary disease) and emphysema. As a retired officer from the St. Louis Police Department and the U.S. Marshals Service, William didn't let his diagnosis slow him down and was enjoying life rehabbing century-old houses.

During follow-up in early 2021 with Bahaa Bedair,MD, a pulmonologist on staff at Missouri Baptist, William learned he had a nodule in his left lung that was identified on a high-resolution CT scan. He had another CT scan in June, where a new left lung mass was identified, in addition to the other nodule. To investigate further, his doctors ordered a positron emission tomography (PET) scan and biopsy, which showed the mass to be NSCLC.

After hearing they had lung cancer, Russ and William both focused on the future. Russ said, "I knew I had a great team of doctors and cancer specialists at MoBap. They listen and support me through every step."

William added he wasn't surprised when he received the diagnosis because the doctors had prepared him for the possibility. "After hearing the news, I focused on a positive mindset by telling myself that I may have cancer, but cancer doesn’t have me."

Profiling Finds Cancer Mutations

After getting his diagnosis, Russ met with Dr. Stein, who recommended molecular profiling to determine the type of mutations in his lung cancer. "By drawing two tubes of blood from Russ' arm and sending it to a commercial lab, we could quickly see if his cancer had certain alterations that would predict a response to targeted therapy."

The test showed Russ' advanced NSCLC contained a BRAF V600E mutation that could be treated with an FDA-approved two-pill combination. "By using this type of precision oncology technique, we were able to find the treatment most likely to help Russ swiftly," Dr. Stein said.

Unlike Russ, William was initially diagnosed with Stage 2 NSCLC, and surgery was planned to remove the mass. Because of the tumor's size and location, William's doctors started him on chemotherapy, hoping to shrink the tumor. However, after two rounds of chemotherapy, it wasn't changing in size.

Dr. Stein performed comprehensive tissue molecular profiling to find out if William's tumor had specific molecular features that could guide further treatment. "The results showed a high PD-L1 score, suggesting his disease could respond to immunotherapy."

Dr. Stein explained that immunotherapy is given as an IV infusion in MoBap's Cancer Infusion Center. "I have treatment every three weeks," William said. He added that he has peace of mind knowing that the
Infusion Center is right by his oncologist's office. "It's a relaxing place with comfortable chairs, privacy curtains and TVs."

Precision Oncology Produces Results

After starting treatment, Russ and William showed improvement. Russ' mucus cleared, his cough went away and he began to feel better. Likewise, William's tumor became smaller and continued to shrink.

Both men also received tailored radiation treatments at Missouri Baptist with the goal of treating any remaining cancer.

William received 30 radiation therapy treatments over six weeks, while Russ had 15 treatments over three weeks.

On June 22, 2022, Russ visited MoBap for a follow-up CT scan to check his lungs, and Dr. Stein told him the test showed no evidence of disease. "I will continue to take the pills at least through the end of the year and will have an echocardiogram and a CT scan with contrast every three months to monitor my lungs."

On June 15, 2022, 11 months after his diagnosis, William had CT scans and received the news that his cancer was barely detectable, with no evidence of recurrence or spread. He will continue to receive immunotherapy infusions and occasional scans.

Getting Back to Living Life

Today, Russ is back at the sewing machine finishing a quilt while planning his next one. "I'm thankful for the professionalism of the entire MoBap team and how everyone worked together to coordinate my treatment. I'm so impressed with my care that I'm switching all my doctors over to those at MoBap."

Sitting on the front steps of his current home rehab project, William is also grateful for the exceptional care he received at MoBap, which helped him keep a positive outlook. Looking to the future, he said, "I'm thankful that people with cancer, like me, have more options for treatment because of all the amazing advances made in cancer over the past few years."