Dr. Bryant Lin is teaching a class on lung cancer in fall 2024. He says he was very nervous about teaching the first class and sharing his story.
The Lin family
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The Lin family
Bryant Lin, a professor of medicine at Stanford, founded the Center for Asian Health Research and Education, advocating in particular for better lung cancer screening. Then, two years ago, Lin became a stage IV patient with the disease he had been battling for a long time.
“It’s very ironic that I co-direct the center that supports research and education about this disease, and that I myself received a diagnosis,” he says.
Lin, who is a non-smoker, tells students he considers himself lucky, even hopeful: “I think the future is really bright, because we’re creating all these personalized, specialized precision treatments for lung cancer,” he says. “I hope that if we can’t cure lung cancer, we can at least turn it into a chronic disease. »
Notable improvements are changing the prognosis of a disease once considered a death sentence. Much of the recent advances are so new that they are only beginning to change survival statistics. Even though the five-year survival rate for all stages of lung cancer has doubled in three decades, it still remains at a low level of 30%. (Disease stage makes a huge difference: 5-year early and localized cancer survival rates were 67% between 2015 and 2021.)
Targeted treatment
The genetics of lung cancers are very diverse and complex compared to other cancers, making their treatment historically difficult. According to Jonathan Goldman, a UCLA oncologist and researcher, one of the key technological developments underlying many new treatments is the ability to identify, through genetic testing, the specific mutation causing a person’s abnormal cell growth. “We can choose a drug that is actually developed for this type of cancer,” he says.
Not only does this help manage or even shrink tumors because the drugs are better targeted, but they also cause less collateral damage, making side effects generally more tolerable for patients.
“Survival used to last less than a year, and now it often lasts several years, even several years,” says Goldman.
Whether it’s breast, liver, or lung cancer, targeting treatments by genetic subtype is far more effective than the blanket treatments of the past, Goldman says, because the drugs are designed to focus their attack on specific mutated cells causing the abnormal growth. Because the drugs are targeted, they also tend to have fewer serious side effects than chemotherapy.
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Tests to identify a patient’s specific cancer subtype — a procedure called comprehensive genomic testing — are already available, and Goldman was a principal investigator in a recent study published in the New England Journal of Medicineshowing dramatic reductions in recurrences when patients with rare subtypes receive targeted drugs as first treatment.
However, access to these tests is uneven. Goldman says that fewer than half of lung cancer patients in the United States undergo genetic testing of their cancer before treatment because this assessment is not yet considered a “standard of care.” Additionally, doctors themselves may not know it exists; Goldman says treatment technology is evolving so quickly that general oncologists may not be aware of some of the newer developments specific to lung cancer.
“The next step is not only about these scientific discoveries, but also about learning how to implement these discoveries,” he says. “We have proven time and time again how important and effective it is to get these tests done early so you can choose your best treatment first.”
It was one of these relatively new targeted drugs, a daily pill called Tagrisso (or osimertinib), which patient professor Bryant Lin started taking when he was first diagnosed in May 2024. Just three months before, the Food and Drug Administration had approved its use in combination with chemotherapy, based on data showing that it prolonged survival.
“I have the benefit of years, if not decades, of research,” Lin says, emphasizing how his treatment regimen is closely tied to some of the most recent drug developments. “Since I got my diagnosis. It’s pretty amazing how quickly – how quickly – our progress has happened.”
Affordability
Treatment is one thing; offering them is another. Even Lin, a patient with the unusual privilege of being a nationally known expert at an elite medical center, is struggling with insurance to get some of these expensive new treatments covered. Insurers almost always require prior authorization for treatments, or deny coverage for new drugs that have not yet received expert approval as standard protocol. Lin says this happened for one of his medications worth $16,000, delaying his treatment at a critical time. He also observes patients fighting similar battles for coverage.
“Oral and intravenous medications cost hundreds of thousands of dollars,” he says. “I don’t know many people who could afford to pay out of pocket.”
A year into her treatment, the initial targeted therapy Lin was on stopped working. At that time, regulators approved another drug combination — amivantamab and lazertinib — an antibody to activate the immune system, and another pill targeting its specific type of mutation, known as EGFR.
Dr. Bryant Lin receives a chemotherapy infusion at the start of his treatment in June 2024.
The Lin family
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The Lin family
Lin, who still teaches, travels and advises the Susan Wojcicki Lung Cancer Foundation, says these new therapies have given her both more life and a better quality life. “My symptoms are really well controlled. I can live my life. I can talk. I don’t think I coughed once during our conversation.”
Additionally, this type of scientific progress has a cumulative effect, as recent advances in other genetically similar cancers may soon be applied to lung cancer.
Personalized treatment
One promising area of potential crossover is pancreatic cancer, which is driven by a gene from the same KRAS family that causes a significant minority of lung cancers. A drug approved by the FDA in August, called Rasonque (generic name daraxonrasib), has doubled the survival of patients with advanced cancer to more than 13 months in clinical trials — a rare victory against pancreatic cancer, a particularly stubborn form of the disease.
There are other promising pancreatic cancer drugs that could eventually find application against lung cancer, including mRNA vaccines, which are tailor-made to match each individual’s cancer genetic profile. Researchers and companies say these results show promise in remobilizing the immune system to fight tumors.
“I studied this on my own – a personalized mRNA vaccine,” says Lin.
Lin’s professional goal remains to advocate for better screening modes and rates, which remain stubbornly at 18% among high-risk patients for whom annual screening with low-dose CT scans (image tests) is the standard recommendation. But with screening, progress has also been made: AI imaging and increasingly sensitive blood tests can help detect, or even predict, the onset of a disease years earlier.
Just as colorectal cancers can now be screened using blood tests, stool tests and colonoscopy, Lin wants to see options other than CT scans for lung cancer. Expanding these types of monitoring technologies could ultimately help further reduce lung cancer deaths.
Lin himself is like a trapeze artist, hanging from one treatment to the next. Another cancer patient told him: All he has to do is hang in there. “He says, ‘Hey, you just have to survive long enough until the next new treatment becomes available’ — and that was the case for me,” Lin says. His life in limbo involves balancing acts – as doctor and patient, optimist and realist. “I’m hopeful,” he said. “But absolutely: the odds are against me.”
Dr. Bryant Lin with his sons at a San Francisco Giants baseball game in the spring of 2025. He says he loved going to Giants games with his sons before he was diagnosed. “Fortunately, we were able to go back as a family in 2025 and 2026,” he says.
The Lin family
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The Lin family
Indeed, a few days after our conversation, Lin received disappointing news: his latest scans showed progression of his cancer. So it must now consider switching to another antibody approved last year, or consider the possibility of new clinical trials.
In the meantime, Lin also stays focused on attending San Francisco Giants games with his wife and teenage sons, or tinkering with an old-fashioned, seafoam-green Smith Corona manual typewriter that he bought to commemorate his upcoming book, Sunshine: An exploration of life when you’re dying.
“We stayed up late when we got the typewriter, just typing and making noise and writing crazy things on the paper.”
Life, he insists, must still be lived with a little stupidity.
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