Neal Augenstein survived Stage IV lung cancer | targeted therapy | tagrisso | osimertinib

DESCRIPTION

It is not easy to survive Stage IV lung cancer, but through a regimen of targeted therapy, and the medication tagrisso, Neal Augenstein went on this episode of the Cancer Interviews podcast to confirm that it can be done. 

In September of 2022, Neal Augenstein, a reporter at a radio station in Washington, DC, found himself coughing more than normal.  At first he chalked it up to seasonal allergies, but when over-the-counter remedies did nothing, he went to a doctor who prescribed antibiotics, which did no good.

About two months later, Neal got a chest x-ray.  A doctor said the x-ray revealed “something suspicious,” and suggested Neal get a CT scan.  Upon viewing the scan, a pulmonologist told Neal he needed to check into a hospital.

Neal underwent a bronchoscopy and a biopsy, which is when he learned he had lung cancer.  If there was any good news from this diagnosis, it was that doctors said Neal’s cancer would respond well to targeted therapy, enabling him to avoid chemotherapy and radiation.

Neal is quick to add that is not, and never has been, a smoker.  Both his parents smoked, so he has no doubt in his youth he inhaled plenty of second hand smoke, but his research showed he was one of a growing number of healthy, relatively-young people diahnosed with advanced lung cancer, in most cases a non-small cell lung cancer.  He also learned biomarker testing can detect the more common adenocarcinoma mutations out there. And that there are different targeted therapies for those types of mutations. 

In Neal’s case, the drug osimertinib, also known as tagrisso, has been shown to be very effective.  Additional probing by Neal showed that people in their seventies had been diagnosed with lung cancer, taken tagrisso, and lived long lives.  Neal’s oncologist said Neal probably could have weathered the nasty side effects of chemotherapy and radiation, but Neal was happy to address his lung cancer with one pill a day of tagrisso.

Three months later, a CT scan revealed almost all of the cancer was gone from his lungs and lymph nodes.  His oncologist said Neal Augenstein should seriously consider surgery to remove the tumor that was the source of his diagnosis.  Neal said if the tagrisso was doing such a good job, why have this surgery?  The oncologist said such a procedure would remove virtually all doubt of his lung cancer ever returning.

In April of 2023, Neal underwent the surgery, and incredibly, he was home the next day.  He credits the tagrisso, but a month later, his chronic coughing went away. 

In a way it sounds hard to believe, but in retrospect, Neal benefited from his cancer being labeled Stage IV.  That positioned him to take the tagrisso, which had a minimum amount of side effects.  Neal says he was told if he had been diagnosed Stage III, the standard of care would have been chemotherapy and radiation.

These days, Neal Augenstein feels fine.  He coughs occasionally, but says it is a small nuisance, and nothing compared to what other cancer patients experience.

By way of advice, Neal says if you have the opportunity to get a lung cancer screening to follow through on it.  He says if you shows your lung are in good shape, that’s great, but if anything is revealed that merits further testing, better to learn it now than six months from now or six years from now.

Additional Resources:

A Breath of Hope Lung Foundation 

https://www.abreathofhope.org

TRANSCRIPT

Bruce Morton: Welcome to the Cancer Interviews podcast.  I’m your host, Bruce Morton.  Every type of cancer is serious, but some can be more lethal than others, especially when early detection is difficult.  That is often the case with lung cancer, and it was the case with our guest on this episode, Neal Augenstein of Washington, D.C.  He overcame Stage IV lung cancer, and on this episode, we are going to hear his story.  So, here he is, and Neal, welcome to Cancer Interviews.

Neal Augenstein: It’s my pleasure to be here, Bruce.  Thank you so much for having me. 

BM: Regarding your cancer journey, all of us who have survived cancer, had a stage, a point in time, in which something about our health went from normal to abnormal.  For you, when and how did that happen?

NA: In September of 2022, I found myself coughing.  The cough that I had, I thought I had allergies, because I have had seasonal allergies.  It didn’t go away despite taking several medications.  I went to my doctor, and he thought it might have been from pneumonia, maybe some sort of bronchial thing.  He prescribed some antibiotics, and they didn’t work.  After about two months, I decided I wanted to get a chest x-ray.  The doctor was pretty confident after listening to my lungs and taking into account my general health, he said he would be very surprised if I had lung cancer; but I am glad that we persisted because a couple hours later, he called me and said he had found something suspicious, that he would like me to get a CT scan.  I had that done a couple of days later.  That was also suspicious.  I realized we were getting closer to finding out what it was.  Like a lot of people in my situation, I started doing some research and try to understand what it might be.  Of course, in my research, I began to realize cancer was a possibility, but it was also a bunch of other things.  I was keeping up that it was one of the other things.  After a while my pulmonologist told me I needed to check into a hospital, because my condition wasn’t going away.  At the end of November 2022, that’s how I ended up in the hospital.

BM: And what was the chain of events that ensued?

NA: Even when I started with the CT scan, the plan was that I was going to have a bronchoscopy with a biopsy to see what it was.  While I was checked into the hospital, I had the bronchoscopy, and that evening, a doctor called me and said that it looked like to him, and it looked like to the doctors that it was cancer.  They also said that it was the kind of cancer that would respond very well to targeted therapy.  They said they were gathering more information and that they would meet with my oncologist and a surgeon the next week, and they would figure out what the plan of attack was.  So, while I got some news I didn’t want to hear, I was reassured that there was a plan in motion, or at least there was a team in motion that was gathering information that would help to determine what my plan would be.

BM: With this diagnosis, you are not a smoker, are you?

NA: Never was a smoker.  My dad and my mom were smokers and obviously I inhaled my share of second-hand smoke until I was in my middle teens, but I have never had any sort of lung issues before. I am one of the growing number of young, relatively healthy people who are being diagnosed with advanced lung cancer.  In most cases it was a non-small cell lung cancer.  That’s the one that people who don’t smoke, or are light smokers, are more prone to get.  Also, the biomarker testing can detect among the more common adenocarcinoma mutations out there, so there have been different targeted therapies for people with that mutation.  Thankfully for me, that drug, osimertinib, also known as tagrisso, has been shown to be very effective for people.  After I was diagnosed with lung cancer and started taking tagrisso, I learned in a very fortuitous way the successes that other people have had with that targeted therapy.  I got hundreds of social media engagements from people who had been on tagrisso, and it worked ten or more years for them.  Other people said they had family members who were diagnosed in their seventies, and they lived long lives with it.  I found that to be very reassuring to hear from people who have gone through the same thing with the same drug.  Luckily for me, I am in relatively good health.  The side effects haven’t hurt me very much.  My oncologist told me I would probably weather chemo or radiation very well, too.  But I was very glad to take one pill a day that I have been doing with my targeted therapy, and that worked better than I could have even dreamed.  Within the first three months, by the time I had my first CT scan, almost all the cancer in both of my lungs and the lymph nodes of both lungs was gone, was resolved.  It went so well that during a visit to my oncologist, he said they could put surgery back on the table and might be able to remove the original tumor in his left lung.  My question was, if the osimertinib is killing all of the cancer on its own, what is the benefit of doing the surgery?  He told me that removing the lobe where the tumor lived can go a long toward can prevent the cancer from coming back in the future.  That seemed to me to be an aggressive approach.  I would continue to take my targeted therapy.  I had the surgery in April on a Friday afternoon.  I unbelievably went home the next day.  It was one blessing after another that things were working as well as they possibly could.  A month after I started the tagrisso, my cough went away. 

BM: I want to talk more about your treatment regimen, but first I want to circle back to  something that I would like to clear up.  When you mention a mutation, did that have anything to do with family history?

NA: No.  It actually does not.  That certainly could have been a possibility with something inherited.  The biomarker testing gives an indication what the mutations are, and it can also get a sense of whether they are hereditary, or it is caused by something else in the environment, or, it just happened.  My doctor specifically told me it was not something hereditary, and that was a relief. 

BM: I am glad I asked, and glad we got that cleared up.  Now, regarding your cancer journey.  You chose targeted therapy, and it looks like you made an excellent choice.  Did you have other choices, or was this the only way to go?

NA: After I had had my bronchoscopy, it wasn’t sure whether my cancer would be Stage III or Stage IV.  They knew that it was in my left lung, but there were still some more tests.  There was a PET scan and a brain MRI still to be done to see if the cancer had spread.  My options were explained to me.  If it was Stage III, if it was in the lymph nodes in the center of my chest, the standard of care was both chemo and radiation.  He thought that given my health, that that would be the most aggressive way to deal with it.  If it turned out that it was something else, someplace else, then I would go on the tagrisso, the targeted therapy.  At this point, I have no evidence of disease and am temporarily cancer free.

BM: It sounds like from a lingering perspective, the part that is sticking with you now, is the coughing.  Is that true?

NA: It is.  It’s a nuisance.  People who have had cancer and live with cancer have had a lot more severe real pain and other symptoms that are certainly more inconvenient than a little cough every now and again.  I am certainly not complaining about the cough.  I trust it will go away eventually. 

BM: Neal, we are going wrap up now, and while we usually wrap up with the same question, we are going to make this a two-parter, because my followup question is germane to the lung cancer equation.  My first question is, if you ran into somebody who had just been diagnosed with lung cancer, and there was one bit of advice you would want to make sure that person remembered, what would it be?

NA: Be hopeful.  Be involved.  Learn about the disease.  I think the more that you learn about it, the more you learn about the possible treatments and the fact that in many cases, if you have a Plan A, Plan B and Plan C, having that information in the back of your mind, at least to me is very reassuring.  Me, I am going to keep learning all I can, I am going to be a very good patient, I am going to be optimistic and enjoy the support of my family and my friends and my employer, and I am just going to keep living as well as I can.  Thankfully, I am living very well.

BM: Neal, the second part of my question involves people who haven’t been involved with lung cancer.  I want to give them the benefit of the doubt, but unlike other cancers, there is this stigma that is attached to lung cancer in that there are a lot of uninitiated people, and again, there might not be any malice on their part, but they might ask someone diagnosed with lung cancer, how many cartons of cigarettes they smoke a day.  That said, what would your message be to the general public regarding this stigma?

NA: One of the reasons that I thought I didn’t have lung cancer was that I never smoked.  So, I went on to read that there are many people diagnosed with lung cancers who are non-smokers.  I do think it is important to note that anyone with lungs can get lung cancer.  There are more and more people who have never smoked who are diagnosed with lung cancer.  I really do think if you have a chance to get screened, a CT scan is a really good thing in terms of shedding a lot of information.  If it turns out clear, that’s great.  If it turns up something that is small or just beginning, having that head start really can make a big difference in your long-term health, and hopefully it will result in fewer challenges that would present themselves in living with that kind of lung cancer.

BM: Wise words, to be sure.  Thanks for an eloquent bit of storytelling in terms of past, present and future.  Thanks so much for being with us on Cancer Interviews.

NA: My pleasure.  Thanks for having me and thanks for the work you are doing with helping people share their stories.

BM: Thanks so much, Neal.  That will conclude this episode of Cancer Interviews.  We want to remind you that if you or a loved one are on a cancer journey, you are not alone.  There are people out there like Neal Augenstein that have advice that will inform and inspire.  So, until next time, we will see you on down the road.

Additional Resources:

A Breath of Hope Lung Foundation: https://www.abreathofhope.org

SHOW NOTES

TITLE: Neal Augenstein, Stage Four Lung Cancer Survivor – Washington, DC, USA

When Neal Augenstein started coughing, he thought it would soon go away, like any cough; but one test led to another, and Neal, who had never smoked a cigarette, soon learned he had Stage Four lung cancer.  Instead of chemo or radiation, he was put on a targeted therapy regimen.  Thanks to that, and a subsequent surgical procedure, he has survived advanced lung cancer.  Neal shares his story with the @CancerInterviews podcast.

Additional Resources:

A Breath of Hope Lung Foundation: https://abreathofhope.org

Time Stamps:

02:30 Neal said his cancer journey began with a cough.

04:20 A chest x-ray revealed what his doctor called “something suspicious.”

06:23 After a bronchoscopy, doctors said lung cancer was indicated.

08:03 Says he has never smoked.

16:59 Neal explains the treatment options he was provided.

19:19 The side effects of targeted therapy.

25:04 Says in some cases, targeted therapy does not last forever.

30:11 Neal says once diagnosed, you can help yourself by learning all you can about lung cancer.

KEYWORDS (tags):

cancer

bronchoscopy

cancer interviews

targeted therapy

cancerinterviews.com

biomarkers

bruce morton

chemo

tagrisso

radiation treatment

chemotherapy

neal augenstein

osimertinib