Doctors thought it was reflux, but discovered rare lung cancer

Doctors thought it was reflux, but discovered rare lung cancer

“You smoke?” One of the questions retired businessman Renato Astor, 60, has received since he was diagnosed with lung cancer in August 2019. This was also the first question he heard from doctors when he sought help at the time, after feeling a dry cough that lasted for weeks.

The suspicion of people and health professionals is not in vain: the consumption of tobacco derivatives, such as cigarettes, is associated with about 85% of cases of this type of tumor, According to data from the Inca (National Cancer Institute). But the disease can also affect non-smokers – as happened with Renato.

The athlete was mistakenly diagnosed with gastroesophageal reflux disease before receiving news of cancer caused by a rare genetic mutation, the most effective treatment that arrived in Brazil nearly two years after his diagnosis. Then, get to know his story.

“I was always very involved in sports, but I started training even when I was 40. I went to the gym every day, about an hour a day, rode a bike and also participated in triathlon events. He did not smoke.

At the age of 57, in August 2019, I was diagnosed with lung cancer. It all started with a persistent dry cough, along with throat clearing. I went to several ENT and gastroenterologists and they did tests. nothing was found.

After the endoscopy, my gastroenterologist said I had reflux. He prescribed me a three-month course of treatment. I took the medications and raised the head of my bed so it was more inclined, but the cough persisted.

All the doctors said it was reflux. Like you always exercised and never smoked, no I thought It could be a lung problem. The first question they asked was: “Are you smoking?’.

Renato Astor, 60, was diagnosed with rare lung cancer in August 2019

Photo: personal archive

So I decided to go back to the hospital. I was referred for a CT scan. I already used to take the test every two years, because I have a bump on my spine. The difference is that the person taking the exam did not leave that glass room to come and talk to me. This time he came out.

The girl asked me why I was there. I said I had a referral from the doctor and I asked: Why is there a problem? She said, “You will speak directly to the pulmonologist. I found it strange.

In the office, pneumo put the exam on the computer and flipped the screen over to me. “What are these white dots, doctor?” I asked. She said: It looks like a tumor.

“My first reaction was shock.

I thought this was not possible, I have always been an athletic young man, and have never smoked in my life. How could this happen? Then I understood that lung cancer can strike anyone. People who don’t smoke can get cancer, too.

My case was clinical: the tumor was already present in both lungs, in a very advanced stage with metastasis to other organs, including the spine. The biopsy showed that the cancer was caused by a mutation in Exon 20 [entenda mais abaixo].

I spent seven months using a drug intended for patients with lung cancer due to another mutation, because in 2019 there was no specific drug for me. I also received chemotherapy and radiation as well as immunotherapy. About eight months ago, I started treatment with targeted therapy. The nodes I had near my abdomen and left collarbone are gone. In the lung there is still, but much less than before.

Medals - Personal Archive - Personal Archive

A set of medals from Renato Astor, an athlete and non-smoker who has been diagnosed with rare lung cancer

Photo: personal archive

I lead a normal life, I can’t exercise with the same intensity as before. What I do today is walk two kilometers a day and sometimes ride a bike on flat ground.

Targeted therapy gives me stability, I can live like this for the rest of my life. But I know it has a deadline and the trend is for the tumor to react and change and the medication is no longer effective. But I hope that with time, other drugs will appear, as they did, and I can continue the treatment.

Cancer made me start to see life differently. It sounds a little cliched, but it’s true. I’ve never been religious, but I’ve always been very spiritual. I believe that in life everything is borrowed. There is no point in getting attached to material things, because one day you won’t be here anymore.

I even wrote a book: “Eu Não Smoke,” whose money raised from sales will go to GRAAC (The Support Group for Adolescents and Children with Cancer). There I tell my story, show that people who don’t smoke can also get cancer and have the idea that having cancer is synonymous with death. Today, if there is no solution for some cases, at least there is a cure.

Doctors say I have a drug survival rate, but if you stop to think about it, everyone will survive: You might be crossing the street, a truck hits you and you die. Nobody knows when they will die.”

Renato Astor - Personal Archive - Personal Archive

Cycling was one of Astor’s favorite activities before he was diagnosed with lung cancer – today, he hasn’t given up the habit, but he does avoid downhills.

Photo: personal archive

Lung cancer in non-smokers

Lung cancers caused by direct smoking are not the same. The genes that mutate in each case, for example, are different. Mutations in the EGFR gene, in the case of Renato, are most common among non-smokers.

“We don’t know exactly why these mutations occur,” says William. Kinsman William Jr., medical director of oncology and hematology at Beneficência Portuguesa in São Paulo. “This is an area of ​​extensive research, but we don’t yet have a sufficient answer from the science as to why some patients develop this type of mutation, even without smoking at all,” he explains.

According to official Inca statistics, about 30,000 cases of lung cancer are diagnosed annually in Brazil. Most of them are related to cigarette consumption: so the best way to prevent a tumor is not to smoke. The official body also estimates that 10% is not caused by direct smoking. Being a passive smoker (inhaling other people’s cigarette smoke), inhaling toxic gases like radon (released from the ground in mineral-rich areas), and exposing yourself to environmental pollution also increases your risk.

According to the doctor, molecular testing, also known as next-generation sequencing, is the most effective and modern method for mapping these genetic mutations. Screening should be performed by patients with suspected lung cancer, regardless of whether or not they have a history of smoking.

Jr says these molecular tests are often not available in the public health system or covered by the private network. But the specialist assures that some global pharmaceutical companies, such as Pfizer and AstraZeneca, have an initiative that offers tests for free – the program, called Lung Mapping (lung mapping, in Portuguese), has been around since 2019.

Molecular testing is essential to determine the optimal treatment for each patient.

Renato Astor - Personal Archive - Personal Archive

Renato hopes other drugs will emerge and he can continue treatment.

Photo: personal archive

How does targeted therapy work?

There are currently effective treatments for cancer caused by genetic mutations – these are called targeted therapies. These drugs were developed to block specific mutations that contribute to tumor growth and survival: they act exactly on the altered target in the lung cancer cell, producing “highly effective results and with very favorable toxicological properties,” Junior describes.

A targeted therapy that acts on the mutation responsible for causing cancer in Renato arrived in Brazil in October 2021. Developed by the pharmaceutical company Janssen, the infusion drug amivantamab is the only one able to block activation of the EGFR gene with a mutation in exon-20, considered rare – According to a BP doctor, only 10% of mutations in the EGFR gene occur at loci other than exon-19 or 21, which are the most common.

Jr explains that the treatment of lung cancer is closely related to the stage of the tumor, that is, the earlier it is diagnosed, the higher the chances of eradication of the disease. “In general, advanced stage lung cancer with spread to other organs is considered an incurable disease, regardless of whether the mutation is present or not,” says the doctor.

“But it is important to emphasize that the fact that a patient has a terminal illness does not mean that they have an incurable disease, because incurable cancer can still be cured, until we have prolonged control over the disease. This translates to a better quality of life and lifespan for the patient.” , explains.

Be aware of the main symptoms of lung cancer:

  • Cough
  • hard breathing
  • blood sputum
  • Source
  • Losing weight for no known reason
  • Anorexia
  • fatigue

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