Pathologist: Legacy Of A 31-Year-Old Lung Cancer Patient

Microscopic image of the lung cancer that killed Kevin, a non-smoker, at just 31. (Courtesy M. Misialek, with family permission.)

Microscopic image of the lung cancer that killed Kevin, a non-smoker, at just 31. (Courtesy M. Misialek, with family permission.)

He was only 31 years old, the autopsy paperwork said.

What could have taken the life of someone just a few years younger than me? Stage 4 lung cancer, the chart said. And Kevin wasn’t a smoker.

I made the first incision. As I worked, it became clear that cancer had overtaken Kevin’s body. Tumor had encased his lungs, growing into the rib cage and heart, blurring the normal anatomical landmarks.

As a pathologist, I have learned that cancer knows no boundaries. It can strike anyone regardless of age, sex, race or class. I’ve also witnessed a disheartening trend over the past few years: many of the patients I see with cancer are younger and younger.

When I began my training, it was eye-opening to diagnose breast cancer in a 40-year-old. Over time, that yardstick has dropped a decade, then more. Once, my colleagues and I would stand in amazement having diagnosed the disease in 30-year-old patients. Now, unfortunately, that bar is set at more like age 20.

Kevin (Courtesy M. Misialek, courtesy of the family.)

Kevin (via M. Misialek, courtesy of the family.)

What is cancer? Cancer can be microscopic, only a few cells under my microscope, or it can be large and disfiguring. It can be indolent or aggressive. Some cancers may never cause harm while others will be relentless and deadly. This is something I have yet to understand. Many pathologists and other researchers are working on this exact question.

To me, everyone who battles cancer is a hero. Each patient is unique. It might be tumor characteristics seen on a pathologist’s slide or data collected from a clinical trial, but all patients teach us important lessons. They add to our growing understanding of cancer and search for a cure.

Kevin’s oncologist, Dr. Daniel Costa of Beth Israel Deaconess Medical Center, came over to collect some tumor tissue. It turned out that Kevin was one special patient. His tumor harbored a rare mutation in the ALK gene which made him eligible for the then still-experimental inhibitor PF-02341066. Being one of the first patients treated with the drug, he was a pioneer, blazing a path where no one had been before.

Kevin was also an outspoken advocate for lung cancer, working to erase the stigma that it is a patient’s fault because they smoked. About 15% of lung cancers occur in patients without a smoking history, many of them young like Kevin. It is in this population that the likelihood of finding a mutation that can be targeted is highest. This is the new world of personalized medicine, and as a pathologist I am looking for these mutations.

Kevin’s tumor initially responded well to the drug, but then developed resistance. He lost his battle just days after his marriage.

His journey helped establish that experimental drug as the standard of care for his particular tumor, leading to FDA approval of the drug, now called crizotinib. I encourage everyone to read Kevin’s story, told best by Dr. Costa in a Journal of Clinical Oncology article: More Than Just an Oncogene Translocation and a Kinase Inhibitor: Kevin’s Story. He writes in part:

“Patient advocates play an increasingly important role in cancer drug development, and I am certain that Kevin’s efforts on behalf of other patients during those short months when he felt well were much more important to lung cancer research than anything I have done in my career to date.”

Kevin’s legacy lives on. He worked tirelessly, urging patients to make sure their tumors got tested for specific mutations, which added to our knowledge of the molecular basis for lung cancer.

We are in the midst of a genomics revolution in which molecular profiling of tumors is becoming more and more commonplace. This era of personalized medicine is changing our perception of cancer.

A paper recently published in Nature Genetics suggests that we treat cancer based on its genetic signature, not its organ of origin. In other words, there will likely be a day when we no longer look at a cancer as a lung, breast or colon cancer, but a tumor with X, Y or Z mutation. The search for and targeting of these actionable mutations in cancer will be the new norm.

What is cancer? It is patients like Kevin that have furthered our understanding. We are closer to this answer than ever before.

What can you do? For information on how you can help, please visit the Lung Cancer Alliance. Note: It’s holding its 5th Annual Shine a Light on Lung Cancer vigil on Nov. 14 at the Prudential Center.

Dr. Michael Misialek is Associate Chair of Pathology at Newton-Wellesley Hospital and Assistant Clinical Professor of Pathology at Tufts University School of Medicine. Don’t miss his previous post on “The Unseen Pathologist: Why You Might Want To Meet Yours.”

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  • JohnMayer

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  • Jedi Knight 72

    Kevin blazing the Trail is no surprise and makes everyone who knew him very proud. We miss him so much but he would be very happy to see that the research from his fight is helping other people.

    • Michael Misialek

      Thank you for your touching insight. He certainly touched a lot of people. It is these stories that give my work meaning.

  • Diane Daniels Legg

    Thanks Michael – Kevin was a friend of mine who inspired me every day! He would be proud of how he changed people and the way we look at lung cancer!

    • Michael Misialek

      Thanks Diane! He was a special person and touched so many lives.

  • Wendy Jackson

    Not enough “Specialists” share like you have…..Thank you…..
    Too many ppl are stricken with this disease….It doesn’t discriminate…between anyone.. young…old…black…white….smoker…non smoker…..
    If you have Lungs you can get Lung Cancer…
    Survivor 3 years…1 Lung Removed due to this beast.

    • Michael Misialek

      Thank you Wendy for sharing your story. We all need to continue with advocacy and awareness to help battle the disease.

  • Mk Parker

    My 2 daughters (10 & 29) and I were all diagnosed last year with Adenocarcinoma so far we have tested negative for mutant genes for smoking/non smoking and environmental causes.
    Our family history of Lung Cancer appears to date back to before 1800 but we appear to be the first females in the line, my father was 39 when he died his father was 35… We have exceeded and surpassed expectation from the original diagnosis of stage IV last July.
    Latest testing appears to show no progression.
    We are waiting on research to begin in to our family,….the sooner the better I say.

    • Michael Misialek

      Thank you for sharing your story. Lung cancer does not discriminate. We have made great advances in recent years but there is still a lot to learn.

  • Y Kushner

    Thanks Michael, for helping to spread the word about compassionate pathologists who are dedicated health care advocates.

    • Michael Misialek

      Thanks for your comments Yael! It is important for pathologists to share stories such as Kevin’s with the public.