This is the fifth story in a series that marks the 20th anniversary of the publication of papers on the role of EGFR mutation in lung cancer. This multimedia series is guest-edited by Suresh S. Ramalingam, a lung cancer expert, executive director of Winship Cancer Institute of Emory University, and editor-in-chief of the journal Cancer. The series explores the process of discovery of EGFR mutations in lung cancer, the learning curve for using the drugs that target those mutations, and the unparalleled impact on patients with lung cancer and other diseases.
Something odd turned up in one of Lawrence Phillips’s routine health screenings in 2008.
Phillips, who was 67 at the time, had been receiving annual CT scans to monitor calcified plaque in his coronary arteries since 2005. He started this screening because he was curious about the relatively new technology, the coronary calcium scan.
Family history intensified Phillips’s curiosity. His father had died of a heart attack.
“The radiologist who was reading my coronary artery calcium score asked me what I was doing with this lung cancer that showed up on my CT,” said Phillips, an endocrinologist at Emory Clinic, a professor of medicine at Emory University School of Medicine, and medical director of the Clinical Studies Center at the Atlanta VA Medical Center.
Phillips replied that when he had learned about the mass in his left lung—a variant of non-small cell lung cancer—more than a year before, doctors had said not to worry, because it wasn’t growing.
“Well, that’s not true,” Phillips recalled the radiologist saying.
After viewing the CT scan images later that day, the two physicians agreed: the mass had clearly grown, Phillips said to Deborah Doroshow, associate professor of medicine at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai.
Doroshow, a historian of medicine, is a member of the editorial board of the Cancer History Project. Her conversation with Phillips is available on the Cancer History Project podcast.
The lung cancer diagnosis in the mid-2000s took Phillips by surprise. He was a lifelong distance runner, and he had never been a smoker. Although, he had often been surrounded by smoke.
“There was plenty of secondhand smoke,” said Phillips, who attended Harvard Medical School in the 1960s, where several of his classmates smoked. “In med school, you would go to a scientific meeting, and by the end of the session, there was such an amount of smoke in the air, sometimes it made the slides hazy to see.”
Fifty years later, as Phillips learned more about his lung tumor, the radiologist said he should do something about it.
Phillips’s CT scan results came in on a Sunday in 2008. On the following Wednesday, Phillips had the mass removed via a segmentectomy.
“It seemed to be over and done with,” Phillips said. The margin came back clear of cancer, and, at the time, segmentectomy was thought to be adequate for small tumors, he said.
“But it was a bigger deal,” Phillips said.
He attended follow-up appointments for the next several years, tracking the scar left behind from surgery.
Eventually, the scar changed. And it lit up in a PET scan.
“I had to have a lobectomy,” Phillips said. “I was concerned, not so much for myself, but how am I going to tell my children about this?”
With insight from a psychiatrist, he did manage to tell his son, an electrical engineer, and his daughter, a clinical endocrinologist, like Phillips. He received a lobectomy in 2014.
Phillips went through a tough recovery from that surgery, but the athlete continued to exercise throughout this period. “As soon as they would let me out of bed, I remember walking up and down the hall to be a mile, every day, before the tubes came out,” he said.
The surgically-removed specimen turned out to have one blood vessel with a malignant cell, Phillips recalled, so he went through four cycles of chemotherapy. “I did everything I could to have chemo not interfere,” Phillips said. “They gave me IV this and that and anti-nausea drugs, and I would sit in the chemo chair with my laptop, continuing to work.”
That tumor specimen also revealed that Phillips had an EGFR mutation.
The genetic mutation’s influence made sense to him, given Phillips’s experience as a basic scientist and his wife’s work in karyotyping and oncology cytogenetics.
“The concept of a molecular signature? Standard stuff,” Phillips said. “And it was totally logical that I would be given a drug that was thought to be useful based on that particular phenotype that I exhibited.”
Phillips began by taking erlotinib (Tarceva), but it came with excruciating side effects. He then switched to a half dose of gefitnib (Iressa), which he found more tolerable.
Although Phillips had no signs of lingering disease after chemotherapy, he and his oncologist, Suresh Ramalingam, of Winship Cancer Institute at Emory University, came up with a plan to prevent recurrence.
“I think that’s part of the genius of Dr. Ramalingam,” Phillips said. “He discussed it with me, signs of a scientist to a scientist: there’s evidence for this, it’s probably useful for that, in patients who no longer have evident disease. But it seemed logical to him and logical to me.”
Today, at 82, Phillips continues to take gefitinib and get CT scans every three months.
Besides a growth spotted in his left lung in 2019, which was taken care of with radiation therapy, Phillips has remained free of evidence of disease. He still exercises daily—using an elliptical and weights these days, rather than running—and he continues to work.
“My patients ask me, ‘Are you going to retire?’ and I say, ‘Look at what I get to do. I get to see patients, teach, and do research—and they even pay me!’”
