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General Thoracic Surgery Research

With more than 224,000 diagnoses and 160,000 deaths each year, lung cancer is the leading cause of cancer death in the U.S. and worldwide. Early, accurate diagnosis is critical to effective treatment and survivorship. In terms of lung cancer research, this work is gaining new ground in efforts to accomplish the following:

  • Develop innovative blood tests to quickly and accurately diagnose lung cancer.
  • Identify optimal treatment options.
  • Understand the mechanisms driving cancer growth.
  • Help prevent postoperative recurrence of the disease — advances with the potential to radically trans­form the way we diagnose and treat lung cancer.

Research efforts focusing on esophageal cancer are also ongoing at Rush University. Despite ongoing clinical and laboratory efforts, the incidence of esophageal cancer continues to rise and five-year survival rates are stable at 15-25 percent. We hope to improve survival from this deadly disease by gaining insights into the significance of tumor depth and muscle loss on patient outcomes. The general thoracic surgeons at Rush University are involved with multiple collaborative research efforts with other Rush departments, as well as researchers on a national and international level.

The general thoracic surgery research program at Rush University Medical Center is led by Michael J. Liptay, MD, and Jeffery Borgia, PhD, and focuses on many aspects of thoracic oncology. Faculty members Christopher W. Seder, MD and Gary W. Chmielewski, MD contribute to this research.

Translational research

Cancer patients at Rush benefit from the close integration of clinical care and translational research that quickly moves discoveries from the patients’ bedside to the laboratory and back again.

Development of a lung cancer screening tool

Today, lung cancer screening is less invasive and more effective than ever before at identifying lung masses. In recent years, hospitals’ use of low-dose CT-based (LDCT) screening to detect lung nodules in patients at risk for lung cancer has become increasingly com­mon and is already improving survival rates; however, these LDCT scans only show the presence of a nodule, which necessitates additional screening to determine whether the mass is cancerous. It is essential to the success of this new lung cancer-screening paradigm that we find new, more effective methods to diagnose malignancies at their earliest—and most treatable—stages.

The lung cancer research team at Rush is in the process of developing a simple and cost-effective blood test that has the potential to address these challenges and serve as a companion diagnostic to CT scanning. The diagnostic blood test helps to identify a fingerprint that gives important information about each patient’s condition and increases the chance of identifying lung cancer at a more curable stage.

Optimizing treatment for lung cancer

A range of new targeted chemotherapies have recently become available and have significantly advanced our ability to treat patients with lung cancer. However, physicians’ ability to match the right drug to the unique needs of each patient is limited by our current understanding of tumor biology. Defining the most effective treatment plan for patients with advanced lung cancer is crucial for promoting long-term survival and avoiding the toxic side effects associated with standard chemotherapies.

Physicians and researchers at Rush are aggressively investigating the molecular characteristics that lead to a lung cancer’s susceptibility to particular treatment types. This work has great potential to identify a series of blood tests that will help physicians select the most effective cancer-fighting treatment targeted to each individual patient.

Stopping postoperative recurrence

A major hurdle in the successful treatment of lung cancer is the detection of patients who are most likely to have their cancer return after surgery. The ability to identify these individuals will allow physicians to select the right postoperative treatment plan to promote long-term disease survival.

Rush’s lung cancer research team is involved with the development of a noninvasive blood test, capable of identifying a protein “fingerprint” that we can use to predict whether a patient’s cancer is likely to return. Our team of physicians and researchers at Rush have partnered with other medical centers, including the Mayo Clinic and Washington University, to develop this important diagnostic test. Currently, we have successfully developed an initial version of this blood test, which is undergoing a multicenter validation studies required before clinical implementation.

Investigation of metformin as a chemotherapeutic agent

Metformin is the most widely prescribed anti-diabetic medication in the world. In the last several years, emerging evidence has suggested that metformin may also have a role in fighting cancer. However, controversy still exists about exactly how metformin fights cancer and if there is a role in lung cancer, specifically.

We are conducting a series of studies investigating the mechanisms by which metformin inhibits lung cancer and the genetic changes associated with this response. With this, we hope to generate a more complete understanding of the effect of metformin on lung adenocarcinoma and potentially offer insight into metformin’s role as an adjuvant therapy in lung cancer with these studies.

Clinical research

Our faculty are involved in a number of clinical trials designed to better inform the diagnosis and treatment of lung and esophageal cancers.

Investigation of metformin as a chemotherapeutic agent

Studies have reported that patients with cancer who have been exposed to metformin may have a better survival. We have performed studies that demonstrate an association between metformin exposure and improved progression free survival in patients with early stage lung cancer. These data contribute to a growing body of literature supporting the anti-neoplastic effect of metformin.

Correlating coronary calcium scores with lung cancer radiation doses

Radiation therapy has been shown to reduce rates of cancer recurrence and death due to cancer and is, therefore, often recommended as a treatment option. However, it has also been shown that radiation exposure to the heart results in heart disease. In conjunction with the departments of cardiology, radiology and radiation oncology at Rush University, we are performing studies to evaluate the incidence, progression and amount of coronary artery calcium as a marker of radiation-induced coronary artery disease in lung cancer patients.

Esophageal cancer studies

The thoracic surgeons at Rush University Medical Center are the leading investigators in a multi-institutional study examining how deeper cancer invasion into the muscular layer of the esophagus correlates with reduced survival, as compared to limited muscular invasion. Acknowledging depth of muscular invasion may be a useful factor in risk-stratifying patients and determining who may benefit from adjuvant therapy.

Patients with esophageal cancer commonly experience weight loss because rapid tumor growth leads to increased metabolism and depletion of energy stores. In collaboration with the Department of Radiology at Rush University, we have used advanced software applications to examine the relationship between change in muscle mass during treatment for esophageal cancer and outcome.