It all started in the spring of 2022 when 68-year-old Lake Wylie resident Terri Lemon took her dog outside for a walk. The dog spotted a coyote and tried to run after it, pulling Terri along with her. At first, Terri thought she had broken a rib. After her primary care physician took an X-ray of Terri’s chest, she asked her to come back for a chest CT scan.
Terri’s daughter-in-law, Carey McPeek, is a nurse practitioner with Atrium Health Levine Cancer Institute’s inpatient care team. Terri and Carey looked at the results of the chest X-ray and CT scan together that identified a mass on Terri’s lung, along with enlarged lymph nodes –two symptoms that can be linked to lung cancer.
“When I read the report, I contacted Dr. Daniel Haggstrom, a thoracic medical oncologist at LCI, and said, ‘I think you’re going to get to meet my mother-in-law,’” says Carey.
Terri’s lung cancer diagnosis
In looking at Terri’s CT images, there was concern for potential advanced lung cancer, as nearly 80% of lung cancer patients have stage III or stage IV disease by the time it’s discovered. “I was relatively certain Terri had at least stage III lung cancer based on how her scans looked, but we needed to get additional scans as well as a biopsy to confirm the diagnosis,” says Haggstrom.
Further testing confirmed Terri had stage IV non-small cell lung cancer with PD-L1 over expression, or increased levels of the protein PD-L1 on the surface of her cancer cells. Although her disease had spread to her brain and bones, her PD-L1 status opened a treatment avenue that would allow her to avoid chemotherapy as her first line treatment.
Though Terri was a former smoker who had quit 15 years ago, she had been diligent about getting annual physicals, screening mammograms and colonoscopies.
“There’s no history of cancer in my family, so this was so shocking,” says Terri.
Treatment for stage IV non-small cell lung cancer with high levels of PD-L1
Although not curable, Terri’s cancer was treatable due to the high expression of PD-L1. Dr. Haggstrom recommended an immunotherapy drug called pembrolizumab as the best treatment option for Terri.
“We know through research that patients who express high levels of PD-L1 have an excellent chance to respond to immunotherapy by itself rather than chemotherapy or a combination of chemotherapy and immunotherapy,” he says. “What these medicines do is train your immune system to find cancer cells and fight them. Compared to treatment with chemotherapy, immunotherapy gives fewer and less severe side effects for most patients.”
The power of lung cancer research
Terri has been on pembrolizumab and a bone-strengthening treatment for nearly six months. Her most recent scans showed no signs of cancer in her lungs or brain. Terri couldn’t believe it when Carey gave her the news.
“The treatment is giving people more longevity and good quality of life,” says Carey. “This medicine is a complete game-changer for patients with lung cancer.”
Dr. Haggstrom says Levine Cancer Institute clinical trials actively contributed to research for therapies like pembrolizumab to help patients like Terri.
“We are constantly looking for new clinical trials or medications to expand treatment options for lung cancer patients, including novel immunotherapy drugs and targeted therapies,” says Haggstrom.
Terri’s treatment plan moving forward
With minimal toxicity and an excellent response, Terri will remain on pembrolizumab for now. “If Terri continues on her trajectory without evidence of disease progression, she will become eligible to stop treatment at the two-year mark and be observed,” says Haggstrom. “The body’s immune response will continue to fight cancer even when she comes off the treatment.”
Support from her daughter-in-law and the LCI team
Carey has served as her mother-in-law’s nurse navigator and one of her caregivers throughout this treatment process while looking at lung cancer with a whole new perspective. She says it’s been emotional and gratifying caring for Terri, whom she affectionately calls “Grandma.”
Dr. Haggstrom adds, “It was an honor for Carey to entrust her loved one’s care to me. I take that responsibility very seriously. Having Carey as a cancer care provider was also very helpful because she could take some of the complicated information from Terri’s visits and review it with her mother-in-law to make sure the plan was understood.”
Terri’s new outlook on life
Terri’s stage IV cancer diagnosis has given her a fresh perspective on life and she’s filled with gratitude for the support of the Levine Cancer Institute team.
“I feel blessed,” says Terri. “I think Dr. Haggstrom is the best doctor I’ve ever met and the nurses have all been very good.”
Terri’s goal is to stay active as she enters this new chapter of her life. She’s considering returning to her job and hopes to travel to Nova Scotia in the near future.
“Terri’s case highlights how far we’ve come [with lung cancer treatment] in the last 10 years,” says Haggstrom. “These new medicines and testing capabilities allow us to attain results that were previously unachievable. This would not have been possible without clinical trial research and awareness, which we are actively championing at Levine Cancer Institute.”
Learn more about lung cancer care at Levine Cancer Institute.
