This podcast was produced for the Lung Cancer Initiative at Johnson & Johnson by Scientific American Custom Media, a division separate from the magazine’s editorial board.
Avrum Spira, MD, MSC, Global Head of the Lung Cancer Initiative (LCI) at Johnson & Johnson, shares his perspectives as a pulmonologist and critical care physician and vision for transforming this deadly disease. He discusses how the LCI is taking an interventional approach to address the root cause of disease, better understand the needs of patients and physicians, and innovate with less invasive and more accurate treatment options for early-stage lung cancer.
Megan Hall: Any cancer diagnosis is devastating, but lung cancer patients face an especially daunting journey. Lung cancer is the leading cause of cancer death in the world. It is difficult to detect early on and difficult to treat once detected.
But there is hope on the horizon.
dr. Avrum Spira leads a multidisciplinary team that takes a convergent approach to address the cause of the disease and detect lung cancer before it develops to help improve patient outcomes.
It’s all part of his efforts as Global Head of the Lung Cancer Initiative at Johnson & Johnson.
Scientific American Custom Media recently sat down with Dr. Spira to learn more about his work and the future of lung cancer treatment.
Hall: dr. Avi Spira learned about the devastating effects of lung cancer early in his career.
Avi Spira: I was a physician assistant at the time and suddenly one weekend I got a call.
Hall: It was about his aunt.
Spira: She was full of life. Always, ever since I’ve known her from a young age. And she had led a very healthy life, never smoking, exercising, eating well.
Hall: But she had fluid around her lungs
Spira: And as it turned out, she was diagnosed with stage four lung cancer within a few days. And her prognosis was that she would only live a few months.
Hall: While bravely fighting the disease, she died within a year of her diagnosis
Spira: Watching her take her last breath was incredibly traumatic. But I also realized at that point in my career that I wanted to do something to change the trajectory of this disease.
Hall: Avi’s Aunt Was A Case Of A Non-Smoker Who Got Lung Cancer
Spira: Lung cancer is the deadliest cancer because it is almost always diagnosed at an advanced stage.
Hall: It’s easy not to know you have lung cancer because of the way it develops.
Spira: It starts insidiously as a tiny, tiny cluster of cells deep in your lung tissue, doesn’t impede your breathing, you have no chest pain, you don’t cough up blood, and it grows silently for months and possibly years. And by the time you start to feel it, it’s too late.
Hall: As Avi moved forward with his career, he did so with a focus on early detection of lung cancer.
Spira: As an academic, I’ve made amazing lung cancer discoveries for 15 years about diagnosing lung cancer earlier, but it was so hard to turn those discoveries into patient benefits, very hard to do as an academic.
Hall: Avi was not satisfied with those discoveries. He wanted to see them used in the real world to help patients — right away.
Spira: I became a serial entrepreneur. And I started three companies, one of which did one of my early detection tests for lung cancer and successfully marketed it.
It took us over ten years from the discovery in 2007 to actually see it in the clinic and help patients.
Hall: So when he worked as a consultant for Johnson & Johnson, he saw an incredible opportunity. The company was looking for a way to use the full breadth and depth of its resources to change the way we prevent, detect and treat a specific disease.
Spira: We have made the leadership at Johnson & Johnson very strong that there is no disease that is currently a greater unmet need globally than lung cancer, in terms of a holistic cross-sector solution.
Hall: So you kind of whispered in their ear and said, Hey, lung cancer first?
Spira: I think I was whispering more. I may have screamed a little. Back then, as a doctor on the front line, I saw day in and day out what this disease was doing to my patients, their families, society and the world – the cost of the disease. And I felt that this was a disease, more than any other disease, that needed a new approach: transformative innovation. I couldn’t imagine any company in the world that could do it like J&J could, since they had medical devices and pharmaceuticals under the same umbrella.
Hall: The leadership listened. With the support of Dr. Bill Hait, then Global Head of External Innovation, founded the Lung Cancer Initiative at Johnson & Johnson in 2018 and Avi became Global Head. Since then, he has assembled a diverse team from inside and outside the company.
Spira: I call it the dream team we were able to put together. And that’s because I think it’s relatively unique to have deep, deep expertise in medical devices alongside very deep expertise in pharmaceuticals, all under one roof. So that allows us to really put together a multidisciplinary group of scientists, clinicians and all the support staff that one would need to create unique solutions that were previously unimaginable for this disease.
Hall: In the four years since the Lung Cancer Initiative was founded, Avi’s team has worked to address the two greatest unmet needs in the patient journey. Think of a robotic bronchoscope that can make it easier to see if a growth or spot on a person’s lung is cancerous or not.
Spira: It’s a robot-controlled endoscope that goes through your mouth or nose that can swing its way out in a relatively non-invasive manner, all the way to previously unreachable parts of your lung.
Hall: Once this bronchoscope reaches that distant part of the lung, it may take a small sample of the growth to test for cancer cells. But there’s more to the Lung Cancer Initiative’s vision at Johnson & Johnson. dr. Spira, can you tell what could happen in the future to meet other unmet needs?
Spira: We are excited to use this robotic bronchoscope to not only diagnose lung cancer earlier, which was the first unmet need, but in that procedure also to treat the lung cancer by injecting a drug or energy directly into it through the bronchoscope. And with a less invasive, more precise way to treat that disease and treat it more effectively
Hall: It is very exciting to learn that one day in the future you may be able to treat a tumor known as intratumoral therapy and we hope that Dr. Spira will come back one more time to tell us about further progress that has been made. The Lung Cancer Initiative is also working with a global consortium on something called a “pre-cancer atlas,” which is exciting to delve deeper into understanding the disease. Can you tell us about this?
Spira: What a pre-cancer atlas is – think of all the cellular and molecular changes that occur when a normal cell in your lung becomes pre-cancerous and eventually becomes a full-blown invasive cancer. So it’s a map of all those changes.
Hall: Avi’s team hopes to use that map in the future to identify the earliest signs of lung cancer development before it becomes a clinical problem.
Spira: And the analogy here is cardiovascular disease. You know, in the last 30/40 years, cardiologists no longer wait for someone to have a full-blown heart attack to treat the patient. They treat the patient for years and decades before they get sick. And they are able to do that because they understand the root cause of what causes the earliest part of their disease.
Hall: Avi hopes to find ways to determine that someone is on the path to developing lung cancer.
Spira: If we had that map of the molecular changes from a precancerous stage to cancer, we could develop ways to find people who carry these precancerous lesions and then prevent them from ever developing an invasive disease.
Hall: Would these future developments have ensured that his aunt did not die? Avi may not say any time soon. She didn’t smoke, so she probably wouldn’t have been screened for lung cancer.
Spira: But I do think in that longer term future, a non-invasive blood test or a nasal swab, or some sort of breath test, could be done every year at your annual GP visit. My aunt could have had one of those tests when she was in her late thirties, early forties, and then had some sort of treatment that would have prevented her from getting the disease, or at least been monitored very closely.
Hall: Thanks to the work of the Lung Cancer Initiative, Avi believes such a future is possible. A future that includes earlier diagnosis and treatment in one procedure… and a transformation of the paradigm of lung cancer care that will help impact millions of people around the world.
Hall: dr. Avrum Spira is the global head of the Lung Cancer Initiative at Johnson & Johnson. He is also an attending physician in the Medical Intensive Care Unit at Boston University Medical Center and a professor of medicine, bioinformatics and pathology at Boston University. The Lung Cancer Initiative was established in 2018 to unleash the full potential of science and technology to change the trajectory of this complex disease.
This podcast is produced by Scientific American Custom Media and made possible through the support of Johnson & Johnson’s Lung Cancer Initiative.
Learn more about how Johnson & Johnson is taking a multidisciplinary approach to tackle lung cancer.