Stanford professor who fought lung cancer becomes Stage IV patient as targeted therapies advance

"Super ironic that I would be co-leading the center that supports research and education in this disease, and I get diagnosed myself," Lin said.

Lin tells students he considers himself lucky and even hopeful. "I think the future is really bright, because we're creating all of these personalized, specialized precision therapeutics for lung cancer," he said. "My hope is if we're not able to cure lung cancer, we can at least turn it into a chronic disease."

Improvements are shifting the prognosis for a disease once considered a death sentence, though the recent progress is new enough that it is only starting to move survival statistics. The five-year survival rate across all stages of lung cancer has doubled in three decades but remains at 30%. Stage at diagnosis matters greatly: for early, localized cancer, the five-year survival rate was 67% between 2015 and 2021.

The genetics of lung cancers are very diverse and complex relative to other cancers, which made the disease historically difficult to treat. UCLA oncologist and researcher Jonathan Goldman said a key technological development underlying many new treatments is the ability to identify, through genetic testing, the specific mutation driving a person's abnormal cell growth. "We can pick a drug that's really been developed for that type of cancer," he said.

Such drugs can manage or even shrink tumors and, because they are better targeted, cause less collateral damage, making side effects typically more tolerable for patients. "Survival used to be under a year, and now it's often several years and sometimes many years," Goldman said.

Goldman said targeting treatments by genetic subtype is far more effective than the generalized treatments of the past for breast, liver or lung cancer, because the medicines focus their attack on specific mutated cells driving abnormal growth, and they tend to have fewer harsh side effects than chemotherapy. Comprehensive genomic testing to identify a patient's specific cancer subtype is already available, and Goldman served as principal investigator on a recent study published in the New England Journal of Medicine showing dramatic reductions in recurrence when patients with rare subtypes receive targeted medicines as their first treatment.

Access to such testing is spotty. Goldman said fewer than half of lung cancer patients in the United States get their cancer genetically tested before treatment because the evaluation is not yet considered standard of care, and doctors themselves may not be aware it exists. Treatment technology is changing so rapidly that general oncologists may not be up to date on recent developments specific to lung cancer. "The next step is not just these scientific discoveries, but learning how to implement these findings," he said. "We've proven time and time again how important and effective it is to get this testing done early so you can pick your best treatment first."

Lin began taking one of those relatively new targeted drugs, a daily pill called Tagrisso, or osimertinib, when he was diagnosed in May 2024. Three months before that, the Food and Drug Administration approved its use in combination with chemotherapy, based on data showing it lengthened survival. "I am a beneficiary of years — of decades — of research," Lin said, noting how his treatment regimen has closely mapped with some of the most recent drug developments. "Since I've been diagnosed. It's quite amazing how quick — how rapid — our advances have been occurring."

Paying for treatment is another matter. Lin, despite being a nationally known expert at an elite medical center, has fought with insurers to get some of the new, expensive treatments covered. Insurers almost always require prior authorization, or deny coverage for new drugs that have not yet received expert endorsement as standard protocol. Lin said that happened for one of his $16,000 drugs, delaying his treatment at a critical time, and he watches other patients fight similar battles over coverage. "Oral drugs and the IV drugs — they're hundreds of thousands of dollars," he said. "I don't know too many people who could afford to pay out of pocket."

A year into his treatment, the initial targeted therapy Lin was taking stopped working. By then, regulators had approved another drug combination.