Laura Greco was sure she had dodged a bullet on that bitter cold day in February 2015.
As she drove through falling snow with her 6-year-old son, she saw an SUV traveling head-on on their side of the road. Greco honked, but the SUV kept coming. A wall of snow blocked her from steering to the right, so she guided her vehicle into the empty oncoming lane. “Suddenly, everything on the right side of the car exploded as the SUV sideswiped me,” Greco recalls. Minutes later, she and her child were in a hospital emergency room near their Wilton, New York, home being checked for injuries and feeling shook up. “All I’m thinking is, We just walked away from this and we could have died,” says Greco.
Her son had a concussion but was otherwise OK. After Greco had a CT scan, a physician assistant came in and said, “We don’t see anything related to the car accident, but you might want to get that mass in your lung checked out.”
Greco was still so unnerved from the collision that his words barely registered. He asked whether she had ever smoked or whether she had a cough or shortness of breath. Greco, then age 40, answered no to each question. The physician assistant said it was probably nothing, but suggested she follow up with her family physician.
“I left thinking it was no big deal,” she says. “I was more shaken up about the accident.”
News and Disbelief
Three days later, Greco visited her primary care doctor, who reassured her that she was at low risk for lung problems but wanted to see the scan. Later that day, after viewing the image, the doctor called to tell Greco she needed a biopsy right away. “There was clear concern in her voice,” Greco says.
She immediately went online to find information about lung cancer. “I thought, This can’t be me!” she recalls. “Like most of us in this country, I had been brainwashed with the idea that only smokers get lung cancer. And that if you don’t smoke, you don’t need to worry about lung cancer.”
The biopsy showed she had Stage IIIa non-small-cell lung cancer (NSCLC). The five-year survival rate was about 16 percent. “It was the worst day of my life,” Greco recalls.
Many people are astonished to learn that they have lung cancer. The disease has lurked in the shadows of public awareness for decades because its link to smoking and its high death rate stigmatize patients, limit research and curb support (see sidebar).
Lung cancer is expected to cause about 154,000 deaths this year in the United States, according to the American Cancer Society—more than breast, prostate and colon cancers combined. It is by far the No. 1 cancer killer of both men and women. People who have never smoked, like Greco, account for as many as 20 percent of those with the disease. When just lung cancer among never smokers is measured, it’s still the seventh leading cause of cancer death.
Greco was unfamiliar with those statistics when she was diagnosed. Because her family lives in a small town, she decided to go to the Dana-Farber Cancer Institute in Boston for treatment. The doctors there said they would give her aggressive therapy, with the goal of curing her disease. “I liked the sound of that, even though the chance of a cure was low,” she says.
Greco learned her cancer had a change in the ALK, or anaplastic lymphoma kinase gene. ALK mutations occur in about 5 percent of lung cancers. Drugs that target the mutation are usually given only to patients with Stage IV or metastatic disease that has spread beyond the lungs, so Greco initially received chemotherapy with cisplatin and etoposide.
Having treatment about 200 miles from home was tough physically, emotionally and financially. Taking a leave from her full-time job as a lawyer, Greco stayed at a short-term rental apartment in Boston on weekdays and traveled home on weekends to spend time with her two young sons and her husband.
“It left me very tired and nauseous. It was not fun. But I survived it,” she says.
Perseverance and Purpose
Greco had surgery to remove part of her left lung and several lymph nodes. Her doctors next advised her to undergo further chemotherapy because some nodes had not responded well to the earlier treatment. She went for a second opinion to an ALK-positive lung cancer specialist, who agreed with that advice.
Greco finished the added chemotherapy in October 2015. To increase her energy, she exercised several times a week. She became active in lung cancer advocacy, helping to form the online support organization ALK Positive, which now includes more than 800 ALK-positive lung cancer patients, survivors and caregivers.
A year later, Greco’s neck started to hurt. The lung cancer had metastasized. Finding out she had Stage IV disease was “devastating for me and my family,” she says. “Now it’s not curable.”
But her lung cancer was treatable. She switched her care to the specialist and went on Alecensa (alectinib), a drug that targets ALK. After three weeks, scans showed her cancer was reduced by 50 percent. At six weeks, it was down by 75 percent and had stabilized.
In February 2017, when blood tests showed problems with two liver enzymes, Greco went off the drug for five weeks. The cancer grew, but after starting treatment again, it was reduced and stabilized once more.
“Since then, knock wood, I’ve been OK,” she says. A scan performed in January 2018 showed “no sign of progressive disease.”
Greco has visited Congress to push lawmakers for more lung cancer research, spoken to survivors and their families and been involved with fundraising for ALK Positive. This year, in partnership with the LUNGevity Foundation, the group is awarding its first ALK-positive research grant.
“I’m really dedicated to speaking up about lung cancer because nobody talks about it,” Greco says. “Whether I live or die is dependent on a future medical advance.”
Click here to read the sidebar “The Stigma of Lung Cancer.”