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Life After Lung Cancer

Genetic testing, targeted therapy and an early clinical trial prove effective for Dr. Allen Fremont’s fight against lung cancer.

Allen Fremont was strangely stoic that day in 2010 when he watched a pulmonologist—clutching a long, fine needle—drain liter after liter of fluid from his chest. The fluid build-up, called pleural effusion, filled the spaces between his lungs and chest wall. Fremont, a physician, knew it could only mean one thing: He had cancer.

He’d been fighting a cough, shortness of breath and fatigue for months. Although he never smoked, Fremont, a researcher with the Rand Corporation in Santa Monica and a professor at UCLA, was diagnosed with advanced non-small cell lung cancer.

He was placed on “palliative care,” which means he would undergo chemotherapy to try to hold the cancer at bay and extend his life. Fremont and his wife, Chloe, have two sons: Jeremy and Evan, who were ages 13 and 7 at the time. He thought about not being there to help Chloe raise them.

“I knew the odds, and I wasn’t at all sure there was going to be an effective treatment,” he says.

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The timing of his diagnosis, however, was lucky. In 2010 the field of oncology was on the cusp of several breakthroughs in personalized, targeted therapy—treatment designed to address the unique genetic mutations of each individual patient. At UC Irvine Health, oncologist Dr. Sai-Hong Ignatius Ou was about to start a clinical trial for a drug aimed at a genetic mutation called ROS1, which is found in only 1 to 2 percent of patients with non-small cell lung cancer.

Fremont, who had undergone genetic testing and knew he had the ROS1 mutation, heard about the trial. In January 2011 he began taking the drug crizotinib, which Ou and his colleagues had shown to be effective in lung cancer caused by a different mutation. It was unclear, however, if it worked for the ROS1 mutation. After four weeks on the medication, he underwent a PET scan. Astonishingly his lungs looked normal. The tumors were vanishing.

Thrilled, Ou began emailing Fremont’s PET scan to colleagues around the world who were working on the clinical trial. “That got everyone to say, ‘Holy moly, this does work on ROS1,’” Fremont recalls.

Fremont, who is in surprisingly good health, continues to take crizotinib and visits UC Irvine Health every two months. In 2014 Ou published a paper in the prestigious New England Journal of Medicine showing that 72 percent of non-small cell lung cancer patients with the ROS1 mutation responded to crizotinib.

The scan of Fremont’s celebrated “normal-looking” lung illustrated the study.