Stage 4 lung cancer: A story of hope

Adrian Cheong has been a multisport athlete his entire life. And as a middle school technology teacher from Fairfax, California, he frequently joins his students for pickup soccer games after school.

But in August 2018, he started to feel body aches and pain in his hips. As the school year went on, he had more and more difficulty getting around. By January, he was no longer able to play sports with his students.

“Given my athletic history, it was easy to explain away the pain as sports injuries that had never healed,” said Cheong. “I was 33 at the time, so I thought, ‘Maybe I’m just over the hill.’”

But his pain continued to get worse, and he developed a cough that lingered for months and resisted treatment with antibiotics. Maria Chan, MD, ordered a CT scan of his chest to investigate.

Cheong received a call just a few hours later. The images revealed lesions, or abnormal growths, on his lungs that Dr. Chan suspected were cancer.

Stage 4 lung cancer

Within a matter of days, Cheong underwent CT scans of his hips and spine, and an MRI of his brain.

It was an overwhelming time, but Cheong appreciated how Kaiser Permanente’s integrated care model helped simplify and expedite the process.

“I could just show up at each facility with my membership card and they had all the most up-to-date information about me on hand,” he said. “That was a huge help for me and my wife because we could just concentrate on making it to the right place at the right time.”

The scans revealed that he had stage 4 cancer, meaning the cancer had spread from his lungs to his brain, spine, ribs, and liver.

“The image of my brain looked like a Christmas tree,” Cheong said. “There were bright white spots like speckles everywhere.”

The disease had also eaten away at the bone in his hip socket and his spine. Cheong’s care team fit him for a wheelchair and told him he shouldn’t walk or lift anything heavier than a glass of water.

“Adrian’s disease was very extensive,” said Dinesh Kotak, MD, a medical oncologist with Kaiser Permanente in Northern California who is co-chair of the National Precision Medicine and Genomics Technology Initiative.

Targeted chemotherapy and radiation

Cheong’s doctors removed a small sample of the tumor in his lungs to learn more about the mutations, or changes, in the DNA of his cancer cells. Genetic testing has transformed how physicians detect and treat cancer.

“We’re in an era of precision medicine,” said Dr. Kotak. “We can now test the genome of the cancer and decide the best kind of treatment based on certain mutations that we find.”

When Cheong’s biopsy results came back, genomic sequencing showed that the cancer was a match for a targeted chemotherapy pill that could effectively treat most of the cancer in his body.

There were 6 large tumors in his brain, however, that were better treated with a CyberKnife, a robotic device that delivers noninvasive radiation with pinpoint accuracy. Cheong lay on a table while a robotic arm moved around his head firing beams of radiation from different angles to give each tumor a full dose of radiation while minimizing damage to the surrounding tissue.

The radiation successfully destroyed the tumor cells and stopped their growth. If Cheong’s care team hadn’t acted quickly and provided these targeted therapies, he may not have kept his memory or ever been able to walk again.

“The advanced procedures and medication were critical to my healing, but it's the people behind it all that were instrumental in getting me to this point,” said Cheong. “Without the researchers, nurses, doctors, technicians, family, friends, and community around me, I wouldn’t be where I am today.”