Center for Thoracic Cancers
The Center for Thoracic Cancers at Smilow Cancer Hospital consists of a multidisciplinary team of experts dedicated to providing evaluation of and treatment for patients with a thoracic malignancy, including lung cancer, esophageal cancer, thymoma, or chest wall tumors. Patients in Connecticut and beyond have access to nationally recognized expert clinicians, who provide an organized, collaborative approach to cancer care, as well as the latest technologies and treatments. Our team consists of a collaboration of specialty physicians, including medical oncology, radiation oncology, thoracic surgery, pulmonary medicine, digestive diseases, pathology, diagnostic imaging, and nursing.
In addition to our expert clinicians, patients also receive comprehensive care to help with the physical, emotional, and psychological issues that are part of confronting cancer. Patients also benefit from the attention of the team's care coordinators, who make management of even the most detailed multidisciplinary treatment plan less complicated.
Our team is active in clinical research, and focuses on developing advances to care in areas of thoracic oncology where the standard treatment needs improvement and where the optimal treatment approach remains unclear. To provide the best care, most of our patients are enrolled in a clinical trial where they can receive innovative therapy for their advanced disease, including immunotherapy, which was first used in clinical trials at Smilow Cancer Hospital.
Our medical oncologists are nationally recognized for their leadership and expertise in lung cancer treatment and research, and are dedicated to offering personalized treatment options. Biomarker testing is often performed on the tumor to look for specific mutations that can be targeted by medication. There are currently FDA-approved lung cancer treatments for tumors showing abnormalities in EGFR, KRAS, ALK, ROS1, BRAF V600E, MET, RET, and NTRK genes.
Recent studies conducted at Yale have led to FDA approval of drugs for the treatment of lung cancer, such as the immunotherapy drug Tecentriq (atezolizumab), which has been proven to improve patient survival for newly diagnosed NSCLC. This drug is designed to block PD-L1, a protein that was discovered by scientists at Yale and that has been instrumental in improving survival for lung cancer patients. Another FDA-approved drug, osimertinib, which stemmed from Yale Cancer Center and Smilow Cancer Hospital researchers, was approved for the treatment of adults with early-stage NSCLC with EGFR gene mutations.
Many patients in need of surgery are referred for a minimally invasive surgery known as a video-assisted thoracoscopic surgery (VATS), which is done through several small incisions—rather than a major chest incision—and requires no rib-spreading. Most lung cancer patients in need of surgery at Smilow Cancer Hospital are scheduled for a VATS procedure. VATS for lung cancer is only available in a small minority of hospitals in the U.S.
The da Vinci Robotic System is also available, and provides patients with a less invasive surgical option, quicker recovery time, and decreased side effects. Our thoracic surgeons are experienced in this technology—and use it to perform lobectomies for the treatment of lung cancer. Together, they perform the most robotic lung procedures in Connecticut. Smilow Cancer Hospital’s robotic technology, the da Vinci Xi, is the most advanced robotic platform available.
Smaller incisions, greater surgical precision, less pain for the patient, and a quicker return to normal activity, are just some of the benefits this technology allows for. Yale was one of the earliest institutions in the country to provide robotically assisted thoracic surgery for lung cancer.
The Center for Thoracic Cancers provides access to highly technically advanced radiation therapy treatment planning. A non-invasive technique, stereotactic body radiotherapy (SBRT) provides high doses of radiation with a high level of accuracy to lung cancer tumors. This precise treatment also results in less radiation delivered to surrounding tissue and fewer side effects.
Available to some patients who are not able to (or don’t wish to) undergo surgery, radiosurgery requires an array of specialized equipment and a well-trained staff of physicists, dosimetrists, and therapists. Radiation treatment is available to our patients at Smilow Cancer Hospital and at our Smilow Cancer Hospital Care Centers throughout Connecticut.
Pulmonary Medicine and Pulmonary Intervention Program
Our pulmonary medicine experts provide seamless care for patients from lung cancer screening and diagnosis through survivorship care. The Pulmonary Intervention Program (PIP) is a joint program between pulmonary/critical care medicine and thoracic surgery at Smilow Cancer Hospital. This collaboration combines advanced, state-of-the-art technology with physicians dedicated to the evaluation and treatment of patients with lung diseases. Our Pulmonary and Critical Care Medicine services are nationally and internationally recognized for providing advanced care for patients.
The following minimally invasive procedures are some highlights of the program:
- Peripheral endobronchial ultrasound (EBUS): Smilow Cancer Hospital is one of only a few hospitals in the state with this technology. This technology improves diagnostic sensitivity for lung nodules, masses, or infiltrates, compared to bronchoscopy without ultrasound-guidance. Our physicians have the most experience in the state with EBUS and provide the greatest diagnostic accuracy possible.
- Electromagnetic navigation: An innovative procedure using electromagnetic technology that allows for better access to obtain tissue samples of lung masses. Smilow Cancer Hospital is the only hospital in the state of Connecticut offering this “GPS-like” bronchoscopic guidance through the lungs to nodules or masses in need of diagnosis.
- Confocal microscopy: Physicians at Yale are among the first in the world to use and research this endomicroscopic system that enables visualization of microscopic cells in the lung.
- Whole Lung Lavage: PIP physicians are trained to treat patients with pulmonary alveolar proteinosis (PAP) through this and other techniques.
The Smilow Interventional Oncology Program offers cutting edge specialized services supporting all disciplines at Smilow Cancer Hospital. For the care of patients with thoracic malignancies, a team of dedicated and committed professionals with the highest level of expertise offers image-guided therapies, among other services. These minimally invasive therapies can be used either as primary or adjuvant treatments, and contribute to care that is truly multidisciplinary at Smilow Cancer Hospital. The program complements medical, surgical, and radiation oncology to provide optimal patient care.
In partnership with the Yale Thoracic Pathology Service, patient tissue obtained from the thorax, including lungs, trachea, and chest wall, are carefully reviewed. The service includes evaluation of prognostic features relative to tumor immunotherapy (PD-L1 expression levels), and team members have extensive experience in diagnosing and classifying the full range of histopathology of lung disease, which is vital when making an accurate diagnosis that ultimately directs treatment planning. In this highly specialized area, our pathology team utilizes state-of- the-art techniques and approaches to provide diagnostic and prognostic pathology reports that are critical for the care of our patients. Characteristic mutations can be used as markers for the detection of very small numbers of tumor cells to increase the sensitivity and accuracy of pathologic diagnosis.
Thoracic Oncology Center Members
Roy S. Herbst, MD, PhDMedical Oncology, Thoracic OncologyRoy Herbst, MD, PhD, is chief of medical oncology and a pioneer of personalized medicine and immunotherapy whose goal is to cure lung cancer. Dr. Herbst, who is also associate director for translational science at Yale School of Medicine and Yale Cancer Center, says the way to a cure is understanding how lung cancer grows and finding new targets and new immunologic ways to enhance therapy to treat it. He adds that understanding and preventing metastasis and treatment resistance—two factors that often result in cancer fatality—is critical to our ability to increase survivorship rates. “A favorite part of my job is leading and mentoring the physicians and teams that work together to treat patients with cancer,” he says. “We have built integrated clinical and research programs at multiple care centers around the state to deliver the best care to patients. I really like bringing the group together and building teams.” Dr. Herbst says he has been interested in cancer from an early age. “As an undergraduate at Yale, I worked in the very same hallway where I work now, on the emerging science of electrobiology that impacts how cells grow and divide, which is the very basis of cancer,” he says. “I also enjoy clinical medicine, where I can help patients and blend science and cancer care.” He says the best part of his job is witnessing new drugs helping patients improve. “That really just makes my day to see people benefit from the treatments we have developed, some of them here at Yale,” he says. To reassure patients, Dr. Herbst says he tells patients that they “have come to a place where we are devoted to their care—to the quality of their care and the innovation of their care—and that, here at Yale, they will have the very best treatments and multimodality care to help their disease.”
In the News
- Hartford Courant
Joining medical clinical trials and receiving new treatments can be tough. Here’s how a CT hospital is changing that.
- Delaware Business Now
2 AstraZeneca lung cancer drugs perform well in late-stage trials
FDA Approval Insights: Adjuvant Pembrolizumab in Stage IB, II, or IIIA NSCLC
Lung Cancer Trials
- Lung Cancer
A Biomarker-directed Phase 2 Platform Study in Patients With Advanced Non-Small Lung Cancer Whose Disease Has Progressed on First-Line Osimertinib Therapy
- Lung Cancer, Breast Cancer
A Phase 1, Multicenter, Open-Label Study to Determine the Safety, Tolerability, Pharmacokinetics, and Preliminary Efficacy of ABBV-927 and ABBV-368 With and Without ABBV-181 in Subjects With Locally Advanced or Metastatic Solid Tumors