In 1967, while in elementary school, a young Corey J. Langer, MD, FACP, watched the science fiction classic Fantastic Voyage. A movie he describes as “fun, absolutely ludicrous, and cheesy.” A movie that propelled him toward medicine and his own fantastic voyage that has included 35 years working in thoracic oncology.
Dr. Langer, who is director of Thoracic Oncology at the Abramson Cancer Center and professor of medicine at the University of Pennsylvania, spoke during the faculty dinner at the 2023 Targeted Therapies of Lung Cancer Meeting. He recounted the “perils, pitfalls, promises, and poetry” that have shaped his precarious journey from nihilism to hope.
At the genesis of his medical career, lung cancer was considered a death sentence. Dr. Langer recalled a seminal debate in the mid-1990s between Drs. Phil Bonomi and Larry Einhorn about whether it was even practical or “humane” to treat patients with non-small cell lung cancer (NSCLC). In stark contrast to the abysmal outcomes of the past, the 5-year survival rate today in NSCLC has improved to 30% with much of this brought about by prospective clinical research, crucial studies in which Dr. Langer had the privilege of participating. For NSCLC patients with metastatic disease and a PDL1 expression score of 50% or higher, we may be able to abandon platinum-based chemoradiotherapy altogether.
“It’s been an amazing adventure. A fantastic voyage from nihilism to hope,” Dr. Langer said. “I’ll be blunt: I never envisioned this day would come. Obviously, we still need to do better, but here we are.”
As the treatments have evolved, so too has Dr. Langer. In recent years he has become a self-described “liquid biopsy evangelical.” He highlighted research showing patients who undergo both tissue and liquid biopsies have an increased overall survival rate compared to those who undergo partial or inadequate testing. An economic analysis he cited showed that this comprehensive testing strategy led to more accurate detection of genetic mutations and saved institutions an average of more than $37,000 per year because of reduced costs associated with the inappropriate use of chemo-immunotherapy.
Dr. Langer also advocated for additional research targeting underserved populations, such as those with performance status (PS) 2 and elderly patients. While these two patient subgroups can overlap, he urged his colleagues to resist conflating studies of PS 2 patients with elderly patients. He said that performance status should trump age considerations when planning therapy regimens because fit elderly patients experience similar outcomes from treatment as their younger fit counterparts, unlike those with compromised PS. However, he also said that actionable oncogenic drivers should trump PS when considering TKIs.
“I learned from spending so many years treating PS 2 patients that it’s not a proper venue for drug approval, but the ubiquity of the population absolutely mandates companion or parallel trials focused on toxicity and quality of life,” Dr. Langer said.
A recurrent motif underlying Dr. Langer’s speech was the importance of humanity in medicine. He shared pictures and memories of family and colleagues from his past and present who have helped him along his journey. He stressed the necessity of interdisciplinary collaboration and the value of mentors and mentees at each stage of one’s career path. Despite his affinity for clinical research, Dr. Langer clearly hasn’t forgotten that his patients are people, not data points.
“Everything we do underscores what I consider our sacred mission: The therapeutic alliance between patients and health care providers is absolutely sacrosanct,” he said.
His belief in this alliance shows in his art. Beyond his great affinity for classic films such as the Fantastic Voyage, Dr. Langer is an accomplished published poet and current president of the US1/Delaware Valley Poets Cooperative. In this vein, his prose weaves scientific thought with artistic expression.
Dr. Langer closed his keynote address by reciting his 2014 poem Beyond the Median, which he dedicated to lung cancer patient advocates.
Beyond the Median
By Corey J. Langer, MD, FACP
To be a human tick mark
On the tail of a survival curve
Is therapeutic nirvana
If only I could position all my patients
On this precious, paradisal piece
Of fourth dimensional real estate
Most worship a Supreme Being of some sort
But I also serve an exacting
More tangible, less forgiving deity
I worship at the altar of the p value
Where statistical significance
Alters biology, Perturbs clinical reality
And where I am a faithful postulant
Beyond the median
That’s where miracles accrue
Where life may start anew