there’s no cure—all they can offer is palliative care,” he says. “We were in total shock.” Hufnagel, a longtime smoker, had quit five years earlier. Cigarette smoking is the number one risk factor for lung cancer, and in the U.S., is linked to nearly 90 percent of lung cancers, according to the Centers for Disease Control and Prevention. The Hufnagels saw another oncologist to discuss treatment, but she offered no options other than palliative care, “to try to buy time until hopefully medical science might find a cure,” says Hufnagel. “But I was determined to fight this.” They began researching various options for care, including major cancer centers in New york City. Then a friend told them about Rutgers Cancer Institute of New Jersey. “If Jim could be treated, having a world-class center close to home would be a real plus,” says Pam Hufnagel. As an added benefit, one of Hufnagel’s two adult sons lives in New Brunswick, where the Institute is located. In July the Hufnagels met with medical oncologist Joseph Aisner, MD, and radiation oncologist Salma Jabbour, MD. Dr. Aisner is the co-director of the center’s Lung Cancer/ Thoracic Oncology Program, a multidisciplinary group offering the most advanced treatments for cancers of the lung, pleura, and mediastinum. Dr. Jabbour’s subspecialty is lung cancer. The two physicians agreed Hufnagel’s case was unusual and complex. The cancer was seen in three areas around the lung, but the originating primary tumor was not seen in the lung itself. The origin of his cancer thus was not certain, but nevertheless they believed this was a lung cancer. This can be important, as cancers from different organs sometimes require different therapies. Aisner and Jabbour thought Hufnagel might benefit from new thinking about the approach to his cancer. Despite the finding of stage 4 disease, the amount of metastases appeared limited and confined to only one organ. Rationalizing single-site metastases represents a smaller cancer burden, they hypothesized that more aggressive treatment could be better controlled and the outcome might be more positive than palliative care for stage 4 disease. “Finding no primary tumor, we made the assumption that it was TO P P H OTO By : N I C K R O M A N e N KO stage 3 primary lung cancer and treated him accordingly,” adds Jabbour. “It was exciting to be able to offer him this option.” Aisner first treated Hufnagel’s pain with slow-acting and long-acting medicines, including a fentanyl patch in order to ‘even out’ the pain control. “From that point on I was pain-free,” says Hufnagel. “I felt confident about these doctors. I’m pretty sure I remember Dr. Aisner saying, ‘We can cure you.’ But Dr. Aisner remembers saying, ‘I think we can control your cancer.’ Whatever he said, I had no doubt I was going to make it.” A unique aspect of Hufnagel’s care is that the physicians “customized” simultaneous chemotherapy and radiation therapy to make it more tolerable without reducing the effectiveness. “In our approach,” says Aisner, “we use a chemotherapy combination usually given every three weeks, reduce the dose so that we can give it weekly (to the same total dose), and then give it for seven weeks dur- “ I learned you must go to the right place with the right doctors,” says Jim Hufnagel. “I’m grateful to medical oncologist Joseph Aisner, MD (above), and radiation oncologist Salma Jabbour, MD (below), for granting me a wonderful and much longer life than I originally hoped for.” ing the ongoing radiotherapy. This strategy maximizes the interaction between the chemotherapy and radiotherapy, but also minimizes toxicity. We’ve found this a very effective approach to allow us to give full therapy.” In a previous study Aisner and Jabbour treated patients first with chemotherapy to assess the tumor’s responsiveness. If the cancer was responsive, they proceeded to a more aggressive approach, including the addition of surgery and/or radiotherapy. Their review of this experience showed treatment outcomes and survival far in excess of what is normally seen in stage 4 disease treated for simple palliation. Before starting combined chemotherapy and radiation treatment, Hufnagel received two rounds of chemotherapy to see whether the disease showed evidence of response. It did. Thus began his long, grueling summer. He became ill with fevers, disorientation, shortness of breath, weakness, and a bad cough. A BOT TOM P HOTO By: JOH N O’BOyLe Summer 2017 I Cancer Connection I 17