Key personnel making an impact in the world of lung cancer - 2: 

Professor George Eapen, Deputy Department Chair and Professor of the Department of Pulmonary Medicine, Division of Internal Medicine at the University of Texas MD Anderson Cancer Centre. 
Professor Eapen completed his training at the University of Benin before undertaking his residency at the Southern Illinois School of Medicine and a clinical fellowship at Baylor College of Medicine, Houston, Texas.
In addition to his position at the Department of Pulmonary Medicine, Professor Eapen is Section Chief of Interventional Pulmonology, University of Texas. He is also a member of American College of Chest Physicians and the President-Elect of the American Association for Bronchology and Interventional Pulmonology.  
What first motivated you to work in pulmonary medicine and lung cancer? 
When I started working 20 years ago, attitudes to lung cancer were negative and nihilistic. A diagnosis was tantamount to a death sentence and there was an undercurrent of victim blaming – a sense that lung cancer was self-inflicted because it is often caused by smoking. I always felt this was unfair and that this neglected patient population deserved more attention and care. This attracted me to practice in lung cancer. 
I was then drawn to interventional pulmonology because it was an optimistic speciality, looking for solutions. Interventional pulmonologists were exploring new possibilities in treating lung cancer, experimenting with new technologies and techniques like stents or rigid bronchoscopy. It was an energetic field and I found this very appealing. 
What is different about your role today from when you started your career?
The role of the interventional pulmonologist has morphed and expanded as new technologies have come through. When surgery was the only curative treatment available, we used to be confined to the pre-operation assessment, working out whether a patient could cope with surgery.
Today, we have a major footprint in diagnosis and staging, with the use of less-invasive procedures like endobronchial ultrasound (EBUS). Our options for curative treatment have expanded beyond surgery to less invasive procedures. We also have better techniques and tools for symptom management, so that gives us a bigger role in patient care.
Secondly, we have seen a decisive shift toward multidisciplinary care. 20 years ago, patients were treated in silos. Now, with MDTs we have a one-stop shop to discuss individual patients’ needs and bring together different perspectives and expertise to enhance their care. This is a very positive development. 
What have been the biggest advances in your specialty, in terms of how we have improved outcomes for people with lung cancer? 
Change is often incremental, and small steps add up to a big impact. One of the biggest advances is that we now know that lung cancer screening can provide a mortality benefit. If we can shift from two thirds of people being diagnosed with a late-stage cancer to two thirds being diagnosed with an early-stage cancer, we can increase survival rates. 
In staging, EBUS has been a major step forward: a minimally invasive way of getting the right information, with a better safety profile than surgery, increasing the numbers of patients who have staging information. In terms of treatment, stereotactic ablative radiotherapy (SABR), is becoming more mainstream. We’re seeing more patients with controlled disease at three years – almost equivalent to lobectomy. 
What do you see as the most significant challenges to continuing to improve outcomes for people with lung cancer in the coming years?
The key issues are cost and accessibility. The cost of developing and then rolling-out new treatments is high. Equally, geographic access to high-quality and appropriate care is another challenge. It is no use building a better mouse trap if you don’t put it where the mice are.
Some patients live far away from expert centres. Since we can’t put a centre in every town, we need to find ways for professionals to disseminate their expertise to expand access. We must aim to deliver the greatest amount of care to the greatest number of people. 
What are you most excited about in your field?  
Immunotherapies have changed how we approach lung cancer treatment. Consider the past: we dealt only in crude terms of small cell or non-small cell lung cancer. Now we have identified over 23 actionable mutations and treating the right target with the right drug has resulted in big improvements in progression-free survival. 
SABR is also very promising. If we can move towards more non-surgical approaches to lung cancer treatment, that would be very exciting. From my perspective as an interventional pulmonologist I find transbronchial biopsy and ablation the most exciting development. It’s early days but the fact that resources are being moved in this direction fills me with optimism. 
What role do you see international collaboration playing in advances in lung cancer treatment?
I believe science is a team sport. As Isaac Newton said, if we see further, it is because we stand on the shoulders of giants. Collaboration means we can advance science and get better outcomes for patients. We can always improve on what we knew or had before.