Shots on Goal

Bryant Lin, MD, clinical professor of primary care and population health, received a diagnosis of stage IV lung cancer despite never having smoked.

When clinical professor of primary care and population health Bryant Lin, MD, received a diagnosis of stage IV lung cancer, despite never having smoked, hope took on new meaning. His cancer is not curable. The path forward is not knowable. But cancer has not dented his hope for the future. 

Lin’s story has been widely covered in the media, including profiles in Stanford Magazine, CBS News, the San Francisco Chronicle, and The New York Times. The general narrative arc is this: Lin had a lingering cough that he first thought was caused by allergies. When he asked his primary care physician at Stanford to take a look, Lin set in motion a series of exams and tests that revealed he had non-small cell lung cancer with metastases across his body, including in his lymph nodes, bones, and brain. Lin began treatment, which was effective in mitigating but not eliminating the cancer. He continued his work treating patients and co-directing CARE, the Center for Asian Health Research and Education. 

“Hope and fear are linked together… They are the ends of the spectrum. My fear is lung cancer screening in nonsmokers will never get on any guidelines, because there’s not attention to it.” – Bryant Lin, MD

He also developed and taught a new class at Stanford, MED 275, A Doctor’s Journey With Lung Cancer. Over the 10-week course, Lin invited experts to present on topics ranging from diagnosis – for which his own primary care physician joined – to precision oncology and cancer epidemiology. He also shared his firsthand experiences with chemotherapy. One of his hopes for the class was to show that medicine is really about people. All the latest science and all the greatest technologies fundamentally serve the most human needs. 

Lin’s own very human experience with lung cancer involves a mutation in the gene that codes for a protein called the epidermal growth factor receptor (EGFR). Part of the treatment regimen includes taking inhibitors that block the EGFR protein’s activity and, in doing so, stop the cancer’s progression. However, the drug he is taking now, osimertinib, is unlikely to work indefinitely. His cancer will likely develop resistance to osimertinib. That much, his physicians can predict. The when is not certain.

One of Lin’s biggest goals is to see the younger of his two sons graduate from high school. His son started eighth grade this fall. 

“That’s where the hope part comes in,” he says.

Hope, Statistics, and Individual Outcomes

It’s easy to talk about and dwell on survival rate statistics and numbers, Lin says, especially as a physician. “Historic numbers for stage IV lung cancer are about 10% over five years. If you hear that, you can take it two ways. You can say, ‘Geez, that’s horrible, it’s a death sentence.’ Or you can take it with hope, which is, ‘Well, one out of 10 people do survive at five years.’”

The statistics should be improving, Lin says, after recent advancements in lung cancer drugs. But he tries not to focus on the numbers. “We in medicine apply population health statistics to individuals,” he says. “But who is the average individual? Nobody is the average individual. Of course, you always hope to exceed that average. But you could also be on the other side, where you’re far worse.” 

Lin leans on advice he received from a colleague of a medical school classmate who also has EGFR lung cancer. “He said this great thing: ‘You only have to live long enough until the next treatment comes out.’” 

There are no numbers around a goal like surviving until the next effective drug emerges. What there is, Lin says, “is a lot of hope in those types of statements and those beliefs.” 

 After his diagnosis, Lin developed a class for undergraduate and medical students about his experience as a lung cancer patient.

Hope in Action

At the heart of Lin’s work now is an effort to increase the pipeline of lung cancer research and potential treatments, particularly for EGFR lung cancer. “I’ve been working so hard to figure out, how do I stimulate more development in my area so that I have more shots on goal?” he says. “If there are five new treatments coming up, there’s more likelihood that you’re going to respond to one of them.”

Some of that research is taking place at Stanford. Lin’s oncologist, professor of medicine Heather Wakelee, MD, along with her collaborator Joel Neal, MD, PhD, a professor of oncology, has run many clinical trials testing different therapeutic approaches to EGFR mutations. Some involve combining different kinds of inhibitors to block multiple pathways that contribute to the cancer’s growth. Others involve combining different classes of drugs, such as pairing chemotherapy with various types of inhibitors, including immunotherapy. 

Developing varied drugs and therapeutic approaches to combating EGFR mutations may improve the odds for Lin and others with EGFR lung cancer. There are many ways a tumor can develop drug resistance. When – or if – a tumor becomes resistant to first-line drugs, such as osimertinib, Wakelee says, the next question to ask is why that resistance developed. The best second-line treatment may depend on the specific pathway driving the cancer’s growth. Having options – more shots on goal, to borrow Lin’s expression – increases the odds that something works.

Improving Screening and Clinical Decision-Making

In all forms of cancer, early detection leads to better outcomes. But lung cancer poses an unusual difficulty: It often doesn’t cause symptoms in its early stages, and it is usually diagnosed only after it has advanced. 

Natalie Lui, MD, assistant professor of cardiothoracic surgery, was one of Lin’s first guest speakers in the Med 275 class. In her presentation, she noted that there is a 90% five-year survival rate for stage I lung cancer, compared with less than 10% for stage IV. Screening and early detection are essential to saving lives. In 2025, CARE awarded a seed grant to Lui to fund her work on increasing the rates of lung cancer screening in Asian never-smokers. 

CARE also awarded a 2025 seed grant to Ruijiang Li, PhD, associate professor of radiation oncology, to fund his research on a vision language model that can look at pathology images and predict lung cancer treatment outcomes in Asian populations. While using artificial intelligence to examine images and aid physicians in cancer diagnoses has become increasingly common, using AI tools to predict prognosis and assist physicians in making clinical decisions is new. It may not be another shot on goal for Lin, but it may be for someone in his shoes in years to come.