Dave Nitsche’s lung cancer diagnosis arrived not with a cough or chest pain but with a sudden blurring of vision, a symptom that led first to a suspected detached retina and then, three weeks later, to the news that stage 4 non-small cell lung cancer (NSCLC) had spread to his eye, bones, liver, kidneys, and brain. Nitsche, now 57, had never smoked, had no family history of the disease, and was at the time competing in ultra-running and triathlon events, including Ironmans, while hiking around Calgary, Alberta.
‘It was just a very active lifestyle, nothing unusual,’ Nitsche told Business Insider. Then, a few days before his 50th birthday, ‘everything changed, the engine light turned on.’
How the Dave Nitsche Lung Cancer Story Unfolded
In late 2019, Nitsche noticed that straight, vertical objects like telephone poles appeared wavy. He contacted his optometrist and was booked for an appointment days later. By the time he arrived, he had completely lost vision in the eye. The optometrist suspected a detached retina and sent him to hospital for ultrasounds. Nitsche had so much fluid buildup and pressure behind the eye that vision could not be restored. The eye was removed and replaced with a prosthetic, and the fluid was biopsied.
From there, Nitsche was sent to hospital nearly every day for bone scans and eventually to a lung specialist. The diagnosis, when it came, was a shock. ‘It was definitely a shock,’ he said. His doctor’s prognosis was a 1- to 2-year life expectancy, despite Nitsche otherwise feeling normal. His ex-wife, who accompanied him to the appointment, suggested he move back in with her. He set about putting his finances and will in order.
Targeted Therapy and the EGFR Mutation
Because the cancer had spread so extensively, Nitsche was told he had ‘no chance’ with traditional chemotherapy or radiation at that stage. Instead, his treatment turned on the specific EGFR (epidermal growth factor receptor) mutation driving his cancer. Targeted therapies block particular molecules, genes, or cellular pathways that enable tumour growth, and his mutation made him eligible for them.
He began with Gilotrif (afatinib), an oral medication that inhibits cell growth signalling in tumours, before moving to Tagrisso (osimertinib), which was directed at tumours in his brain. Tagrisso works by binding to mutated proteins to stop them from signalling cancer cell division. Nitsche remained on Tagrisso far longer than his expected survival date, a total of six years. He has since had radiation to address a small area in his brain, and is now on Rybrevant (amivantamab), a targeted antibody therapy that blocks cancer growth signals and helps the immune system attack cancer cells. Because he lives in Canada, all of his treatments have been covered by national health insurance.
The broader clinical picture for Tagrisso continues to develop. AstraZeneca has reported that Tagrisso combined with chemotherapy demonstrated a median overall survival of 47.5 months in EGFR-mutated advanced lung cancer, compared with 37.6 months for Tagrisso monotherapy, in a global phase III trial. That combination data did not exist when Nitsche began treatment, underlining how quickly the targeted-therapy landscape has shifted.
Osimertinib has also been assessed in the phase 3 LAURA trial in patients with stage III EGFR-mutant NSCLC, according to CancerNetwork, pointing to a broadening body of evidence for the drug across disease stages. The picture is not uniformly straightforward, however. EGFR Lung Cancer Resisters notes that while osimertinib extends median progression-free survival compared to first-generation TKIs (tyrosine kinase inhibitors), it reduces individual progression-free survival in 15 to 20% of patients relative to those older agents, a nuance that underscores why treatment sequencing remains an active area of clinical discussion.
NSCLC in Non-Smokers: A Pattern Worth Knowing
Nitsche’s experience is not isolated. NSCLC is the most common category of lung cancer, accounting for 85% of all cases. In small cell lung cancer, the cancer cells generally appear larger under a microscope; in NSCLC, common symptoms such as coughing, chest pain, or fatigue can be mild enough to go unnoticed until the disease has reached stage 3 or 4, when treatment options narrow.
Smoking remains the biggest risk factor, but others include exposure to radon, asbestos, metal and mineral dust, air pollution, radiation therapy, and some infections and diseases. There are currently no annual lung cancer screening recommendations for non-smokers in the US; the CDC recommends annual low-dose CT screening only for asymptomatic adults aged 50 to 80 with a 20-pack-year smoking history who either currently smoke or quit within the past 15 years.
A recent CT scan for Nitsche showed that his tumours have shrunk considerably, with some nodules resolving and being replaced by scar tissue. Side effects have been manageable compared with those associated with chemotherapy, mostly skin issues such as acne and fingernail infections. Now retired, he bikes 20 minutes each way to his appointments. He is currently training for his second BC Epic 1000, a bike race spanning nearly 700 miles across British Columbia.
‘I joke that I live three months at a time, between scans and MRIs and CTs, but three months is better than no months,’ he said. ‘It’s kind of surreal: You get past that first year and go, “Oh, well, prove them wrong.” Then you get past the two years and go, “Oh, I’ll prove them wrong again.”‘