In Trials, New Targeted Drugs Help Make Cancer Manageable
New and experimental drugs are extending the lives of people with the deadliest forms of cancer. At the University of Colorado Cancer Center in Aurora, Dr. Ross Camidge leads clinical trials for lung cancer, which kills more people each year than breast cancer, colon cancer and pancreatic cancer combined.
Camidge calls them "niche-busters" – targeted therapies that dig deep into the profiles of each individual cancer. Researchers have discovered that just as individual patients have different genetic make-ups, so do their tumors.
The revolution in the last decade has been in diagnosing and treating cancer at the molecular level, said Camidge.
"It's not one miracle drug," said Camidge. "It's lots of different miracles for lots of different cancers."
His patient Polly Rogers is a former soap opera star – she was "naughty girl" Kate Lodge on The Secret Storm – and a retired professor of public speaking at Arapahoe Community College who lives in Highlands Ranch. She is enrolled in a clinical trial using a combination of dabrafenib and trametinib. British pharmaceutical company GlaxoSmithKline PLC won licenses for the two drugs in 2013 to treat melanoma for patients who exhibited a mutation in a gene called BRAF.
The mutation is common in melanoma but rare among patients with lung cancer. Rogers is one of only around 4,000 people nationwide who have the mutation. Fewer than three dozen people around the country are enrolled in a trial to see if the drugs can also slow tumor growth in lung cancer as they do for melanoma.
"If I would have had the same cancer present itself 10 years ago, I would not have had such a good outcome, to put it mildly. I couldn't ask for a better time to have cancer."
The regimen has worked for Rogers.
"The cancer has melted away," Camidge told Rogers, during a recent visit. He showed her a line chart that plummeted toward zero. He asked her about side effects. She had missed a dose because of an intolerably high fever, and she had a rash.
Rogers said she felt "somewhat of a shock" when she first received her diagnosis in January 2013. She and her husband had been avid travelers, saving their money for trips to Australia, New Zealand, Jordan, Iceland, France. Scotland was her favorite; she turns actress when she slips into a Scottish accent. Since the diagnosis, they've traveled closer to home, opting for jaunts to the Columbia River, New Mexico, and Florida to visit the grandkids.
"I was told when I met with a doctor first that I had less than a year to live," said Rogers, in a voice that is raspy but clear. "Here I am more than two years later, being frisky. So not bad."
The University of Colorado Hospital is among the top-ranked cancer treatment centers in the nation, according to U.S. News and World Report. Outcomes for its cancer patients routinely top state and national rates. The Cancer Center is one of 68 institutions given a special designation by the National Cancer Institute to conduct cancer research, the only such facility in the state.
Clinical trials provide a chance to try a potentially life-saving treatment with little or no financial cost. They also give patients access to drugs that are not yet available on the market. But being the first to try a drug can be costly in its own way.
Michael Moore was a high school basketball coach in Pueblo when he was diagnosed with stage four lung cancer on his 40th birthday. It blindsided him; he worked out with his students, and was never a smoker. Moore jumped on the chance to try a drug targeted to the EGFR gene mutation that he exhibits.
"It feels like walking into a dark room," Moore said of the clinical trial. "But anything that's going to prolong my life, I'm going to try."
It controlled his cancer. But it also caused brutal side effects, unknown before he exhibited them. Moore went blind.
As Camidge explains it, a drug-induced diabetes brought on cataracts. They developed over just two days, said Moore. He lived in darkness for three weeks until surgery restored his eyesight.
For others, the ride has been easier. Joe Schneider hasn't stopped working for Hewlett-Packard in Fort Collins since getting diagnosed with stage four lung cancer in 2012. The impact of the disease on his day-to-day life has been negligible, he said.
Schneider does his research. He knows what clinical trials are available, and where. Xalkori, a drug designed for his ALK gene mutation, stopped working on his cancer. So he signed up for an early-phase clinical trial for a second-generation ALK inhibitor. On March 11, he took his first dose. For him, the treatments have been remarkably effective.
"It has changed cancer from being a death sentence to a chronic illness," said Schneider. "It's manageable the same way a person might manage diabetes or arthritis. Your life continues and you manage the illness."
Other promising treatments, said Camidge, spark the immune system to attack cancer. In about one in five people, cancer stimulates the immune system. But cancer expresses a molecule that allows it to hide from immune attack. New drugs block that communication, leaving the cancer exposed.
"My job is to pick the winners (among the clinical trials) in advance," said Camidge. "We've been pretty good at that."
The odds of surviving stage four lung cancer are disheartening. Nationwide, fewer than 3 percent of those diagnosed will live five years. At the University of Colorado Hospital, the odds are twice as good, but still just more than 5 percent.
There is still no cure. Cancers eventually adapt to the drugs. Some adapt quickly, and some adapt slowly.
But the numbers don't tell the full story. They don't tell the story of what people decide to do with their time when, as Camidge puts it, "they're staring down the barrel of a gun."
Polly Rogers calls herself a "half-day lady" – that's the portion of the day when she feels good. She's been using it to read serious non-fiction, the kind she never had time to read. Right now, she's reading The Sixth Extinction, Elizabeth Kolbert's look at the mass die-off of plant and animal species resulting from human interference.
"I should have studied geology," Rogers exclaims.
Michael Moore got married to the woman he'd loved for years. They said their vows on a beach in Destin, Florida, with 40 of their closest friends and family as witnesses.
"I was going to marry her anyway," he said, looking a little sheepish as his wife Erin laughed. "I keep telling her that."
Joe Schneider has been basically carrying on as before. He and his wife don't put off things they want to do, which means plenty of trips to New York for walks in Central Park, jazz at the Blue Note and brunch at Sarabeth's.
He thinks a lot about luck.
"If I would have had the same cancer present itself 10 years ago, I would not have had such a good outcome, to put it mildly," he said. "I couldn't ask for a better time to have cancer."
This report appears in partnership with Rocky Mountain PBS I-News. Contract Kristin Jones at firstname.lastname@example.org.