Personalized Cancer Treatment

Treatment Gets Personal

One size just doesn’t fit all anymore. Not, at least, when it comes to treating cancer.

Using factors such as a person’s cancer type, disease stage and tumor marker testing results, as well as the person’s age and overall health, physicians are tailor-making treatments and generating increasingly positive results. The traditional treatment options — surgery, radiation therapy and chemotherapy — are now being used in combination with hormone treatment and targeted therapy to battle disease on several fronts. Here, two people with cancer tell their stories about their experience with personalized medicine to fight against cancer. Their stories illustrate the pros and cons of the new and developing approach of personalized cancer therapy.

More Than Normal

Jennifer Mills is no ordinary woman with breast cancer, which means she needed a bit more from her treatment than other women with the disease.

At 35, Mills is already battling breast cancer for the second time in her life, and it is her fourth cancer overall. She first faced cancer when she was just 24 years old.

“The first time I was diagnosed with breast cancer, [the tumor] was ER/PR positive,” Mills said. Tumors that are estrogen receptor (ER) and progesterone receptor (PR) positive tend to grow more slowly than cancers without these receptors, which means the outlook is usually better. ER-positive and PR-positive cancers are usually treated with hormone therapy, such as tamoxifen or aromatase inhibitors, after surgery. About two-thirds of breast cancers are positive for at least one of these receptors.

After breast cancer, pancreatic and thyroid cancer developed and then Mills had a second breast cancer diagnosed.

“I have a very high rate of cancer in my family, due to what is known as Li-Fraumeni syndrome” Mills said. “My father died at 38 and my brother died at 28 from adrenal cancer. So in my family, we are just trying to make it to 40.”

Li-Fraumeni syndrome is a rare disorder that greatly increases the risk of several types of cancer, particularly during childhood and young adulthood. Because of this disorder, Mills and her doctors developed a personalized treatment approach that was aggressive in order to decrease the risk of recurrence.

The second breast cancer tested positively for human epidermal growth factor receptor 2 (HER2), which meant that Mills was eligible for trastuzumab (Herceptin). This drug, which is given intravenously, specifically targets HER2 cancer cells. Mills was treated with a combination of trastuzumab and chemotherapy. Trastuzumab does have some possible serious side effects — congestive heart failure and allergic reactions among them.

“Herceptin has worked fine for me,” Mills said. “The only side effect I experienced was feeling tired. I’m due for some more scans next month, but to date, I’m doing great.”

“Coming in every 3 weeks for a year for the treatments is a lot to take, and it may be too much for some, but I made it fun,” she said. “The other girls I was being treated with, we had a few parties — a chemotherapy disco and a luau to name a few — and just made it entertaining. It sounds bizarre, but it turned out to be a really great way to pass the time. If you’re going to be hooked up to that 3-foot [intravenous] leash, you might as well make the best of it, and I cherish the friendships I developed.”

Mills said she believes that having a positive attitude has made a big difference in terms of how her body has responded to treatment each time she has been diagnosed with cancer.

“I just look at it like this — you’ve got to go through the treatment to survive the cancer, so if you want to live, you had better make the best of it,” she said. “I really recommend finding different ways to entertain yourself, especially when you have to sit around for a few hours every time you get your treatment. If nothing else, it makes the time go by faster.”

Mills said she also sticks to eating a good diet and exercises when she can.

“I try to eat healthy and stay active,” she said. “Of course, I do have a pretty serious weakness for chocolate, but I try to avoid that whenever I can. I stress the word ‘try.’”

Determined to Fight

Charlie Bartlett had been working in the construction industry for 35 years when his neck got sore enough for him to seek medical help. After trips to the chiropractor, family physician and physical therapist failed to find the cause—or a solution—to the pain, he finally had a magnetic resonance imaging (MRI) scan.

“I’d quit smoking 5 or 6 years before any of this ever happened, so I wasn’t really concerned about cancer,” he said. “But then the doctor comes out and sits me down on a bench and explains that they’d found a tumor on one of my vertebrae and that the bone cancer most likely metastasized from my lungs.”

Bartlett said the news felt like a punch in the gut, but he was determined to fight the disease. So he opted for 10 rounds of chemotherapy and began getting treatment once every 3 weeks.

“The chemo was really starting to wear me out,” he said. “At first, the tumor started to get smaller and my doctor said we were getting at the primary cancer, but I could also feel the chemo really beginning to take its toll on me.”

Bartlett’s doctors then ordered some tests on a sample of the lung tumor and found that there were abnormalities in the epidermal growth factor receptor (EGFR) gene, a gene that controls the EGFR protein. This protein sends signals that tell cells how and when to divide and grow. The gene abnormality, also known as a mutation, causes the protein to send signals that lead to increased multiplication of cancer cells, causing the tumor to grow.

Researchers have discovered that the targeted therapy drug erlotinib (Tarceva) is more effective for people who have the EGFR mutation in the lung cancer tumor cells than for people who do not have the mutation. Erlotinib is known as an EGFR inhibitor because it blocks the signals of the EGFR protein, thereby helping to slow or stop the spread of cancer.

Bartlett’s doctor decided to begin treatment with erlotinib.

Bartlett said that since he began taking erlotinib, his cancer hasn’t grown or spread. He said he’s also feeling like his old self.

“I started back working part-time recently, doing some work for a homeowner,” he said. “And I’ve gotten the chance to travel with my son and spend a lot of quality time with my 9-month-old granddaughter.”

Bartlett said that his cancer has served as a bit of a wake up call and that the treatment with erlotinib has given him a second chance to get more out of every day.

“I’ve been given the chance to enjoy my time here and really pay attention to the quality of the life I’m living,” he said. “In January, I went to Puerto Vallarta, Mexico, with my son, Josh, and had a wonderful time, which is something I don’t think I would have been able to do if I had been undergoing 3-week cycles of chemotherapy.

“I’ve heard it said that chemotherapy can be likened to taking a shotgun to the cancer — it can do a lot of damage to the tumor, but it takes it toll on the rest of you as well. Instead, I feel good and I’ve been able to take advantage of every moment.”

Bartlett said he encourages anyone facing cancer to stay positive.

“I think the main thing a cancer patient can do to fight this disease is to continue to eat well, have a good attitude and get plenty of exercise,” he said. “You have to continue living your life — taking care of the things that are important, the things that make every life worth living — instead of falling into the desperation of having cancer. You have to focus on the things you can control, instead of letting the disease control you.”

Of course, that advice comes easy to a man who appears to be outrunning his cancer, Bartlett said.

“You have to live every day like it is your last,” he said. “And while I know that is easy to say and hard to do, it’s still true.“