with renal cell carcinoma, medullary thyroid cancer,
gastrointestinal stromal tumors, non-small cell lung cancer,
metastatic colorectal cancer, and pancreatic neuroendocrine
tumors (see Figure 4, and Tables 2 and 3, pp. 24, 40-41,
42, respectively). Clinical trials are now underway to
determine if other types of cancers can be effectively
treated with these therapies.
Harnessing the Patient’s Immune System
Recently, it was discovered that many cancers are able to
inactivate a patient’s immune system (see Figure 6, p. 29).
This finding led to the development of the therapeutic
antibody, ipilumumab (Yervoy), which helps to re-activate the
patient’s immune cells (meet cancer survivor and
ipilumumab patient Andrew Messinger, p. 57). This drug is a
new and welcomed advance for patients with metastatic
melanoma, an aggressive type of skin cancer with few active
treatment options. Clinical trials are now underway to test its
effectiveness for the treatment of prostate and non-small cell
Immunotherapy, using a vaccine to program the immune
system to attack cancer cells, is another new development.
The cancer vaccine, sipuluecel-T (Provenge), is now being
used to treat patients with metastatic prostate cancer. This
strategy is currently being studied in a number of clinical
trials to see if it is effective against other cancers. Finally,
other immunotherapeutic strategies are in their early stages
of development and are showing great promise (meet cancer
survivor and immunotherapy patient Roslyn Meyer, p. 59).
In the summer of 2005, I discovered a pea-sized lump beside my left ear, and an MRI
revealed cancer in my parotid gland and a nearby lymph node. Biopsies suggested
an aggressive head and neck cancer, but a full-body PET scan showed a malignancy
in my liver as well. A liver biopsy determined that the tumors were actually
melanoma. I was 56, married with three children in their 20s. Full of life, despite the
terrifying prognosis of stage IV metastatic melanoma, I was determined to fight.
My husband and I consulted a melanoma expert who suggested that I try to get into
a clinical trial for a treatment known as adoptive immunotherapy or TIL therapy. TIL,
which stands for “tumor-infiltrating lymphocytes,” attempts to harness the body’s
own immune system to recognize and kill cancer cells. At the National Cancer
Institute, where this experimental trial was being conducted, doctors would remove
my cancerous lymph node and isolate white blood cells, or lymphocytes, that
recognized and were attacking my tumor. The researchers would clone these cells,
and try to grow billions of them. Finally, the doctors would return this powerful army
of cells to my body, where they would fight my cancer. After a number of tests, I was
found eligible for the clinical trial, and I enrolled in October 2005.
I entered the hospital and had my cancerous lymph node removed, and the doctors
tried—unsuccessfully—to grow the cells for the TIL treatment. (They are currently
unable to grow the cells from about 40% of patients.) But while they waited to see if
the cells would grow, they put me on high-dose interleukin- 2 (IL- 2). IL- 2 is a tough
treatment, and as few as 10 to 20% of people have a favorable response to it. I was
one of the lucky ones, and it caused my tumors to shrink. I hoped perhaps I would be
one of the few who would be cured, but that was not to be. Over the next 3 years I
rode a roller coaster of recurrence and multiple surgeries, but I believed that
anything that gives you a chance to live another year, or another month, may mean
that a successful treatment could be developed by the time you need it.
I needed such a breakthrough in August 2008, when, to my horror, dozens of tumors
appeared in my abdomen. Although the scientists had not been able to grow my cells
for TIL therapy that first time in 2005, tumor tissue from my later surgeries allowed
them to succeed in 2008, and I was the first person to get a particular variation of
the TIL treatment at the National Cancer Institute. The researchers hoped this new
variation would be as successful as it had been in animal testing. But it had never
been tried in people.
One of the most moving moments for my family was the day the technicians brought
in the cells they had been lovingly growing for weeks, along with a card signed by all
of them wishing me health and luck. An amazing 84. 6 billion cells were infused back
into my body along with more IL- 2 (see Harnessing the Patient’s Immune System,
p. 59). My children, husband, and I did a little war dance around the I.V. pole. “Go
cells, GO,” I said to myself.
I was in the hospital for almost a month, and the treatment was very difficult. But by
March 2009, all of the tumors except one had disappeared. My doctor recommended
removing it surgically, so we did. The pathology report showed no live tumor cells.
We were ecstatic! It has now been 3 years since I received the TIL therapy, and I
continue to have no signs of cancer. The doctors are hopeful that the melanoma will
not recur. Although I have been fortunate, and this type of immunotherapy is a very
active area of research, it is not yet a typical treatment. It is currently being pursued
as a clinical trial at the National Cancer Institute and at The University of Texas MD
Anderson Cancer Center in Houston.
So what wisdom can I share from my experiences? Educate yourself about clinical
trials, because cancer science is evolving every day. Know all of your options before
proceeding. Become an advocate for yourself and others. And never give up hope.