The Case of Georgette – Squamous Cell Lung Cancer
Georgette was a 66 year old woman from British Columbia, Canada whom had recently been diagnosed with squamous cell carcinoma of the lung (SCLC). While she had been a pack a day smoker for a significant part of her life, she had quit many years ago.
Since her tumors were localized, her doctors decided to remove them. After surgery, Georgette was told that she was completely cured, and that no further follow up would be required. Her file was to be closed and that she was being released from her local cancer agency (BCCA).
This was concerning because a recent PET-CT performed a few months after her surgery had showed two potential tumors. Her doctors however, assured her it was more than likely due to residual inflammation from her surgery.
Georgette wasn’t ready to just accept this and so she reached out to us to ensure she was doing all that she could do.
How We Helped Georgette Using Our 5-Step System
1. Interim support/initial personalized research
First, we reviewed Georgette’s medical records and history. We noticed that Georgette had a very poor diet and lifestyle, so we created a healthy diet plan to reduce the growth of the cancer. We based this on human clinical trials and association studies that linked the intake of certain foods, to the survival rates for her type of lung cancer.
Interestingly, our research found a significant association between the intake and avoidance of specific foods leading to a significant reduction in the risk of SCLC and the progression of disease. These data were important because the protective benefit of these foods was only found for lung cancers in smokers and ex-smokers.
2. Introduced advanced diagnostics
We then obtained a sample of Georgette’s tumor tissue and sent it for tumor DNA sequencing. We looked for cancer causing mutations in the DNA of over 340 genes involved in lung and other cancers.
3. Interim Treatment Support
The results from Georgette’s tumor DNA sequencing results showed that she had an EGFR L858R mutation. This mutation is a negative prognostic feature and patients with this mutation have minimal response to chemotherapy.
However, this mutation allows for the use of EGFR targeting drugs such as tarceva. Patients that receive EGFR targeted drugs such as tarceva live about 2-3 times longer than patients receiving standard chemotherapy. Importantly, since this is a targeted drug, it has minimal side effects.
We immediately wrote up a patient report for Georgette’s public healthcare treatment team urging them to put her on this life saving drug.
Unfortunately, her doctors told her that this drug was not approved for her type and stage of lung cancer and that they would not be able to prescribe it for her until she was palliative and had advanced stage IV cancer.
We then asked her to contact an independent community oncologist near her home town that we had experience working with. Her community oncologist was able to prescribe Georgette tarceva and was also able to get her healthcare plan to cover the cost of the drug.
4. Monitoring During Treatment
In order to ensure that we knew the current status of her cancer and so that we had a way to measure the benefits of the tarceva, we performed a liquid biopsy to detect the level of her EGFR mutation prior to her treatment.
This liquid biopsy detects circulating tumor DNA (ctDNA), and measures the ratio of the mutated EGFR to the non-mutated EGFR genes in order to provide us with a rough idea of the actual amount of cancer cells in her body at a given time.
Since Georgette’s EGFR mutation was unique to her tumors cell, we could measure the amount of the EGFR mutation prior to and during her therapy to get an idea of the relative amount of tumor cells in his body. If the treatment worked, we would see a significant decrease in the percentage of the EGFR mutation from a sample of her blood.
Testing all of the body’s tumors at the same time using liquid biopsies is much more accurate way of determining responses to EGFR inhibitors than other methods such as radiographic imaging and other non-specific blood-based tumor markers such as CEA and 19-9, which are used by the public medical system. Plus, patients are not subjected to ionizing radiation as with CT and PET-CT scans.
Looking at a complete body-wide drug induced anti-tumor response is essential for determining how well the treatment is working.
Prior to her treatment, Georgettes EGFR levels were undetectable.
During the course of her treatment, a government funded PET-CT scan showed that there were still two remaining suspicious growths in her lungs.
PET-CT, which unlike other forms of medical imaging, is able to identify active tumors at a very small size, based on the biological activity of the tumor.
While most forms of imaging look at the density of the tumor and compare it to the surrounding tissues, PET-CT uses a harmless radioactive isotope that is bound to a sugar molecule.
Since tumor cells are constantly growing and therefore highly metabolic, they drink up more of the sugar-isotope solution than the surrounding tissues and any tumors will glow like Christmas tree lights.
Importantly, since only live tumors will drink the sugar-isotope solution, PET-CT can tell if a tumor is alive or if it has been affected (killed) by a specific treatment. No other form of imaging can reveal this essential information!
Furthermore, since the amount of the sugar-isotope solution a specific tumor drinks depends on how fast it is growing, a PET-CT can determine how aggressive a specific tumor is compared with other tumors in the body. This is referred to as the serum uptake value (SUV), and allow doctors to focus on the tumors that are most likely to metastasize.
Unfortunately, the PET-CT showed sites of very low SUV activity and while this could be indicative of a tumor, it was not conclusive.
Therefore, we performed another ctDNA liquid biopsy which also came back as negative, indicating that the PET-CT was most likely based on inflammation from her previous operation.
5. Clinical Trial Support and Advocacy
While Georgette remains stable on tarceva, recent studies identified that another EGFR targeting drug available at her local cancer agency called afatinib, was actually superior to the tarceva.
Our research uncovered the following data;
- Afatinib irreversibly binds to both EGFR and HER2, compared to tarceva, which is only a reversible inhibitor and that only binds to EGFR. This is important because dysregulation of Erb receptors such as HER2, play a role in SCLC progression.
- Afatinib given as the initial treatment significantly reduces the risk of progression by 27% compared with gefitinib. Furthermore, these improvement in PFS were found to be more pronounced over time, with a significantly higher proportion of patients alive and progression-free at 18 months (27% versus 15%; P = 0.018), and 24 months (18% versus 8%; P = 0.018) when compared to other EGFR inhibitors.
- Afatinib offers significant benefits as a 2nd line treatment in patients with SCLC that had progressed while taking tarceva. In these patients, treatment with afatinib reduced the risk of cancer progression by 19%, and reduced the risk of death by 19%, compared to tarceva.
- Importantly, further research confirmed afatinib was also associated with improvements in patient reported outcomes. Studies showed that more patients had improved overall health-related quality-of-life (36% versus 28%; p=0.041), reduced cough (43% versus 35%; p=0.029) and reduced shortness of breath (51% versus 44%; p=0.061), with afatinib than with erlotinib.
In other words, regardless if afatinib was given as the initial treatment or given after the patient received tarceva, the benefits were significant and the overall health and well-being of the patient was improved.
Currently, Georgette is still cancer free and taking tarceva almost 3 years since her initial diagnosis. Unfortunately, BCCA will not provide Georgette with the new and improved EGFR inhibitor afatinib unless her disease progresses. However, she can pay out of pocket if she so chooses to do so.
Furthermore, when tarceva and or afatinib stop working, she has a variety of other targeted therapies that have the potential of providing her with more time, without the damaging side effects of standard chemotherapy.
As you can see, CTOAM’s advanced diagnostics , records review and consultations can result in significant benefits to a patient’s outcome. Having access to a team of knowledgeable scientists, doctors and patient advocates that WORK FOR YOU and NOT THE MEDICAL SYSTEM, can make all the difference in the outcome of your disease!
If you or a loved one is fighting cancer, give us a call so we can do a brief review of your medical records. It is important to be sure that you KNOW that you are doing all you can, and that you have access to the best treatments for your own unique case.
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