Eight years ago, Dian Corneliussen-James
had surgeons cut out half of her right lung, a risky procedure she believes
saved her life.
Though she thinks the
surgery saved her from death from metastatic breast cancer,
which had spread to her lung, she said she is "terrified to go off"
the drug, Faslodex, that doctors say could be keeping her alive.
Her survival has prompted
doctors and others to call her and patients with metastaticbreast cancer like
her "outliers" because they don't know why some patients with the
incurable disease live a long time. Some say the answer to a longer life with
metastaticbreast cancer lies
in targeted treatments, such as Faslodex, a drug designed to treat the cancer
in women after menopause.
Metastatic, or stage
IV, breast cancer is
cancer that has spread to another organ. The median life expectancy of someone
with metastatic breast cancer is
26 months, said Dr. Katherine Tkaczuk, professor of medicine and director of
the breast evaluation and treatment program at the University of Maryland
Cancer Center. About 155,000 Americans are living with metastatic breast cancer,
and about 40,000 patients die annually in the United States, according to the
Metastatic Breast Cancer Network.
A change of pace from
chemotherapy, which targets all dividing cells in the body, such targeted
treatments home in on just cancer cells, said Dr. Robert Donegan, a medical
oncologist at Greater Baltimore Medical Center.
Targeted treatments were
used first in the 1970s and, in some patients today, they are believed to
control metastatic disease so it becomes more like a chronic illness than a
fast-moving deadly one, Donegan said.
Targeted treatments have
fewer side effects than chemotherapy and help patients maintain their quality
of life, he said.
Corneliussen-James, who
was diagnosed with HER-2 negative breast cancer in
2006, is beating the odds with injections of Faslodex every 28 days. She goes
to her Johns Hopkins doctors from her Annapolis home to get the injections,
which produce few side effects.
Though her doctors have
offered the option, Corneliussen-James isn't willing to forgo the drug.
"It doesn't negatively impact my quality of life," she said.
Going off it could have
grave results. The drug appears to suppress the cancer and discourage it from
reactivating, placing Corneliussen-James in a "remission" of sorts.
"We don't know if
the cells are just dormant on their own or because of the drug," she said.
Marlene King, a friend of
Corneliussen-James' and fellow member of Metavivor, an advocacy and support
group Corneliussen-James founded with other survivors of the stage IV cancer,
has had a different experience with targeted treatment.
She was diagnosed
with breast cancer in
2008, and was told it had spread, or metastasized, in 2012. King went off
treatment for the cancer in May, after trying several treatments that each
worked for a few months and then stopped working, she said.
King decided in May that
she didn't want any more drugs, at least for the time being. Her health wasn't
great and her stomach and body couldn't handle the drugs.
"I decided it would
be nice to take a break for a while," she said.
After a scan in July, her
doctors told her there didn't seem to be any major growth of her tumors.
Pending results of another scan at the end of September, she said, she will
decide whether to continue her break.
While targeted treatments
haven't worked for King, there is hope that with targeted therapies, the
disease will begin to act more like a chronic illness, Donegan said.
"There's no
guarantee," he said. "We need to clinically study. ... We really need
good evidence and science to know drugs are going to work in less common
genetic abnormalities."
Research on HER-2
positive breast cancer,
a type 20 percent to 25 percent of patients with metastatic breast cancer have,
is producing new and better drugs. Because so many exist, Donegan tells his
patients diagnosed with HER-2 positive that it's possible the cancer can be
managed to more like a chronic illness with the right drug.
Patients with HER-2
positive "live sometimes years," said Dr. George Raptis, associate
chief of oncology and hematology at North Shore-LIJ Health System in New York.
"We had never seen that in the past."
Raptis had a patient who
lived 18 years with metastatic breast cancer before
dying in 2012. Raptis said that that particular patient benefited from multiple
therapies and that the biology of her cancer was sensitive.
Though some types of
metastatic breast cancer have
relatively successful targeted therapies, much work remains to be done, Donegan
said.
"We'll ideally
develop medicine that can target those less common types of breast cancer,"
he said.
There's room for the
development of more therapies, which may mean looking more closely at the
biology of cancer cells. Now, developing targeted therapies means finding ways
to deny a fuel source that causes the cancer to grow and spread, Donegan said.
Doctors emphasize that
the women who survive longer remain outliers. Even with targeted drugs such as
Herceptin for HER-2 positive breast cancer,
some patients respond to the treatment and some don't.
Tkaczuk gives her
patients, some of whom have lived for years after diagnosis, different targeted
treatments.
While many patients are
not ready to deal with the diagnosis, she said, "the main misconception is
that someone with metastatic disease is going to die right away."
That's not how Tkaczuk's
patient Dianne Harrod reacted when she was diagnosed with stage IV cancer that
had spread to her lungs in 2009.
"I said, 'What are
we going to do about it?'" said Harrod, 65, who credits her positive
attitude and her diet for her survival. "It's what you eat and what you do
and don't feel sorry for yourself."
Since she was diagnosed,
she's done a lot of targeted therapy, which she said "kind of keeps [the
cancer] under control."
"I expect to live a
long time," she said. "I just can't go out like that, you know, dying
from breast cancer."
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