Journey to Cancer Survivorship

Journey to Cancer Survivorship


– Hello and welcome to another
Facebook live broadcast with MedStar Health. My name is Dr. Louis Weiner. I’m director of the MedStar
Georgetown Cancer Institute and the Georgetown Lombardi
Comprehensive Cancer Center. And I’m here today with Diane Tippet who I had the privilege of
treating several years ago for a rare metastatic
neuroendocrine tumor. I’m really excited about today’s broadcast because we’re gonna be discussing a very important topic, cancer survivorship. Sunday was National Cancer Survivors Day and June is National
Cancer Survivors Month. Fortunately, more than
two-thirds of all cancer patients are now surviving their cancers; however, they face a
multitude of aftershocks, problems that are associated with either having had the cancer or problems associated with the treatments that they received. These can last for months
or years after treatment. Diane’s gonna share her
inspirational story with us today. At the MedStar Georgetown
Cancer Institute, we are able to offer our patients tomorrow’s treatments today
because our research engine, the Georgetown Lombardi
Comprehensive Cancer Center, is the only NCI-designated
comprehensive cancer center in the Washington region. And NCI stands for
National Cancer Institute. Through our partnership,
we provide greater access to life-saving clinical
trials and technologies closer to where our patients live and work since our network of hospitals is able to combine medical
expertise, the latest therapies, and research screening,
prevention, diagnosis, personalized treatment, rehabilitation, and survivorship programs. And most importantly, we
can offer our patients hope because we are all about
giving our patients research-inspired cancer care. So stick around. And since this broadcast is live, share it with your friends. And please, ask us
questions and comments below after we’re done. So, Diane, can you tell us your story about how you came to meet me and the journey you took
before you got here? – Sure. Probably December of 2013, I noticed a small bump in my mouth. Ended up finding out that it was stage 1
neuroendocrine carcinoma. After surgery and treatment, which was basically 30
radiation treatments five days a week for six weeks, which was kind of hard, got through that, I was cleared. And then I ended up here and I was doing my every
6 months screening, and in June of 2016, I
was diagnosed with stage 4 neuroendocrine cancer. At the time, my oncologist
didn’t know a lot about it, so he sent me to Dr. Weiner
and I’m so glad he did. So, I came up here, met with Dr. Weiner, and he approached this
completely different. And I wish he would explain it because he’s much better at it. – Well, I think you did a pretty good job. So, when I first saw Diane, she had experienced the
spread of her cancer to her liver and to her
lungs, metastatic disease. And this was a tumor that was very hard to
characterize and understand. And the toolbox available to oncologists of approved and effective treatments for this kind of
situation was pretty bare. So I did what any good doctor working in a comprehensive
cancer center environment would do. I turned to the science and I said, “What can I learn
about my patient’s disease “that can help define
how I should treat her?” So, what we did is we took a sample of her tumor biopsy from her original biopsy and sent it to the KRAS
Precision Oncology Network for an analysis of the tumor to figure out what were the mutations and other genetic and
molecular abnormalities that might give us a hint as to what was turning this cancer on and that might be a target
for a cancer therapy. And I honestly didn’t know
what we were going to find, nor did I know whether or not whatever we found would be
useful and helpful to Diane. But I knew that we had to try. So, we sat down and I told Diane, “Listen, I want to send your
tumor out for this analysis, “and let’s see what happens.” And so Diane, how did that make you feel? – I was thrilled by it, honestly. Radiation or chemotherapy was not something that I
wanted to go through again. So, when he told me that, I remember walking down
and telling my husband now that that was exactly
what I wanted to hear. I wanted to hear something other than the standard cancer treatment which can have very harmful effects. – So, a few weeks later, I get the report back
about what we had found. And what we learned is that her tumor had an unusually high
tumor mutational burden and it expressed a lot of
a molecule called, “PD-L1”. Now, PD-L1 is erected as
a defense that cancers use to avoid being killed by
the body’s immune system. And a high mutation burden suggests that this tumor actually
had a lot of abnormalities that the body’s immune system might see and recognized as being
foreign and want to attack. Armed with that information, I knew that we had to
try a new class of drugs called, “checkpoint antibodies”, immune checkpoint antibodies, that would block the
ability of the tumor cells to put the killer cells of
the immune system to sleep. And so, I called up Diane and I said, “This is what we think we can do”. And then we raced against time to try and find a way to get the treatment supported by her insurance company and to arrange for her
to get her treatment not here at Georgetown, but actually out in Eastern Maryland, Southern Maryland, where she lives. So that she could get her
treatments closer to home by one of the members of our MedStar Georgetown Cancer Institute. And that’s what we did. And once that had been arranged, I basically told Diane, “I
will see you in three months.” Now, I didn’t know whether
I would ever see her again because she had a bad cancer and I didn’t know what
was going to happen. And so, three months went by and she scheduled to come to see me and I get a telephone call from her. Do you remember what you told me? – I don’t, actually. I wish I do. – What she said was I
don’t want to come in. And I’m thinking to myself,
“Oh, she’s not doing well.” And she says, “I feel great. “My doctor says my cancer’s
doing fantasticly well “and I don’t see why I need to come in. “It’s winter time and I don’t
want to make that long drive.” Now, understand that I spent some of my years of medical training in Northern New England, and so I’m used to some real snow. There is no snow in Maryland, okay? So, none the less, I said, “You gotta come in. “I need to know how you’re doing. “I want to see how you’re
doing with your side effects “and I want to take a
look at your CAT scans.” And she said, “I don’t want to come in.” (laughs) So, what happened was we cut a deal. The deal was she said she
would come back in two months. – Okay. – With a repeat CAT scan. And I said, “And when we do, we’ll do
a victory dance together.” – Yes. – Do you remember what happened then? – I came in and we
looked at the CAT scans, and it was amazing. What was it? The liver was shrunken by 50%? – Yep. – It just was a thrilling moment and we definitely did the victory dance. – We did a victory dance and it was a marvelous
moment for Diane and for me because it was one of those
few moments in a doctor’s life where you can say, “I really made a big
difference in this patient. “Maybe another doctor
wouldn’t have done it.” And it made me feel good. And to be able to help anybody, especially somebody as wonderful as Diane, was a real privilege. So, this is the power
of molecular profiling, of using science to understand what’s going on with the cancer and leverage that information, turning that information into knowledge, that knowledge into power, a
power that can cure people. Diane’s tumor had reduced by more than 50% when I saw her that March, six months after we had originally met. And here she is now, two
and a half years later, and as best as we can
tell, her cancer is gone. It’s just gone. And she’s doing great. Tell us about your side effects. What were your side effects? – I didn’t really suffer any side effects. After the initial dosage,
I had a small little rash that my oncologist at MedStar St. Mary’s prescribed Prednisone for. Two days of that and that was gone. And then I never suffered
another side effect from this. I always felt great. I mean, I worked. I did everything. – Mm-hm, yeah. So, as a doctor, as an oncologist, I live for moments like this. I dreamed that this could happen. And the important message is that while it can’t
happen for everybody yet, we’re making progress. More people are doing well. More people are surviving cancer. And were able to accomplish this sometimes with side effects
that are more severe, sometimes without such
severe side effects, and it’s thrilling to be a
part of this new revolution in the way we treat cancer
using immunotherapy. So, there are now 15 and
a half million survivors of cancer in the United States. So, dealing with the
aftershocks is really important. And cancer survivorship, what we’re talking about this month, is really an emerging scientific
and clinical discipline because many oncologists
and many primary doctors really don’t know how to
take care of a patient who’s received cancer therapies. They don’t understand
what to be worrying about in terms of cancer recurrence, what to look for in terms of side effects that might be long-term. There might be peculiar side effects that they don’t ordinarily
see in their practice. And so we’re working on
trying to develop this. And at MedStar Health, through the MedStar
Georgetown Cancer Institute, we’ve created a whole suite of services for our cancer survivors to assure that nobody gets left behind. You may have heard previously about our cancer survivorship program in cardio oncology where people who have had potentially heart-damaging treatments can be screened to make
sure that they’re getting the right care and the right interventions when they need it, as an example. So research-inspired cancer care includes cancer survivorship. And it’s just a privilege
to be living at a time and working at a time
where this can happen. So, Diane, what can you tell us? What are your hopes and
dreams for the future and what do you want to tell our audience as a lasting message
from today’s discussion? – I think that people should look into the new science of diagnosing
or treating cancer. Obviously, it worked for me and I’m very privileged that it did. Make sure… just never give up. You’ve got to keep trying. You can do it, it can be done. I’m proof and I’m very happy to be proof. – We’re happy you are, too. – I am. – Thank you so much, Diane,
– No problem. – for being a continuing
inspiration to all of us. – I’ll be back next year. – Okay, that’s great. So, I am told that we
may have some questions. The first question I have is to tell us more about immunotherapy. So, immunotherapy is different
than conventional treatments. For example, surgery removes a cancer. Radiation and chemotherapy are designed to kill
cancer cells directly. They don’t require the support of the body to kill the cancer cells. The drugs or the radiation kill directly. And one of the side
effects of these treatments is that sometimes the normal
cells get killed as well, and that’s why people have side effects. Immunotherapy has been defined as treating the body’s immune system, so that the immune system
will take care of the cancer. It turns out that every cancer
that grows in somebody’s body has solved the riddle posed
by that body’s immune system to evade recognition and
destruction by the immune system. So, these tools that the cancers use to defend themselves against immune attack are paradoxically the Achilles heels that we can use to attack the cancers. So, Diane received an
antibody, known as Nivolumab, which targets the pd-1 immune checkpoint. And pd-1 binds to, attaches to, a target on the cancer
cell surface called PD-L1 which was the molecule
that Diane’s tumor made. And when those two molecules kissed, the cancer cell puts the T cells to sleep. And what Nivolumab does, it
essentially blocks the kiss. It allows the T cells to stay active so that they can do their job
of killing the cancer cell. And once you stimulate this, once you remind the body’s immune system that there’s a cancer there and that it doesn’t belong there and that it should start
doing something about it, the immune system does a great job. And Diane is living proof of that. There are other kinds of immunotherapy, many other antibodies that target different kinds
of immune checkpoints. Doctor Jim Allison, a good friend of mine, won the Nobel Prize this past year for having discovered the
original immune checkpoint called, “CTLA-4”. And antibodies directed against CTLA-4 are sometimes combined with
antibodies against PD-1 in certain kinds of diseases. And those combined therapies have transformed cancer
care for certain diseases such as melanoma, a malignant disease, kind of a skin cancer. So, in addition to that, there’s a lot of work being
done with cancer vaccines and they’re showing some promise. And perhaps most significantly, there’s a whole new form
of immunotherapy treatments that have been developed
called, “CAR T Cells”, where you take a person’s T cells, you genetically manipulate
it so the T cell is now programmed to attack the cancer that’s growing in that person’s body, and you inject that T cell
into the person’s bloodstream and that T cell goes and does its job. And it has had remarkable
and transformative effects in the treatment of children
with acute lymphocytic leukemia and in other adult patients with other kinds of blood cancers. And that and related kinds of approaches, promise to further transform the field of cancer care
and cancer research. Other questions, in what other cancers is
immunotherapy working? So, one of the interesting
things about immunotherapy is that when it works,
it really works well. People who go into
remission stay in remission more often than not, it seems. And that’s very very encouraging because typically with chemotherapy
for metastatic disease, it can work and it can
work at a high rate. But unfortunately, relapses
are rather frequent. So, the answer is that while
the treatments can work and when they work they
can work very well. For most cancers, there are
probably 25 different cancers where are we now have evidence
of immunotherapy working, notably melanoma which I
described, Hodgkin’s disease, non-small cell lung cancer,
some breast cancers, bladder cancer, head and
neck cancer, you name it. We’re seeing remarkable
benefits of immunotherapy in all of those diseases. More often than not, in a minority of the
patients who are treated. And we still don’t quite know how to pick the winners in terms of matching the patient to the treatment that
they need to receive, and that’s a subject of ongoing research in clinical trials and laboratory science. But it can really work very well. So there’s an awful lot
of exciting new work being done in the field of immunotherapy. It doesn’t work for
everyone, it’s not a Panacea, but, boy, when it works,
does it make a difference. Another question, if a patient is getting
chemo or targeted therapy but not immunotherapy, are they not getting the best treatment? That’s a great question? Every person with a cancer is a unique puzzle to the treating doctor, and the correct solution to the puzzle differs for each person. For some people, immunotherapy
is the right thing to do and you shouldn’t do anything else. For other people, targeted
therapy or chemotherapy is the right thing to do. And for some people, a combination of targeted
therapy and immunotherapy is the right thing to do. We just had our annual ASCO meeting, the American Society of
Clinical Oncology meeting. And I attended a session
where a speaker noted there were 970 new immunotherapy compounds in clinical trials at this moment. And he did the mathematics of saying, “How many two and three-drug “combinations possibilities are there?” and I think there’s something like 138 million three-drug
combinations that are possible when you have 170 new agents. And that doesn’t include changing the sequence in
which you give these drugs or combining it with conventional drugs. So there’s literally hundreds of millions, if not billions, of possibilities of how we can move forward. We obviously can’t test
each one of those in people, so we have to use science
to help us identify what the best and most likely
combinations are gonna be; and that’s how we’re moving forward now. But at the end of the day, the right treatment for the
right person at the right time is what we’re after, and we call that,
“precision cancer medicine”. And immunotherapy represents one of the most elegant and simple ways of thinking about
precision cancer medicine because it’s targeting the abnormalities from the cancer that the
immune system wants to attack. One other question, can I explain why an NCI-designation is important for patients? That’s a great question also. There are 50 National
Cancer Institute designated comprehensive cancer centers. We received our initial NCI designation here at Georgetown Lombardi in
1974, one of the first ones. This designation is kind of like a Good Housekeeping seal of approval from the National Cancer Institute. It’s a way of telling doctors,
scientists, and patients, that this is the place
where the work gets done. I often ask the question, do I want to be treated by a
doctor who read the articles or the one who wrote them? And I always want to be at the place where the doctors who wrote
them are giving the care because they’re the innovators. They’re the ones who are working together in large comprehensive teams leveraging science in the
interest of our patients, providing the most
outstanding new therapies, things like proton therapy, like novel immunotherapies,
novel targeted therapies, overcoming resistance
mechanisms through science. That’s what National
Cancer Institute designated comprehensive cancer centers do. And the other thing we do, we are expected and it is required that we reach out into our communities to make sure that the people
who live in our regions are benefiting from the work that we do, that our work is designed
to help the people who we are responsible for. And we do that. We establish things like the MedStar
Georgetown Cancer Institute to make sure that our patients, wherever they live in our region, have access to
research-inspired cancer care. We focus our research
on the unique problems that exist in a particular area. For example, the DC metropolitan area has a large number of
underserved minority patients who need our attention and need our help, and we are expected to and
gladly take up the challenge of developing strategies to
help our neediest patients. That’s what we’re about. And there don’t seem to
be any other questions. So, with that, I want to
thank you again, Diane. – Thank you. – For being this ongoing
inspiration for us and for letting us know how
important the work we do is because when we’re doing it right, we see the living proof that we’re heading in the right direction. – Yes. – And it makes it a heck of a lot easier to get up in the morning to come to work when we know that the work
we’re doing makes a difference. Thank you.
– I’m sure and thank you. – And thank you all for tuning in.