January 6, 2011

New drug gets ‘personal’ with patient’s cancer

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Leora Horn, M.D., right, examines Paula Hart, who is taking part in the Personalized Cancer Medicine Initiative at Vanderbilt-Ingram Cancer Center. (photo by Joe Howell)

New drug gets ‘personal’ with patient’s cancer

Paula Hart was just 46 when she starting having shortness of breath, along with a nagging cough and intermittent pain in her left shoulder.

After a trip to the emergency room in her hometown of Evansville, Ind., and a series of additional tests, doctors finally diagnosed Hart with non-small cell lung cancer. The cancer was already advanced — stage IV.

“It was very shocking,” remembered Hart. “I was a recreational smoker. I never smoked full-time and shouldn't have smoked at all. But I also work with chemicals because I'm a hairdresser.”

No one could tell her what caused lung cancer in such a young woman with a limited smoking history.

Hart traveled to Barnes-Jewish Hospital in St. Louis, where she underwent four rounds of chemotherapy, and five more rounds of treatment with the drug Avastin, which cuts off the blood supply to tumors.

Eventually, doctors ran out of options and sent her back to Evansville, where she tried more chemotherapy. Nothing worked.

That's when she found out about the Personalized Cancer Medicine Initiative at Vanderbilt-Ingram Cancer Center, where doctors suggested that Hart have her tumor tested for a newly identified mutation in the anaplastic lymphoma kinase (ALK) gene. The mutation is present in only a small percentage of lung cancer patients.

To everyone's surprise, Hart's tumor was positive for the mutation, making her the first VICC patient eligible for a clinical trial of a new investigational drug called crizotinib. The drug targets the signaling protein encoded by the ALK gene, blocking its activity and causing tumor cells to die.

“Even though the ALK kinase mutation is rare, we are now routinely testing VICC patients with non-small cell lung cancer for the mutation because there are new drugs that appear to work in these patients,” said William Pao, M.D., Ph.D., director of Personalized Cancer Medicine.

“We're also testing tumors for other mutations so we can prioritize the most appropriate therapy for our patients.”

For the past seven months, Hart has been taking three pills twice a day and her symptoms have improved.

“Now that I'm on the new drug I'm going on with my usual life,” explained Hart.

“I get up and I have energy. I can stand on my feet for hours at work and my breathing when I'm going up and down these long halls at Vanderbilt is fine. I can do it like anybody else.”

So far, the only side effects have been occasional stomach distress and changes in her vision.

Every three weeks, Hart, sometimes accompanied by her 15-year-old son, Mason, travels to Vanderbilt for blood work or CT scans of her tumors.

VICC lung cancer expert Leora Horn, M.D., has seen encouraging signs.
The tumors show some shrinkage and there is no evidence that the cancer is advancing.

“Ms. Hart is fortunate to have this rare mutation in her tumor that makes her eligible to participate in this clinical trial,” said Horn, assistant professor of Medicine. “As more effective therapies for other known lung cancer mutations are discovered, we hope to offer these to patients, as well.”

Hart feels blessed to have a team dedicated to her disease and is committed to participating in clinical trials.

“I think Vanderbilt is amazing in what they're doing,” said Hart. “It's a whole different way of looking at cancer.”