In January 2021, Ann Rich was eight years into her cancer journey when her lung cancer came back. By April, she couldn’t walk five feet without gasping for air. She said she felt like a prisoner in her own home, unable to walk far enough to even check the mail.
Ann had already undergone surgery, chemotherapy and radiation after her initial diagnosis in 2013 and then after her first recurrence in 2018. Unfortunately when her cancer relapsed standard medications were ineffective.
Her oncologist, Dan Haggstrom, MD, fought to find the right treatment for Ann. To do so, he had her undergo repeat biopsy to allow her cancer to undergo genomic sequencing. On completion the testing revealed that her tumor possessed an NRG1 mutation, a very rare mutation found in fewer than 1% of lung cancer patients. Identifying that mutation opened up a new option for Ann, making her eligible for a clinical trial at Atrium Health Levine Cancer Institute for a new drug designed precisely to fight the NRG1 mutation.
“Levine Cancer Institute has long championed clinical trials for targeted therapies, that match patient to medication. When we sent Ann’s sequencing testing and found this mutation, we learned that she was a perfect match for a clinical trial for a new drug, so it was an ideal situation,” Dr. Haggstrom says.
After two months of treatment in this clinical trial, scans revealed that Ann’s tumors had reduced size significantly. She also regained strength in her lungs, allowing her to walk without losing her breath or without the help of an oxygen tank.
“I still have stage 4 lung cancer, but it's manageable because the tumors have shrunk and they're not moving as long as I get this medication,” Ann says. “This clinical trial saved my life.”
Targeting the Right Treatment to the Right Patient
Genetic sequencing has spurred major innovations in lung cancer care over the past decade. It’s no longer about treating cancer; it’s about treating a specific type of tumor. Expanding diagnostics can now identify genetic mutations present in tumors, which doctors can then match therapies developed to target those mutations. The more targeted these therapies have become, the more effective the treatments provided and potentially fewer side effects for patients as well.
The identification of Ann’s NRG1 mutation was enough to tell her care team more information about the cancer they were fighting and how best to fight it.
“With Ann’s tumor having the NRG1 fusion mutation, we learned that when the cells divided, a protein was made incorrectly and it stayed on all the time. And because it's on all the time, it produces a message to the cell to grow, grow, grow, and it doesn't learn to stop growing,” says Daniel Carrizosa, MD MS, the Medical Director for Disparities and Outreach at Levine Cancer Institute. “Finding a drug that could turn off the NRG1 would give us hope to prevent this cancer from growing. And that is what we're seeing in Ann.”
Receiving Emerging Treatments in Clinical Trials
With the pace of new advancements in lung cancer care, new drugs continually emerge. For someone like Ann, whose cancer no longer responded to approved treatments, a clinical trial provided a much needed option. Such trials can give a patient access to an emerging drug that hadn’t yet completed the approval process but has shown great promise. Clinical trials can be for any type of cancer and at any stage, and Levine Cancer Institute has over 20 clinical trials for lung cancer alone.
“Clinical trials are hugely important because they provide our drugs of the future,” Dr. Carrizosa says. “More importantly, people like Ann are also our future because they not only think of themselves, but they think of the possibilities of helping other people with cancer. Therefore, they can make things better.”
Patients enrolled in clinical trials have a team of support behind them. Dr. Haggstrom was there to guide Ann through her treatments, and Dr. Carrizosa made sure that the rules and regulations of the clinical trial were met, while coordinating with and updating the pharmaceutical company behind the trial.
Ann encourages other cancer patients to consider a clinical trial if they are a match for one, and she offers advice for others on what to consider as they weigh their options.
“For others considering a clinical trial, I would encourage them to ask a lot of questions of their doctor, like, ‘Why am I enrolled in this clinical trial? Do I have the right markers to be in this trial? Is it focused on what I have? Are there any others that fit my criteria better?’” Ann says. “Before this clinical trial, I tried a different medicine for two months and it didn't work, but I've done absolutely wonderfully with this one. I couldn't have done any better than I have with this clinical trial.”
Creating More Hope and Better Outcomes for Lung Cancer Patients
During the 14 years that Dr. Carrizosa has practiced medicine after his fellowship, he says he’s seen incredible advancements in the field of lung cancer care. And now, he sees the progression of lung cancer toward becoming a chronic disease, something that requires ongoing treatment, that people can live with long-term. This momentum inspires him in his work to continue to match patients with the treatment most effective for them.
“Anybody can get lung cancer, no matter what they look like, where they live and who they are,” Dr. Carrizosa says. “We need to be able to support them by finding new medicines through research and by just being there for them.”
Learn more about lung cancer care at Atrium Health Levine Cancer Institute.
