‘I’m cancer free!’ How a diagnosis of stage 4 cancer is no longer a death sentence
Nanita Edwards of Fort Lauderdale got the shock of her life last year.
Edwards, who had prided herself on never missing work, went to urgent care because she had some “pain in her backside.” She was sent immediately to the hospital and diagnosed with Stage IV ovarian cancer.
“I was told it was too advanced. I had maybe six months to a year to live and that there was nothing they could do,” Edwards recalled.
That was in July. In November, a palliative care doctor referred Edwards to Dr. Scott Jordan, a gynecologist/oncologist with Broward Health. By that time, she was too weak for surgery.
“First off, we never write off ovarian cancer patients because approximately 80 percent of the time, they respond to treatment. Even in really advanced disease, giving chemotherapy makes patients so much better and stronger, sometimes even in the intensive care unit, and then we can go back and look and see if they’re a surgical candidate,” Jordan said.
That’s what happened with Edwards. After three cycles of chemo, she “had put on about 20 pounds and had vastly improved her activity level” and was able to withstand extensive surgery, Jordan said.
“It was long-standing dogma until five to 10 years ago to first do surgery, then chemo. Increasingly, data has shown that it’s at least as good to start with chemo, especially if you have a frail patient, and then go for a smaller surgery” because the tumors will have shriveled, Jordan said.
In Edwards’ case, cancer had spread throughout her abdomen. Jordan had to remove Edwards’ reproductive organs, her appendix, the area connecting the stomach with other abdominal organs, known as the ommentum, part of her colon and some enlarged lymph nodes.
Doctors also had to ablate, or burn off, a lot of small tumors implanted throughout her abdomen and pelvis.
“Additionally, she had the BRCA-2, a hereditary gene mutation that puts her in a camp of patients who respond even better to chemotherapy and who will respond very well with a maintenance treatment after therapy, an oral medication called a PARP inhibitor,” trade-named Lynparza. “It works especially well in someone who developed their cancer due to missing one of the BRCA genes. Ms. Edwards was also in that category,” Jordan said.
Edwards is now cancer free. “Based on data published in 2019, she has over a 50 percent chance of being disease free after three years and it potentially never reoccurring,” Jordan said.
“I’m cancer free, cancer free, cancer free,” Edwards said.
Changes in pancreatic cancer treatment
“Twenty or 25 years ago, pancreatic cancer was probably the most lethal,” said Dr. Mike Cusnir, co-director of gastrointestinal malignancies at Mount Sinai Medical Center in Miami Beach. “At that time, we used to say that the patient has such a poor prognosis, why do we make them sick [with treatment]?
“What has changed is we have gone in the opposite direction to give patients the most aggressive therapies, super treatments that are innovative with a lot of different drugs, and what we’ve seen is that we can extend the life of the patient.”
Added Dr. Kfir Ben-David, chairman of surgery at Mount Sinai, “The whole point of treating cancer is to get rid of it.”
When treating pancreatic cancer, the two Mount Sinai doctors are increasingly turning to immunotherapy, which unleashes the immune system of the patient’s own body to fight the cancer cells.
Ben-David and his team also remove diseased parts of the pancreas “with minimally invasive surgery using a small instrument the size of your pen to go through the abdomen to remove lymph nodes and cut out cancer. We are now able to put things back together through these small incisions,” Ben-David said.
New treatments for blood cancers
One of the areas where doctors have more treatments at their disposal is in blood cancers.
“It’s never a great thing to have a cancer diagnosis, but it is comforting to know we have so many cancer therapies available,” said Dr. Mikkael Sekeres, who specializes in leukemia and related bone marrow disorders in older adults. He is chief of the division of hematology at Sylvester Comprehensive Cancer Center at the University of Miami.
“We’ve had a number of innovations in treatment of blood and bone marrow cancers over the last decade. As a result, we have seen a tsunami of approvals by the FDA.
“Some of the most exciting inroads have been the immunotherapy approach using drugs that harness the power of the immune system to attack cancer. Some of these drugs are referred to as checkpoint inhibitors and they have particular efficiencies in lymphoma,” Sekeres said.
Certain cancers no longer a death sentence
Sekeres is optimistic about the future and how certain cancers will no longer be a death sentence.
“I think we’ll increasingly see people live longer and blood and bone marrow cancers managed like chronic disease. Already in the past 40 years, if you look at the survival for leukemia, it’s doubled. I think we will continue to see that trend.
“On a personal note, my grandmother, who lived in Delray Beach, when she was diagnosed with leukemia in 1980s, it was a death sentence. She did, in fact, die within 10 months.
“Nowadays, it’s no longer a death sentence. It’s something we can treat,” Sekeres said.
Carolyn Allen of Oakland Park is one of those grateful cancer survivors. “I went from Stage IV to Stage 0 in a year,” Allen said.
In February of last year, she went to her doctor because she was having trouble with her eyesight and was getting confused. An MRI found a tumor in her brain.
“They put me in the hospital that very day and did the surgery on Saturday. They told me my brain cancer was from another part of my body.”
They found lung cancer, Allen remembered.
Immunotherapy making a difference
Allen’s oncologist, Dr. Mehmet Hepgur of Broward Health, put her on a regimen of chemotherapy and immunotherapy for three months. She’s now on immunotherapy for another year.
“In the past the only treatment of lung cancer stage IV was chemotherapy. Now we have a combo approach,” Hepgur said.
“She has no active cancer. I do anticipate she may remain cancer free for the rest of her life,” Hepgur said.
“Based on CDC data from 1999 to 2019, cancer death rates dropped 27 percent all across the board,” Hepgur said. “In my opinion, immunotherapy is part of the improvement,” he added.
Said Jordan, the oncologist who treated Edwards’ ovarian cancer, “We’re going to a direction of personalized medicine, testing the genes you are born with and also the genes in the tumor to guide our therapy and target with a targeted agent.”
Added Cusnir, “Until we cure 100 percent of our patients, we’re not going to stop studying every single permutation.”