Why Doctors Are Trying A Skin Cancer Drug To Treat A Brain Tumor
MaryAnn Anselmo feared for the worst when she was diagnosed with a brain tumor called a glioblastoma in late 2013.
"You start doing research on that type of tumor, and you're saying, 'Oh my God, you're history.' It's like a death sentence," says, Anselmo, now 59.
Only for her it wasn't.
Anselmo's successful treatment shows how precision medicine — tailoring therapy to each patient's genetic needs — is beginning to transform cancer care.
At first, the outlook seemed grim. Although Anselmo's surgeon was able to surgically remove most of her tumor, she couldn't tolerate traditional chemotherapy that was the planned second step, and had to discontinue it.
Find other stories in the Living Cancer series at WNYC.org.
The chemo failure was the latest in a string of personal setbacks.
The year before she was diagnosed with brain cancer, she'd lost her son to suicide. Weeks after that she was almost killed in a car crash outside a local mall. Her cancer was discovered after she had a dizzy spell, and her husband, Joseph, insisted she return to the hospital to have it checked out.
After all that, Anselmo and her husband weren't ready to give up on her cancer fight. He'd read about advances in targeted therapies — drugs that go after cancer cells at the molecular level.
The family sent samples of her tumor samples for genetic testing to several leading cancer hospitals. Memorial Sloan Kettering Cancer Center, where she was being treated, also did its own sequencing. They all found the same thing. Anselmo's tumor had a BRAF mutation common in skin cancer, but very unusual for a brain tumor.
Her oncologist, David Hyman at Memorial Sloan Kettering, enrolled Anselmo into a new kind of drug trial. Called a basket trial, the study is designed to include people whose tumors have the same kind of genetic fingerprint regardless of where in the body the tumors are found.
Knowing more about the genetic mutations of a tumor enables doctors to find a potentially effective drug much more quickly and accurately. "It's like you're in a parking lot," Hyman says. "And you have a key to one of the cars in the parking lot. And so one option is just to go to each car and try to open the lock. The other is to know that it's the third car on the right. What we're doing now is we're saying, OK, this key fits that lock. And we're only going straight to that car."
When MaryAnn Anselmo sings jazz, her stage name is Mariel Larsen.
Today, Anselmo is doing well. She's been in the clinical trial for a year now, and continues to take Zelboraf (or vemurafenib generically) daily. The pills have kept her cancer from growing.
There are side effects, of course. She's lost some peripheral vision, though she's been able to compensate. And Zelboraf is expensive, though it's free to Anselmo because she's taking it as part of a study.
Now she can focus again on the things she loves, like singing. Anselmo, a jazz singer who performed under the stage name Mariel Larsen before her illness, is planning a comeback. She's back in training with her longtime vocal coach.
As this kind of genetic sequencing of tumors has become faster and cheaper, more patients have access to this technology. More doctors are taking advantage of the information to treat patients with a targeted approach.
"We took a disease where nothing really works for any length of time and we've given her a year of life, and hopefully much more, where she's been much better," Hyman, her oncologist, says.
Still, he cautions that the targeted treatments can't be considered cures. At some point the drug that is keeping Anselmo's cancer at bay could stop working. "Every patient is different in how long it works," he says. "We all have patients that have been on these drugs for years. But I don't know, I mean, I think if I was being honest eventually our expectation would be that it would stop working."
There's no way to predict when. But in the meantime, patients like Anselmo are grateful to have time they wouldn't have had otherwise.
After all the misfortunes she's been through, it would be easy to think Anselmo has been incredibly unlucky. But she doesn't see it that way. No, she says after rehearsing for her comeback show, "I'm the luckiest."
Our series is produced with member station WNYC, and with Ken Burns Presents: Cancer: The Emperor of All Maladies, which will air on PBS starting March 30. Check your local listings for broadcast times.
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Transcript
STEVE INSKEEP, HOST:
Precision medicine - finding the right treatment for an individual's unique illness is changing the way we treat cancer. Doctors are now using genetic sequencing to match patients to drugs quickly. As part of our series Living Cancer produced with our member station WNYC, we now learn of one woman whose life has been dramatically improved by innovations in genetic testing for cancer. Here's reporter Amanda Aronczyk.
AMANDA ARONCZYK, BYLINE: On January 28, 2012, MaryAnn Anselmo had a gig at Chico's House of Jazz in New Jersey.
(SOUNDBITE OF JAZZ PERFORMANCE)
UNIDENTIFIED MAN: You're in for a treat.
ARONCZYK: She were a short, black dress, and her red hair straight and long. She's a beautiful woman in her fifties. Almost immediately after this night, everything unravels. It's the sort of story that's difficult to believe. It's just so bad. First, MaryAnn Anselmo's son committed suicide. Then weeks later, she was out running errands with her father. As they left the mall, she drove her Jeep up to the exit.
MARYANN ANSELMO: And all the sudden, some man lost control of his car. He jumped the curb and hit my side, doing 55 miles an hour.
ARONCZYK: She had to be medevac'd to a hospital. She had two collapsed lungs, a shattered pelvis and several broken ribs. The doctors put her back together. And after that, her husband became extra vigilant about her health. When she felt dizzy one afternoon, he insisted she go back to the doctor. And that's when they found a brain tumor the size of a ping-pong ball - a glioblastoma.
M. ANSELMO: You start doing some research on that type of tumor, and you're saying, oh, my God, you're history. It's like a death sentence.
ARONCZYK: Within weeks of finding it, MaryAnn Anselmo underwent surgery to have it removed. Through all of this, Joseph Anselmo has been her medical advisor, her driver, her chef and her husband. He said that the next stage in her treatment did not go as well.
JOSEPH ANSELMO: Her body didn't - it rejected the chemo. And so they had to stop the chemo.
ARONCZYK: How long did the chemo sort of last for?
J. ANSELMO: Two weeks, three weeks. Yeah, it was very bad. She couldn't even get up out of bed.
ARONCZYK: Things looked bleak. But they would not accept that chemo was their last option. They had heard about drugs that target cancer at the tiniest molecular level. So after the surgery, they sent samples of her tumor for sequencing - a process to figure out what genetic mutations might be causing her cancer to grow. This kind of testing is happening at more and more hospitals and at labs like this one, the New York Genome Center.
UNIDENTIFIED LAB TECH #1: So it looks like we've got five samples. They're all frozen.
ARONCZYK: And technician unpacks a FedEx box. It's DNA taken from cancer tumors similar to MaryAnn Anselmo's.
UNIDENTIFIED LAB TECH #1: Got to dump the dry ice.
ARONCZYK: It's unpacked and checked. Two days later, the samples are moved from tube to testing plate.
UNIDENTIFIED LAB TECH #1: So here are our samples right there, sheared and cleaned up.
ARONCZYK: A week later, another lab tech puts the samples into what looks like a very expensive mini-fridge.
UNIDENTIFIED LAB TECH #2: It is actually sequencing right now.
ARONCZYK: And then that's it? Are we done?
UNIDENTIFIED LAB TECH #2: Yeah.
ARONCZYK: All told, this took several days. Each tumor cost $4,000 to sequence. It's gotten so fast and cheap. A decade ago, this would not have been possible. Now, while it's still too expensive to do for every cancer patient, it is being used to help people who have run out of other options like MaryAnn Anselmo.
M. ANSELMO: You have all the medication, Joe?
J. ANSELMO: Yep, got it right there.
ARONCZYK: When the results from MaryAnn Anselmo's genetic test came back, Dr. David Hyman knew what drug to try her on.
M. ANSELMO: Look who's here.
DAVID HYMAN: Hello. How is everyone doing?
M. ANSELMO: We're doing fantastic.
ARONCZYK: Now her visits to Memorial Sloan-Kettering Cancer Center are short and cheerful.
HYMAN: Yeah, I was reviewing all your scans yesterday. And they're terrific. I mean, you can hardly see any abnormality on them now.
ARONCZYK: Her cancer has a mutation that is almost never found in a brain tumor. So Dr. Hyman put her in a drug trial along with people with lung cancer, stomach cancer, blood cancer.
HYMAN: What this is about is getting patients access and onto therapies that would never have been thought about for their disease if we didn't understand the genetics of their individual tumors.
ARONCZYK: It's not about where the cancer was found. What these cancers all share is the same genetic mutation.
HYMAN: It's like you're in a parking lot, and you have a key to one of the cars in the parking lot. And so one option is just to go to each car and try to open the lock. The other is to know that it's the third car on the right. What we're doing now is we're saying, OK, this key fits that lock. And we're only going straight to that car.
ARONCZYK: And that is how MaryAnn Anselmo found herself on a drug that is keeping her cancer from growing. There are some side effects, but she's doing well.
J. ANSELMO: She lost a little bit of - left peripheral is gone completely.
M. ANSELMO: The superior vision portion.
J. ANSELMO: But you get it back. I mean, you don't get it back, but you get used to it. Your brain compensates for it.
M. ANSELMO: I mean, I'm doing great now. I'm driving.
J. ANSELMO: Yeah, she's driving.
ARONCZYK: You just have to check over your shoulder.
M. ANSELMO: I do.
J. ANSELMO: She looks left a lot.
M. ANSELMO: Let's put it this way. I do look twice, you know, because you never know when something's coming out of nowhere.
HYMAN: You know, we took a disease where nothing really works for any length of time. And we've given her a year of life - hopefully much more - where she's been much better.
ARONCZYK: Do you think that she'll continue to respond?
HYMAN: That's the most important question, actually. And every patient is different in how long it works. We all have patients that have been on these drugs for years. But I don't know. I mean, I think if I was being honest, eventually, our expectation would be that it would stop working.
ARONCZYK: This is a part of MaryAnn Anselmo's treatment that she and her husband do not discuss. These drugs aren't considered cures. But she has faced and survived so many tragedies that the Anselmos remain hopeful. For now, her cancer is at bay. And she's been given more time to do the things that she loves. She's back singing again with her vocal coach. And she's planning a comeback show.
(SOUNDBITE OF SONG, "BUT BEAUTIFUL")
M. ANSELMO: (Singing) Love is funny. Or it's sad. Or it's quiet, or it's mad.
ARONCZYK: After her rehearsal, we left the studio and headed to the subway. As we crossed at the light, I felt overwhelmed on her behalf. How do you lose your son, survive a horrific car accident and then get a brain tumor? Was she the world's unluckiest woman? No, she said. I'm the luckiest. For NPR News, I'm Amanda Aronczyk in New York.
INSKEEP: Our series is produced with WNYC and with "Ken Burns Presents Cancer: The Emperor Of All Maladies," which will air on PBS stations starting next week. Transcript provided by NPR, Copyright NPR.
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