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Sunday, November 23, 2003

A Thanksgiving he didn't expect

Bloomington man with lung cancer 'one in a thousand' from IU

clinical trial

By Laura Lane

Hoosier Times

Sunday, November 23, 2003

Lindsay Towell injects angiostatin into her husband's arm. Dave

Towell receives two shots twice a day of the cancer drug, which

doctors say has almost completely eliminated the tumors in his lung

and are amazed at his success with the experimental treatment.

Staff photo by David Snodgress

The arthritis is his right knee has slowed Dave Towell down more

than the Stage IV lung cancer that most everyone expected to take

his life.

"Last year about this time, I thought we might well have been coming

up on our last holidays together," said his wife, Lindsay Towell.

Despite being a non-smoker and longtime distance runner, Towell

found himself on the receiving end of a grim diagnosis in September


Just a year before, a chest X-ray prompted by a nagging cough that

lingered for months showed nothing. Towell, then a just-retired

Indiana University geology professor, figured all the time he was

spending outside that fall had triggered old allergies.

At the end of 2001, he went to a pulmonologist who thought he

spotted something on the chest X-ray: suspicious dots on the lower

left lobe of Towell's left lung.

"I remember him saying, 'The radiologist will think I'm crazy, but

I'm ordering a CT scan and a bronchoscopy. I certainly don't think

it's cancer.' The test showed everything was OK," Towell said. "They

said we would monitor it."

In July 2002, a CT scan showed that the dots on his left lung were

bigger. A more thorough CT scan and a needle biopsy weeks later

brought bad news: Towell had non-small cell adenocarcinoma, a slow-

growing cancer that is the most common form of lung cancer among non-


It was the beginning of September 2002. Instead of heading out in

their new recreation vehicle, the Towells went looking for a

surgeon. Exploratory surgery showed that the cancer had spread to

the pleura, the lung's thin lining. It was the worst of news. The

cancer was essentially inoperable. "It was beyond surgery, beyond

radiation, beyond a whole lot of hope," Lindsay Towell said.

She and her husband decided to fight the disease aggressively. They

had planned well for their retirement and had dreams to travel the

country. Cancer was not going to stop them.

Towell's daughter-in-law hit the Internet. Cheri Towell, a nurse,

knew the value of researching the latest clinical drug trials

focused on advanced lung cancer. She called medical centers around

the country — Boston, Houston, Nashville — to find out more. "People

were wonderful everywhere," Lindsay Towell said. "They would talk

with Cheri for 45 minutes to an hour. They gave us a lot of hope.

Dave was feeling fine, we had this nice new RV and we decided we

would travel anywhere for the best treatment."

In the end, the best clinical trial for advanced lung cancer was an

hour away, at the Indiana University Medical Center in Indianapolis,

where Dr. Nasser Hanna was conducting research on the use of

angiostatin, a protein that cuts off blood flow to tumors. The

clinical study, kicked off in July 2002, involved combining daily

doses of angiostatin with standard chemotherapy.

"The doctors made it clear all along it was our decision as to what

to do," Lindsay Towell said. "There was no need to sit around and

say 'it's over.' He had Stage IV lung cancer. What did we have to

lose? In clinical trials, you are helping learn about a treatment.

You are a step toward the cure."

The biopharmaceutical firm EntreMed provides the angiostatin, which

is stored frozen until it is injected into the patient. It has not

yet received approval for use beyond medical trials such as the one

Towell is participating in.

All along, Towell never felt sick. He endured four rounds of

chemotherapy well, so Hanna approved two additional chemotherapy

treatments. Through it all, he received two injections of

angiostatin every morning and two at night.

After the first two rounds of chemotherapy/angiostatin treatment,

Towell had another CT scan. There had been substantial reduction in

the size of the tumors in his lung. "Some were clearly gone, some

had shrunken, so we continued on," Towell said.

In December of last year, after four chemo rounds, there was more

significant reduction. Towell said that when Hanna suggested two

additional chemotherapy treatments, "we didn't hesitate."

He and his wife use the word "we" a lot when talking about Towell's

cancer. "Hey, if he's got it, I've got it," Lindsay Towell

said. "We're in this together."

Admittedly squeamish when it comes to needles, she has become expert

at giving the upper arm shots.

"I'm pushing 2,000 injections," Dave Towell said, rolling up the

sleeve on his striped shirt this past Thursday so Lindsay could give

him his morning shots — one in each arm. He receives 60 milligrams

of angiostatin every day via tiny 30-gauge needles stuck about a

half inch into his upper arm, abdomen or thigh. He said dry scratchy

skin at the injection sites in the only side effect he has


Because the drug must be stored frozen at 80 degrees below zero,

Towell can only get a small amount at a time. So every Tuesday and

every Friday, he drives to the IU Medical Center pharmacy in

Indianapolis to pick up a supply that will last three or four days.

Before giving her husband his morning injections Thursday, Lindsay

Towell held the syringes in her closed fists to defrost the clear,

life-saving liquid inside. "This is the quick-thaw method," she said.

The chemotherapy was over in January. A February CT scan showed what

Lindsay Towell called "phenomenal" results. "That word was used by

Dr. Hanna, a conservative doctor who never promised us anything,"

she said. "The cancer is 95 percent reduced." Looking at her

husband's lung scans, neither could detect any difference between

the right and left lobes.

Towell goes in for CT scans every two months, the last one on

Halloween. They have been clear so far. If the cancer returns,

Towell will be taken out of the clinical trial, but would be

eligible for other treatment options. "The sad part is, once the

cancer comes back, you are our of the trial," Towell said. "But

since I've been in one clinical trial, I'm likely to be accepted in


Towell's survival and success make him "one in a thousand," he said.

Overall, 28 percent of cancer deaths are from lung cancer. More

people die from lung cancer than from colon, breast and prostate

cancers combined, Hanna said.

A big scare came this summer after a routine eye exam at the IU

Optometry School. A retinal specialist saw what appeared to be a

tumor behind one of Towell's eyes. But a brain MRI showed no tumors,

and another specialist determined that there might have been a tumor

there, but that it had been destroyed by the chemo and angiostatin


"That was the scariest thing of all, when they found that behind his

eye," Lindsay Towell said. "It was a whole new avenue we didn't want

to go down."

Towell had to stop taking angiostatin for a week or so while the

issue was resolved. A hospital internal review panel convened to

discuss how to proceed, and agreed Towell would continue in the

angiostatin drug trial.

The Towells put their faith in the angiostatin, but realize that

it's not a cure. It's possible, even likely, that the cancer will

return. Until them, they continue traveling. But it presents

obstacles, since the drug can only be had in small amounts and must

be kept frozen.

But with help from friends like Jon Eller, an IUPUI English

professor, Towell gets his angiostatin, no matter where he is. He

has had it delivered on dry ice via Federal Express, with friends

doing the pickup and packaging, to destinations ranging from Florida

to Montana. They are traveling to Sedona, Ariz., the Monday after

Thanksgiving, and the frozen syringes of angiostatin will find their

way there, thanks to friends.

Dave Towell, a healthful-eating, active man, never expected to be

battling cancer. But he's taken it on, and has the upper hand. "I

enjoy everything I do, every menial task — raking the leaves," he

said. In September, he hiked eight miles at 10,000 feet in Montana

and camped overnight. "I said to myself, 'How could you have Stage

IV lung cancer?' But I guess you don't know what's going to get you.

I always figured the most dangerous thing in my life was crossing

10th Street to go the HPER building.""

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