Uncloaking Cancer - The Register-Guard - Eugene, Oregon

[CindyA]

The 80-inch screen in the meeting space at the Willamette Valley Cancer Institute on Country Club Road blinks to life. Dr. Benjamin Cho, a soft-spoken oncologist, pulls up the latest CT scans of his patient, Doug Penn. Two images taken five months apart, almost identical and side-by-side, fill all 80 inches.

At first, the images look like black holes marred by gray and white blobs; two arches that resemble the tentacles of an octopus frame each photo. The “tentacles” are actually Penn’s ribs, Cho explains. And the images are actually a cross-section of Penn’s chest cavity.

In the center of all the “blobs” is the tumor. Penn was diagnosed with lung cancer, specifically non-small cell adenocarcinoma, in June 2012. The good news about this tumor, as shown by the photos, is that it’s shrinking significantly, thanks to an experimental drug developed by Swiss drug maker Roche.

The other good news?

“We’re getting smarter about cancer,” Cho says with a smile.

Cho admits that cancer is difficult to outsmart — in Penn’s case his cancer cells have a protein called PD-L1.

“Basically, it’s a cloaking protein. It disguises the cancer from the immune system,” Cho says.

Our immune systems are like sentinel guards, he says. They guard the body, scanning for and attacking anything that’s foreign.

“But cancer is smart, so it shows this protein and says, ‘Hey, immune system, I’m part of the normal body, just ignore me.’ So the immune cell comes by and says, ‘Yep, you’re part of me — nothing to see here, I’m moving on,’” Cho says.

This cloaking protein allows the cancer to grow in the body undetected, until it shows itself in other ways.

I want a new drug

It was a persistent cough that first brought Penn, 63, in to see a doctor in 2012. Yes, he was a former smoker, but he had quit more than 20 years ago, led a healthy lifestyle and was in the middle of training for a marathon when the cough wouldn’t go away. Doctors saw through the cloaking protein PD-L1 and recognized the cancer immediately.

In addition to the tumor that was found on his lung, the cancer had spread to a lymph node, ensuring that surgery was not an option to remove the cancer. Instead, Cho recommended what he refers to as the “atomic bomb” combo of chemotherapy and radiation.

Penn’s cancer responded to the treatment initially, shrinking the tumor and eradicating the cancer in the lymph node.

“But it started to grow again relatively quickly,” Penn says.

Luckily, Penn wasn’t out of options. When he had first met with Cho upon being diagnosed, the oncologist mentioned there were exciting things on the horizon of cancer treatment.

Indeed, there had been a study where medication was used to uncloak PD-L1, exposing it as a cancer cell and using the body’s own immune system to fight the cancer. At the point when Penn was first diagnosed, the study was in its first phase, in which researchers were trying the drug MPDL3280A, also known as anti-PD-L1, on all types of cancer to see if any specific ones responded.

“They found that 20 percent of all these people with end-state cancer had a response to this (treatment), and they found that people with lung cancer had a response,” Cho says.

The trial moved to the second phase, in which a more refined set of patients are given the new drug and compared to other patients given chemotherapy.

Penn is healthy, has a good immune system and is strong enough to receive chemotherapy — these criteria and more were used to determine if he was a candidate to be included in the second phase of the study.

“We were on pins and needles there when we were trying to figure out which one Doug was going to get, and luckily he got the research drug,” Cho says.

“Why not me?”

Penn is one of six patients at Willamette Valley Cancer Institute and 180 in the world who are a part of the study. If the former number sounds high, it’s because it is.

“We’re one of the higher accruing centers in the world in Eugene, so we’re really ramping up our research program because of this (study),” Cho says.

Penn received his first treatment in August and will receive a total of 17 over the course of the study. It’s administered intravenously, much like chemotherapy, and he comes in every three weeks for treatment and every six weeks for another CT scan to chart the tumor.

His scans show progress; Cho estimates the tumor has shrunk about 40 percent. However, Cho stresses the point of the research study isn’t to wipe out every cancer cell.

“If that happens, that’s great, but basically we’re looking at a response and shrinking down, and the other thing it’s looking at is to see if people live longer. So if it shrinks down the cancer, and it makes people live longer, that’s success for the drug.”

As for Penn, he is feeling well and says he hasn’t really experienced any side effects from the new treatment. He regularly hikes five miles a day, rides his bike almost everywhere, practices yoga regularly and eats healthy.

“There was no ‘why me?’ (when diagnosed), because why not me?” Penn says. “Why shouldn’t it be me? I think I feel more like, ‘why me?’ because I feel so fortunate to be in this study, why am I so fortunate to do this?”

If the results of the study overall are good, it could mean big things for the way doctors look at and treat cancer in the future.

“This is a therapy, and we have a whole bunch of therapies that are similar,” Cho says. “So these are new treatments where we can help preserve quality of life and hopefully extend life, too.

“The Holy Grail is if we can get a treatment to hopefully stimulate the immune system to potentially wipe out cancer that already had spread. Whether this is going to do it, I don’t know, but this is a promising step toward that.”

Jackie Varriano is a Eugene freelance writer. Reach her at jackievarriano@gmail.com.

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