Immunotherapy: a love story

August 10th, 2017
This is a photo of Sandy and Jerry Doria dancing at their wedding.
Sandy and Jerry Doria dance at their wedding. Photo courtesy of the Doria family.

Sandy and Jerry Doria glowed in their wedding pictures.

Her long blond hair flew as they danced on a terrace in the magical light of sunset.

That was July.

A mere four months later, Sandy received jolting news. She had been experiencing some unexplained numbness in her left arm. She wasn’t terribly concerned. But a visit to her doctor revealed she had breast cancer.

Watch a video about Sandy and Jerry Doria.

Every day is a gift.

A can-do optimist, Sandy, now 61, figured she’d quickly get some treatments and put cancer in her rearview mirror before needing to tell her new husband.

But she soon learned that she was dealing with a fast-growing, aggressive form of cancer. Just before Christmas in 2011, she confessed her news to Jerry, now 71. From then on, he was always at her side. A retired engineer, Jerry took the lead in researching breast cancer, methodically tracking every treatment and supporting Sandy at each doctor’s visit.

She made sure they kept joy at the center of their lives: spending time with seven children and seven grandchildren, embracing their new community in Aurora after a move from the California coast and deep-sea fishing in the winters with friends and relatives off the Florida Keys. Sandy kept working as long as she could, giving facials to clients. She tended the flowers in her garden and kept swimming laps, finding serenity in cool, blue water.

Despite multiple surgeries and countless rounds of chemo and radiation, the cancer kept spreading and recurring. All her life, Sandy had loved having long hair, but she lost all of it in treatments she hoped would save her life.

There were certainly times when she felt like giving up.

But the unwanted journey yielded some surprises too. The challenge of facing cancer together only cemented Sandy and Jerry’s love. And Sandy’s saga has left her doctors at UCHealth’s University of Colorado Hospital a bit speechless and mystified. When it comes to metastatic cancer, doctors never speak of cures. And they definitely don’t talk about miracles. It’s hard to characterize exactly what happened to Sandy. But her doctor says it’s nothing short of remarkable.

‘I’m in a bit of trouble’

Sandy’s ordeal began with little drama. She was still seeing clients in California as she prepared to move full-time to Colorado. So when she noticed the numbness in her arm, she visited her doctor there. Even with a diagnosis of breast cancer, she wasn’t panicky.

“I thought I might have to go through some treatments. Then in six months, I’d be done,” Sandy said.

A scan soon showed a very large and aggressive tumor in Sandy’s breast.

Sandy called from California.

“I’m in a bit of trouble,” she told Jerry.

Neither wanted to worry about treatments before Christmas, so they postponed until January. By the time doctors started chemo treatments, the fast-growing tumor had tripled in size.

After chemo, a California surgeon took out the tumor along with 13 lymph nodes “just to be safe.” The doctors felt they had gotten all the cancer.

“Wonderful,” thought Sandy. “I figured I was done. I’ll get my hair back and move on.”

Just six months later, however, the cancer returned: this time in both the breast and in Sandy’s left lung.

Suddenly Sandy’s prognosis had changed dramatically.

“We have metastatic cancer. It’s spreading and it’s terminal,” Jerry said.

Terminal diagnosis fuels search for cutting-edge therapies

Doctors told Sandy that the average life expectancy for people with metastatic breast cancer is 2.5 years.

Her particular kind of cancer — triple-negative — made her outlook especially grave. Typically with breast cancer, doctors can target receptors that cause cancer cells to grow. But in Sandy’s case — and for about one in five people with breast cancer — the cells are not sensitive to three types of receptors: estrogen, progesterone and human epidermal growth factor. Sandy’s type of cancer had a dangerous ability to mutate, making it especially hard to fight.

This is a photo of Sandy and Jerry Doria.
Sandy and Jerry Doria teamed up to fight breast cancer together. Photo by UCHealth.

Sandy reacted to the ominous news with her typical upbeat attitude.

“Let’s have some fun,” she told Jerry.

She quit work. She and Jerry decided to take some great trips. They moved full-time to Colorado and had a blast living on the 18th hole of a golf community. Neither plays golf, but they bonded with new friends at the clubhouse and loved taking the grandkids to the pool. Jerry kept fishing. Sandy kept enjoying life.

And she tried different treatments. At first she and Jerry saw cancer doctors in Denver who were not affiliated with the University of Colorado Hospital.

But as Jerry continued doing research, the couple made a critical decision.

“I decided I needed to go to a university because they are cutting edge,” Sandy said.

“We were searching all over the country for places that would deal with triple-negative breast cancer,” Jerry recalled.

Fortunately their search led them to a new world of treatments at University of Colorado Hospital.

Jerry found Dr. Anthony Elias and asked him to see Sandy. Elias treated her for more than a year, using every tool he could. But Sandy’s cancer kept progressing.

Late in 2014, Sandy’s cancer had reemerged again. This time, it cruelly surfaced with tumors all over the skin on Sandy’s chest. The red bumps and welts were so painful that it was difficult for Sandy to wear clothes, much less enjoy life. She had to rely on morphine to get through some days. Sometimes Jerry would hear her moaning in bed and there was nothing he could do.

“I told Jerry. ‘I’m done. This is how I’m going out,’” Sandy recalled.

But rather than giving up, the couple decided to try throwing everything at Sandy’s cancer. And that meant participating in clinical trials.

So Elias recommended they see Dr. Jennifer Diamond.

Petite and unassuming, Diamond hardly looks like a superhero. For Sandy and Jerry, however, Diamond might as well have a cape to go with her white coat and stethoscope.

Diamond is a founder and co-director of the Women’s Cancer Developmental Therapeutics Program at the University of Colorado Cancer Center. The program, which Diamond and Dr. Christine Fisher launched in 2016, aims to increase access to clinical trials and promising treatments for women with breast and gynecological cancers.

Patients who sign on for experimental therapies can improve or suffer setbacks. They put their bodies on the line to help researchers learn valuable lessons about medications that might make a difference. It’s a world of risks and rewards.
Three times, Sandy got her hopes up.

She tried her first experimental drug in January of 2015. But the cancer progressed and she had to opt out of that trial.

A second trial sounded like a good match, but Sandy was deemed ineligible. She was crushed.

A third trial offered some promise. It combined the newest type of cancer cure called immunotherapy with chemotherapy. Enduring chemotherapy again, meant Sandy would lose her hair again. That was too high a price. Despite all the suffering and pain she was enduring, Sandy wanted to feel like herself.

She said no.

But both Jerry and Diamond had a feeling that the third trial was worth a shot. Together, they tag-teamed Sandy and urged her to give it a try.

“I know this is tough,” Sandy recalls Diamond telling her. “You’re going to lose your hair, but we’ve had great results with this (drug) and it’s really promising. You’re a great candidate. Let’s try it.”

Sandy changed her mind and got the last space in the trial.

That decision might have saved her life.

In combination with the chemo, Sandy received an immunotherapy drug that only had a number at first: MPDL-3280A. It later came to be called atezolizumab and TECENTRIQ and is now FDA-approved for bladder cancer.

Teaching the immune system to fight cancer

Immunotherapy drugs have received a boost in attention since 2015 when former President Jimmy Carter announced that all signs of melanoma that had spread from his liver to his brain were gone. Along with chemotherapy and radiation, Carter had received an immunotherapy drug called pembrolizumab. With Carter’s news, public awareness about immunotherapy has grown. And research is exploding.

Immunotherapy drugs help the body’s immune system detect and fight cancer cells.

Sandy started taking her experimental drugs in May of 2015. On cue, her hair started falling out. But the painful tumors on her chest also began to disappear. At first, Sandy and Jerry would drive from their home in south Aurora to the Anschutz Medical Campus for infusions every Wednesday. After the first four months, Sandy got to stop the chemotherapy, while continuing the immunotherapy. She received those infusions every other week.

Aside from losing her hair, Sandy had few negative side effects for about one year.
Then two scary setbacks hit her last summer. In July, she had a severe bout of colitis that landed her in the hospital in grave condition for five days. She recovered only to suffer severe breathing problems and pneumonitis that resulted in another hospital stay of six days in August.

Both the colitis and pneumonitis can be side effects of the immunotherapy drugs. The atezolizumab was properly fighting Sandy’s cancer. But, it appeared to be causing her immune system to attack Sandy’s organs as well.

Diamond told Sandy she’d have to stop her infusions.

Both Jerry and Sandy were crestfallen. They were convinced that the drugs were necessary to keep Sandy alive.

But they had no choice. All they could do was wait and see what happened and decide on their next strategy to battle Sandy’s cancer.

The couple kept coming in for follow-up visits with Diamond every six weeks. And a remarkable surprise threw all of them for a loop.

Sandy did great.

It seemed that the immunotherapy drugs had retrained her body to find and kill the cancer cells. Even without boosts of new medicine, her body apparently was patrolling for cancer cells and knocking them out.

“The cancer has not come back,” Diamond said. “Whatever the immunotherapy did to her immune system has had a lasting impact.”

Sandy Doria is shown outside next to her garden.
Now that her cancer is in remission, Sandy Doria is embracing everyday pleasures. She loves swimming and working in her garden. And, after losing her hair twice to cancer treatments, she’s growing it out again. Photo by UCHealth.

Sandy is now considered to be in full remission.

“It’s too early to say she’s cured of cancer, but this is as close as we’ve ever come to having a cure for metastatic breast cancer. It’s truly remarkable,” Diamond said.

She said no other cases have yet been described among researchers showing that patients with triple-negative breast cancer can stop their immunotherapy treatments and continue to do well for at least a year. In addition to thriving herself, Sandy may have a profound effect on other doctors and other patients. Her risks could yield big rewards.

Diamond is humble about the results and readily concedes that she has no idea why Sandy responded so well.

“Work is ongoing to look at her tumor biopsies to see why she’s a long-term responder. There have been reports in other cancer types, like lung cancer, where patients have stopped immunotherapy and the cancer hasn’t come back for many years.

“We’re starting to see these cases in our clinics where immunotherapy can result in long-term remission from cancer,” Diamond said.

The breakthroughs are coming, she said, because scientists are learning much more about how tumor cells and immune cells interact.

“The immunotherapy drugs we have now are much smarter than the ones we have used in the past. They don’t just turn on your immune system in a non-specific way,” she said. “They are really trying to prevent the cancer cells from turning off the immune cells.”

Diamond has to be careful about being too optimistic because she has other patients who haven’t done as well as Sandy. Still, Sandy’s case is stunning.

“She’s so strong. She has a great attitude. We’ve been very excited for the promise that she could remain free of cancer and not need cancer treatments,” Diamond said.

The admiration is certainly mutual.

Sandy adores Diamond.

“She’s amazing. She’s the perfect doctor. She listens to you. She gets it. She takes her time. She’s never rushed. She’s as concerned about Jerry as a caregiver as she is about me. She’s part of the family now,” Sandy says.

As for the future, Sandy and Jerry are busy this summer taking care of two young granddaughters, ages 5 and 3. They’re eager to go to Japan and Italy and of course, to the Keys for some fishing this winter.

Sandy doesn’t focus too much on the science that has transformed her health.

She has a much simpler explanation.

“It’s a miracle.”

About the author

Katie Kerwin McCrimmon is a proud Colorado native. She attended Colorado College, thanks to a merit scholarship from the Boettcher Foundation, and worked as a park ranger in Rocky Mountain National Park during summer breaks from college. She is also a storyteller. She loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as a journalist at the Rocky Mountain News and was a finalist with a team of reporters for the Pulitzer Prize for their coverage of a deadly wildfire in Glenwood Springs in 1994. Katie was the first reporter in the U.S. to track down and interview survivors of the tragic blaze, which left 14 firefighters dead.

She covered an array of beats over the years, including the environment, politics, education and criminal justice. She also loved covering stories in Congress and at the U.S. Supreme Court during a stint as the Rocky’s reporter in Washington, D.C.

Katie then worked as a reporter for an online health news site before joining the UCHealth team in 2017.

Katie and her husband Cyrus, a Pulitzer Prize-winning photographer, have three children. The family loves traveling together anywhere from Glacier National Park to Cuba.