Betty Moren was told she had six to nine months to live.

More than six years and countless treatments later, she’s still here.

Hers is a success story, one that demonstrates the remarkable progress medical science has made in the long war on cancer. But her story is also a reminder of how far we still have to go.

Moren, a longtime social worker, had recently arrived in Colorado with husband, Bill, who was starting a new job with Boeing. They bought a house in Castle Rock. In late March 2017, a bout of back spasms sent Betty, then 57, to an emergency room. A CT scan found a mass in her right lung that had nothing to do with the back spasms.

A biopsy and follow-up studies over the first few days of April confirmed non-small cell lung cancer (NSCLC), and it had spread to her left lung. The average five-year survival rate for Stage 4 NSCLC is about 9%, and Betty, already on oxygen because the main tumor was blocking airways, wasn’t expected to make it nearly that long. Notably, her lung cancer’s cells lacked genetic characteristics (related to EGFR, KRAS, HER2, ALK fusion, and others) that might make it vulnerable to the promising targeted therapies of personalized medicine.

What’s more, the Morens’ son Christopher was to leave for California’s Camp Pendleton for U.S. Marines boot camp two days later. They wouldn’t see him again until July, so he would be gone for much of the time Betty had left. Christopher considered backing out; his parents urged him to fulfill his commitment.

Chemotherapy still works

Unfamiliar with Colorado’s health care landscape, Betty and Bill asked around before deciding on nearby UCHealth Lone Tree Medical Center, where Dr. Regina Brown put Betty on carboplatin-pemetrexed (Alimta) chemotherapy from May through August 2017. As Christopher’s time at boot camp passed, and the tumor in her left lung shrank 70%, enough that she could now get by without supplemental oxygen. There were setbacks, including several hospitalizations, two of them for febrile neutropenia, one which brought a fever of 106.7 degrees.

Betty went on a maintenance infusion of just pemetrexed for another eight months before the risk to her kidneys outweighed the continued suppression of her cancer. In May 2018, she started on nivolumab (Opdivo), an immunotherapy effective against many cancers. That worked for more than two years until the cancer showed signs of growing again as it mutated to dodge the drug’s mechanisms.

Dr. Jose Pacheco, who had taken over Betty’s cancer care, tried adding trametinib (Mekinist) to the nivolumab as the drug’s effectiveness waned. That had little effect. Meanwhile, in September 2020, Betty suffered one of three strokes within a few weeks. She happened to have been in the middle of a video visit with UCHealth Lone Tree Family Medicine physician Dr. My Giang at the time.

“I looked at my hand and said, ‘Whose hand is that?’” Betty recalls. “Dr. Giang yelled for Bill to call 911.”

Scans at UCHealth Highlands Ranch Hospital showed that the stroke was probably caused by blood clots that formed in the wake of her many cancer treatments. A congenital hole in her heart’s central wall, called a patent foramen ovale, or PFO, had made strokes more likely. Periodic injections of the anticoagulant Lovenox have stopped them from recurring, Betty says.

She did physical, occupational, and speech therapy to regain capabilities, but she needed a walker and had to give up her twice-weekly bridge games as her mind no longer kept up with the cards. As months passed in 2021, it became clearer that the trametinib-nivolumab combination wasn’t working. Pacheco searched for another solution and found one: an experimental drug called sacituzumab govitecan-hziy (Trodelvy). The clinical trial involved an infusion two of every three weeks. Soon thereafter, Dr. Ross Camidge, a University of Colorado School of Medicine lung cancer specialist, assumed Betty’s care.

Chemotherapy that hitches a ride into cancer cells

Camidge had known Trodelvy since it went by IMMU-132. UCHealth University of Colorado Hospital on the Anschutz Medical Campus was among the 10 U.S. study sites for the drug’s first clinical trial, launched in 2012. Called an antibody-drug conjugate, the drug consists of a protein that binds to a receptor common on cancer cells. The protein carries a payload of a handful of chemotherapy molecules. Trodelvy’s protein unlocks the door to the cell; once inside, the chemotherapy goes to work. The idea is that, unlike typical chemotherapy that hits cells, whether they are cancerous or not, Trodelvy targets the likely cancer cells and spares the healthy ones. Like personalized medicine, it’s an attempt at a magic bullet.

“It’s like you figured out that the cancer lives in houses with red doors, and so you tell the FedEx chemotherapy delivery man to say, ‘Look, you just want to take this to the ones with red doors,’” Camidge says. “And, presumably, most of Betty’s cancer has red doors, and most of her normal cells don’t have a red door.”

Betty’s hair follicles apparently also had metaphorical red doors. Her second infusion was on Christmas Eve 2021, and her hair fell out within a couple of days – a first for her despite years of cancer therapy.

Nearly two years hence, Betty is still bald – and that’s good news because the Trodelvy infusions she does two of every three weeks are still keeping her cancer in check while vacating her scalp. She’s no longer using a walker or cane. She’s playing bocce twice a week. She’s in two book clubs and a weekly Bible study group. And she has continued to run a little handmade greeting card business whose proceeds she donates to cancer research. It’s called Stage 4 Creations, and Betty launched it after receiving greeting cards shortly after friends and family learned about her cancer diagnosis back in 2017.

Despite her prognosis, “the cards would say something like, ‘Get well soon,’ Betty says. “I wanted to do something to help – a tool to give people when someone in their family or a friend gets a cancer diagnosis.”

Walking on a bridge still being built

Her cards, decorated with her own watercolors, say things like “Dream,” “You’re in my thoughts today,” “Embrace the journey,” and “You’ll always be brave enough to fly.”

Betty has been brave. Camidge describes her as “tough as nails.” Bill, who has been with her at every appointment along the way, has documented the ills that have accompanied her cancer fight: nausea and vomiting, diarrhea, fatigue, neutropenia, vertigo, pneumonitis and pneumonia, infections, bloody noses, “chemo mouth,” the list goes on.

Still, Betty says, “Not much crying, I have to say.”

“Speak for yourself,” Bill says.

The Trodelvy probably won’t work forever. Doing so many infusions for so long would be hard on anyone, regardless. And why it works on less than one-third of the NSCLC who try it remains a mystery – just as the root of Betty’s cancer isn’t clear.

There is probably a genetic aspect to her cancer – but it’s one that has yet to be understood. She’s had a handful of relatives diagnosed with lung cancer, including her brother Tom, who succumbed within months of his diagnosis at age 62. Many smoked, as did Betty – though she quit a quarter century before cancer appeared and is, Camidge says, considered a nonsmoker from a medical perspective.

What her case does represent is another example of cancer care that can, with some science and some luck, look a lot like chronic disease management. The longer the patient survives, the better the chance that a new therapy will present itself.

“You’re kind of walking across a bridge that they haven’t finished building yet,” Camidge says. “And if the therapy or drug candidate lets you walk slow enough, they will continue to build the bridge so that your feet land safely.”

So far, Betty’s feet have landed safely, and she and Bill have no plans to stop walking across that bridge.