It was the week of Thanksgiving, and Gail Sadler’s daughter Alex was back from college for the holiday. Sadler, 52, a competitive tennis and volleyball player in her youth, had not slacked off since. They went to the gym and went hard. When Sadler was working her arms and back, she felt was a sharp pain in her right lat (that’s latissimus dorsi for you anatomists).
“That’s what you get for showing off, mom,” Alex said.
Fair enough. But this sort of thing was nothing new for this mom. “I’m always hurt at the gym, trying to push it,” Sadler said.
But the pain lingered. Her primary care doctor didn’t like it and sent her off for tests. On December 4, 2013, the diagnosis: non-small cell lung cancer.
It was stage 4, meaning that the cancer had spread, in Sadler’s case from her left lung to her left hip to her right femur, to the T12 vertebra in her spine, to her sternum, to a spot behind her vocal cords.
She was given six months to two years to live. This just before the holidays.
“How can you have Christmas without mom being given a death sentence?” Sadler asked with a laugh. This is a wry woman. And a fighter.
C’est la vie
She started with chemotherapy. She decided she was going to live while she was dying. When the weather warmed up again, she took daughters Alex and Shannon, granddaughter Ava, son Cameron and his girlfriend Kathleen to Paris in May 2014 to see the French Open. It had been on Sadler’s bucket list. Cameron added to the magic: he snuck off to a jewelry store, bought a ring, and proposed to Kathleen one night under the Eiffel Tower, with Gail and the girls all there for the big moment.
Back home, back to reality, a second-line chemotherapy called docetaxel took her in its grip. She felt worse, she looked worse, the hair went, and it wasn’t working. “Whether the drug failed me or I failed the drug, I don’t know,” she said. In December 2014, a year into her fight, the brain scans came back with more bad news: a brain scan came back with a tumor. Advancing disease had cast its shadow on another Christmas.
But unbeknownst to her, that previous September, the U.S. Food and Drug Administration had given Sadler and many others a gift: the agency had approved an immunotherapy called nivolumab (trade name Opdivo). Immunotherapies tip off the body’s natural defenses to cancers that have found ways to trick the immune system into letting those cancers take over. Nivolumab focuses on T-cells. Sadler’s cancer was sending out chemical signals that fool T-cells into not attacking it; nivolumab blocks those signals so T-cells can go about their killer business. When immunotherapy works, the T-cells can wipe out cancer in ways the field of oncology could only dream of just a few years ago.
“Immunotherapy has really revolutionized life expectancy for patients,” said Regina Brown, MD, Sadler’s oncologist. “When we’re talking about non-small cell lung cancer, especially stage 4, those patients were lucky if they lived six months.”
Not quite a miracle
Brown is UCHealth Lone Tree Medical Center’s director of Oncology and a University of Colorado School of Medicine medical oncologist. She and colleagues prescribed Sadler nivolumab infusions every two weeks starting in June 2015. Earlier this month, Sadler had taken took what she described as “my 55th hit” of Opdivo. Her scans were clean.
“It’s nothing short of a miracle,” Sadler said.
It’s miracle-by-design. On the pharmaceutical end, there was the decade-plus development of nivolumab as well as the creation of molecular testing capable of determining which patients might benefit from nivolumab or other immunotherapies via straightforward blood tests. And at places like UCHealth Lone Tree Medical Center, there was the hard work of designing a tailored care path for each patient, one involving a lot more than a T-cell tickler.
In the case of nivolumab, for example, chemotherapy comes first. Even if it doesn’t take the cancer out completely, chemo shrinks tumors and makes nivolumab’s job easier, Brown said. There are also different immunotherapies that can precede nivolumab – ones designed for cancers triggered by genetic mutations to the ALK gene (such as crizotinib/Xalkori) or the EGFR gene (such as osimertinib/Tagrisso). Sadler was also on a drug to slow the bone breakdown her cancer was causing, among others. There were visits with UCHealth lung cancer specialist Ross Camidge, MD, PhD, neurosurgeon Kevin Lillihei, MD, and radiation oncologist Brian Kavanaugh, MD, MPH.
Most importantly, Brown said, is that the miracle is not a silver bullet.
“Patients are able to live longer with better quality of life and less evidence of disease, but we don’t have an option for the patient if the cancer comes back,” she said.
And Sadler has to keep taking Opdivo. Think of it as cancer as a chronic disease, Brown says, with Opdivo analogous to insulin.
“If you stop the insulin, the diabetes is going to go crazy again,” Brown said.
All in the ‘Tree
Sadler sees Brown and does her immunotherapy infusions at the Lone Tree Medical Center, where she and others benefit from care at a fully integrated branch of UCHealth’s National Cancer Institute-designated Comprehensive Cancer Center based at the Anschutz Medical Center in Aurora. For tough cases like Sadler’s, Brown calls into the weekly multidisciplinary lung cancer clinic at the Anschutz Medical Campus, which brings together medical oncologists, oncological surgeons, radiation oncologists, pathologists and radiologists to establish and adjust care approaches. With the full suite of PET, MRI, and CT scanners, chemotherapy stations and the UCHealth TomoTherapy Cancer Care Clinic – Lone Tree a mile down the road, patients can receive all their care in Lone Tree.
That’s important, Brown said. In the first year alone, a cancer patient can expect the appointments, infusions, scans and tests to add up to 100 visits.
“I have been in the best hands possible from the minute I walked through the door,” she said. “They’re amazing.” She described Brown as “the bomb.”
While a long way from Paris, Sadler’s living her life while living. She works out; she climbs the Red Rocks Amphitheater steps, though a surgically repaired hip has slowed her down temporarily. She really, really enjoyed a wedding this past August, up in Aspen – her son Cameron’s, the product of that Eiffel Tower proposal three years ago. He and Kathleen are coming in to spend Christmas with Sadler and family. It should be a merry one.
“I’m still in the process of redefining myself in 2018 as a woman who’s alive and healthy,” Sadler said.