{"id":72845,"date":"2023-11-27T11:10:26","date_gmt":"2023-11-27T18:10:26","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=72845"},"modified":"2023-11-29T16:24:34","modified_gmt":"2023-11-29T23:24:34","slug":"now-on-trodelvy-therapies-old-and-new-keep-this-lung-cancer-patient-moving-forward","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/now-on-trodelvy-therapies-old-and-new-keep-this-lung-cancer-patient-moving-forward\/","title":{"rendered":"Six years ago, she was told she had months to live. Therapies old and new keep lung cancer patient moving forward."},"content":{"rendered":"
<\/div>
\"Now
The case Betty Moren, a non-small cell lung cancer patient, demonstrates the immense progress in cancer care \u2013 and that there\u2019s much work to be done. Photos by Cyrus McCrimmon for UCHealth.<\/figcaption><\/figure>\n

Betty Moren was told she had six to nine months to live.<\/p>\n

More than six years and countless treatments later, she\u2019s still here.<\/p>\n

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

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.<\/p>\n

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<\/a> for Stage 4 NSCLC is about 9%, and Betty, already on oxygen because the main tumor was blocking airways, wasn\u2019t expected to make it nearly that long. Notably, her lung cancer\u2019s 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<\/a>.<\/p>\n

\"Husband
Husband Bill has been with Betty every step of the way.<\/figcaption><\/figure>\n

What\u2019s more, the Morens\u2019 son Christopher was to leave for California\u2019s Camp Pendleton for U.S. Marines boot camp two days later. They wouldn\u2019t 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.<\/p>\n

Chemotherapy still works<\/strong><\/h2>\n

Unfamiliar with Colorado\u2019s health care landscape, Betty and Bill asked around before deciding on nearby UCHealth Lone Tree Medical Center<\/a>, where Dr. Regina Brown put Betty on carboplatin-pemetrexed (Alimta) chemotherapy from May through August 2017. As Christopher\u2019s 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<\/a>, one which brought a fever of 106.7 degrees.<\/p>\n

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<\/a> (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\u2019s mechanisms.<\/p>\n

Dr. Jose Pacheco, who had taken over Betty\u2019s cancer care, tried adding trametinib (Mekinist) to the nivolumab as the drug\u2019s 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<\/a> at the time.<\/p>\n

\u201cI looked at my hand and said, \u2018Whose hand is that?\u2019\u201d Betty recalls. \u201cDr. Giang yelled for Bill to call 911.\u201d<\/p>\n

Scans at UCHealth Highlands Ranch Hospital<\/a> 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\u2019s central wall, called a patent foramen ovale<\/a>, or PFO, had made strokes more likely. Periodic injections of the anticoagulant Lovenox have stopped them from recurring, Betty says.<\/p>\n

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\u2019t 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>, a University of Colorado School of Medicine lung cancer specialist, assumed Betty\u2019s care.<\/p>\n

Chemotherapy that hitches a ride into cancer cells<\/strong><\/h2>\n

Camidge had known Trodelvy since it went by IMMU-132. UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a> was among the 10 U.S. study sites for the drug\u2019s first clinical trial<\/a>, 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\u2019s protein unlocks<\/a> 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\u2019s an attempt at a magic bullet.<\/p>\n

\u201cIt\u2019s like you figured out that the cancer lives in houses with red doors, and so you tell the FedEx chemotherapy delivery man to say, \u2018Look, you just want to take this to the ones with red doors,\u2019\u201d Camidge says. \u201cAnd, presumably, most of Betty\u2019s cancer has red doors, and most of her normal cells don\u2019t have a red door.\u201d<\/p>\n

Betty\u2019s 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 \u2013 a first for her despite years of cancer therapy.<\/p>\n

Nearly two years hence, Betty is still bald \u2013 and that\u2019s 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\u2019s no longer using a walker or cane. She\u2019s playing bocce twice a week. She\u2019s 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\u2019s called Stage 4 Creations<\/a>, and Betty launched it after receiving greeting cards shortly after friends and family learned about her cancer diagnosis back in 2017.<\/p>\n

\"Betty\u2019s
Betty\u2019s experience with a disease for which \u201cget well soon\u201d doesn\u2019t apply inspired her to make cards for those in similar circumstances.<\/figcaption><\/figure>\n

Despite her prognosis, \u201cthe cards would say something like, \u2018Get well soon,\u2019 Betty says. \u201cI wanted to do something to help \u2013 a tool to give people when someone in their family or a friend gets a cancer diagnosis.\u201d<\/p>\n

Walking on a bridge still being built<\/strong><\/h2>\n

Her cards, decorated with her own watercolors, say things like \u201cDream,\u201d \u201cYou\u2019re in my thoughts today,\u201d \u201cEmbrace the journey,\u201d and \u201cYou\u2019ll always be brave enough to fly.\u201d<\/p>\n

\"Although
Although playing bridge is no longer in the cards, bocce is a twice-weekly pastime when weather permits.<\/figcaption><\/figure>\n

Betty has been brave. Camidge describes her as \u201ctough as nails.\u201d 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, \u201cchemo mouth,\u201d the list goes on.<\/p>\n

Still, Betty says, \u201cNot much crying, I have to say.\u201d<\/p>\n

\"\"
Dr. Ross Camidge<\/figcaption><\/figure>\n

\u201cSpeak for yourself,\u201d Bill says.<\/p>\n

The Trodelvy probably won\u2019t 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 \u2013 just as the root of Betty\u2019s cancer isn\u2019t clear.<\/p>\n

There is probably a genetic aspect to her cancer \u2013 but it\u2019s one that has yet to be understood. She\u2019s 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 \u2013 though she quit a quarter century before cancer appeared and is, Camidge says, considered a nonsmoker from a medical perspective.<\/p>\n

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.<\/p>\n

\u201cYou\u2019re kind of walking across a bridge that they haven\u2019t finished building yet,\u201d Camidge says. \u201cAnd if the therapy or drug candidate lets you walk slow enough, they will continue to build the bridge so that your feet land safely.\u201d<\/p>\n

So far, Betty\u2019s feet have landed safely, and she and Bill have no plans to stop walking across that bridge.<\/p>\n","protected":false},"excerpt":{"rendered":"

Betty Moren was told she had six to nine months to live. More than six years and countless treatments later, she\u2019s 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 […]<\/p>\n","protected":false},"author":23,"featured_media":72963,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,49,167,6836,137,4781],"class_list":["post-72845","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-cancer-treatment","tag-clinical-trials","tag-lung-and-thoracic-cancer","tag-personalized-medicine","tag-research-in-health-care"],"acf":[],"yoast_head":"\nNow on Trodelvy, therapies old & new has lung cancer patient moving forward - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Living with non-small cell lung cancer, she's shown the astounding progress medical science has made in treating lung cancer.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/now-on-trodelvy-therapies-old-and-new-keep-this-lung-cancer-patient-moving-forward\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Six years ago, she was told she had months to live. Therapies old and new keep lung cancer patient moving forward.\" \/>\n<meta property=\"og:description\" content=\"Living with non-small cell lung cancer, she's shown the astounding progress medical science has made in treating lung cancer.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.uchealth.org\/today\/now-on-trodelvy-therapies-old-and-new-keep-this-lung-cancer-patient-moving-forward\/\" \/>\n<meta property=\"og:site_name\" content=\"UCHealth Today\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/uchealthorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2023-11-27T18:10:26+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-11-29T23:24:34+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2023\/11\/29162104\/Betty-Moren-bocce-portrait-web.jpg\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Todd Neff, for UCHealth\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@uchealth\" \/>\n<meta name=\"twitter:site\" content=\"@uchealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Todd Neff, for UCHealth\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/now-on-trodelvy-therapies-old-and-new-keep-this-lung-cancer-patient-moving-forward\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/now-on-trodelvy-therapies-old-and-new-keep-this-lung-cancer-patient-moving-forward\\\/\"},\"author\":{\"name\":\"Todd Neff, for UCHealth\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#\\\/schema\\\/person\\\/da7733ff5562e48e55c027d111ee5911\"},\"headline\":\"Six years ago, she was told she had months to live. 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