News — As a woman in her mid-forties who didn鈥檛 smoke, Elizabeth Lacasia never expected to be diagnosed with lung cancer. But in 2006, after she developed a persistent and serious cough, a chest X-ray and CT scan revealed several tumors in her lower left lung.
She was eventually diagnosed with stage IV lung cancer, a rare subtype called 鈥渂ronchioalveolar carcinoma.鈥� Over the next 18 months, she underwent two surgeries followed by a tough combination of a targeted drug treatment and two chemotherapies. Yet the cancer continued to spread. As it turned out, the chemotherapy she was taking was later found to be ineffective against her cancer, although it caused significant side effects.
Lacasia, who was an avid rollerblader, a snow skier and had a successful career with a biotech oncology company, was not a woman who gave up easily. She contacted David Gandara, a nationally recognized lung cancer expert and senior advisor for clinical research at the UC Davis Comprehensive Cancer Center.
Gandara is known for his emphasis on 鈥減ersonalized treatment鈥� using information available through genetic testing of a patient鈥檚 tumor to find the most effective therapies. Lacasia underwent a battery of molecular and genetic tests to help identify whether her cancer would respond to drugs designed to target specific genetic mutations in her cancer. These tests can also reveal which chemotherapies might be most effective in fighting a patient鈥檚 tumor.
鈥淭he genetic testing panel I underwent at UC Davis was very cutting-edge, and it provided important information about how to effectively treat my cancer,鈥� Lacasia now says.
In Lacasia鈥檚 case, the molecular and genetic tests revealed that her cancer was a 鈥渨ild type,鈥� meaning it did not have the mutations that can cause some lung cancers to take hold and spread, and which can be effectively targeted by new state-of-the-art medications. So Gandara recommended a clinical trial that used an approach now proven effective for people with Lacasia鈥檚 鈥渨ild type鈥� cancer.
Instead of just one medication, patients like Lacasia in the clinical trial received two drugs, usually considered ineffective when used together. Yet in the clinical trial, Lacasia took the two drugs 鈥� erlotinib (Tarceva) and pemetrexed (Alimta) 鈥� in a novel alternating schedule that Gandara knew from experience could help treat Lacasia鈥檚 cancer.鈥淭he novel schedule in which we give the drugs enables patients to get the greatest benefit from both therapies,鈥� Gandara says.
鈥淏y using this approach, we took two drugs that ordinarily just provide disease control 鈥� that is, the cancer stops growing 鈥� and made them much more effective,鈥� he says. This approach is now being used at hospitals worldwide, as well as in UC Davis鈥� oncology program clinical trials, chaired by oncology physician-scientist Tina Li.
The treatment Lacasia received in the clinical trial proved to be extraordinarily effective against her cancer. She had a 鈥渃omplete response鈥� 鈥� meaning that there were no visible signs of lung tumors on screening tests, and the cancer has stayed in remission for more than two years.
鈥淲e hope my cancer can be managed more like a chronic disease, since I will be on treatment for the rest of my life,鈥� Lacasia says.
Now, Lacasia is able to do the things she enjoys, such as gardening and creative writing. Married two years before her diagnosis, she lives in a house she and her husband designed and built together. She enjoys traveling and, for her birthday last year, she hiked to the top of one of the waterfalls at Yosemite National Park. She鈥檚 involved in the Bonnie J. Addario Lung Cancer Foundation as a support group participant. She also found solace through a group that helps cancer patients and survivors write about their experiences. 鈥淚鈥檝e learned to confront my fears about lung cancer and find peace, and also be an advocate for the best cancer treatment I can obtain,鈥� Lacasia says.
Through the genetic testing she underwent and the innovative treatment she received at UC Davis, Lacasia found renewed hope.
鈥淚 believe Dr. Gandara and the approach he took saved my life,鈥� she says now.
At the same time, choosing to become an informed participant in her diagnosis and treatment 鈥搃ncluding genetic testing for her tumor and working with Gandara to try innovative approaches to therapy 鈥� has been crucial to her survival, she says.
鈥淚n fighting cancer you can鈥檛 be passive. If I had not switched to an oncologist whose philosophy aligned with my own, I don鈥檛 think I would be here today,鈥� she says.
--------------------------------------------------------------The is a . These centers are characterized by scientific excellence and the capability to integrate a diversity of research approaches to focus on the problem of cancer. They play a vital role in advancing towards NCI's goal of reducing morbidity and mortality from cancer.This piece does not necessarily represent the views of the National Institutes of Health.
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