Dyann House, a cancer trial participant at Phoebe Cancer Center, will continue to receive Herceptin for a full year. House, who will be part of the study for an additional 20 years, said she is glad to be a part of something that will help women all over the world.
ALBANY, Ga. — It was toward the end of January, as 61-year-old Dyann House prepared for a Caribbean cruise, that she noticed a lump in her breast. She needed to have her cholesterol checked anyway, she thought, so to “be on the safe side” she went to see her doctor.
A mammogram and subsequent biopsy of the lump led to a diagnosis no one wants to hear. Cancer.
While such news is never good, further tests at the Phoebe Cancer Center indicated the tumor had been detected relatively early. House’s was a stage 2 cancer of the breast (out of four possible stages), according to Dr. Chirag Jani, a hematologist and oncologist at the center.
In House’s case, that meant the tumor was between 2 and 4 centimeters in size and had not yet spread, or metastasized, to the lymph nodes. Though shaken by the news, House inquired whether treatment could wait until after the two-week cruise she was looking forward to.
“Not a chance” was, in effect, Jani’s response.
“He told me that while the cancer was at a fairly early stage, it was of a more aggressive type, and we should get right to the treatments,” House said. “I wasn’t about to argue. Dr. Jani wrote to the cruise line and to Delta Airlines trying get a refund for me. Delta was very good about it, but the cruise line said no.”
House’s tumor had tested HER2 positive. Simply put, that meant the presence of a specific protein called human epidermal growth factor receptor 2 had been detected. About 20 percent of all breast cancers are HER2 positive, according to Jani, and most experts consider them much faster-moving than other cancer types.
The good news: Some very effective drugs are available to combat HER2 breast cancers.
Her treatment strategy would involve almost every option commonly considered to combat cancer, House said, including chemotherapy, surgery, radiation, then follow-up medication. In consultation with Jani and her surgeon, Dr. Joseph Burnett, it was considered safe to perform a lumpectomy, or simple excision of the tumor and surrounding tissue, rather than remove the entire breast.
Preceding surgery, however, House would undergo a long and challenging regimen of chemotherapy, designed to shrink the tumor and increase effectiveness of the procedure.
According to House, it was around this time she was approached by Phoebe Cancer Center staff, including Jani and Cathy Shoemaker, a certified clinical research professional and clinical trial coordinator for the center, about participating in a cancer trial. It was explained to House that patients taking part always receive no less than standard treatment alone, and as more patients become involved, cancer treatments around the world improve.
House also learned that of the 25 percent of cancer patients who qualify for trials, just 3 percent of that number actually do take part. She, however, didn’t hesitate.
“I trust my doctors to look after me. I knew I wouldn’t miss out on treatment I needed. The only way we have to test these new drugs is for patients to volunteer, and besides,” House said, smiling, “I thought I might get more special attention if I volunteered.”
Before receiving treatment, House would undergo an exhaustive battery of tests, designed to establish a physical baseline to compare against changes caused by her cancer treatments. One essential test would be the MUGA, or Multiple Gated Acquisition scan, to assess the function of her heart — important because of heart tissue damage sometimes experienced in chemotherapy treatments, Shoemaker said.
The trial in which House would participate, according to Shoemaker, would be labeled NSABP B-41, a nationwide study of 522 breast cancer patients. Each patient within the study would be selected randomly to receive either a treatment considered standard for the type of tumor, or one of two alternative treatment programs consisting of the standard plus an additional drug or drugs.
The primary aim of the study, said Shoemaker, would be to determine whether one or both alternative groups would yield a greater rate of pCR (pathologically complete result) than for the women in the standard treatment group. Those whose tumors, for all known means of detection, had become benign would have experienced a pCR, Shoemaker said. It had been randomly determined that House’s treatment would be standard.
The initial round was by far the worst, according to House, consisting of an 84-day “chemo cocktail” of doxorubicin and cytoxan administered intravenously through a life port surgically installed in her upper chest. Doxorubicin is sometimes referred to by patients and staff as red devil or red death for the unsavory effects on cancer patients, including hair loss, nausea, reduction of white blood cells and possible heart damage. The chemical typically colors the urine bright red.
Cytoxan may be even less inviting than doxorubicin, despite the absence of a colorful nickname, and may cause a certain kind of leukemia.
“I was tired a lot, and nauseous,” House said. “But I got through it all. The medicine helped a whole lot with the nausea.”
House said her second round of chemo was a lot easier. It consisting of Paclitaxel on a mixed schedule for 112 days, along with Herceptin once each week for the same period, until her surgery.
According to Shoemaker, Herceptin is a breakthrough drug, beneficial to patients like House, who are HER2 positive, because it interferes with production of the HER receptors, proteins embedded in the cell membranes that turn genes on and off.
Seven months from the time House’s breast cancer was diagnosed, she underwent her planned lumpectomy. The specific area inside the breast was removed and biopsied on the spot. According to House, there was no trace at all of malignancy. She had achieved the coveted pathologically complete result.
House would still receive a 35-day round of radiation therapy, hopefully to destroy any malignant cells which might remain. The therapy was “like a real bad sunburn,” according to House, and she’ll remain on Herceptin for a full year.
Her tumor block, a sample of heart cells, blood plasma and serum, will be sent to a central study lab, and as a part of the cancer trial House will continue to be followed for 20 years. The study, sponsored by NSABP, is concerned with more than House’s simple cancer survival. It also notes how the the treatments may have affected various organs and systems, including her heart, liver and lungs.
“This has really been hard at times,” House said. “But it’s absolutely worth it, and it feels good to know that what I’m doing here is helping women all over the world.”