I believe in miracles. That might sound odd coming from an
oncologist—especially since our field is driven by the data. Our path forward
continues to be built through trials and the collaboration between clinicians
and patients, working together to forge a better way to treat cancer. I
certainly believe it, but still…I believe in miracles.
Judy* is one of those miracles. I had met her eight years
earlier after she had been diagnosed with metastatic endometrial cancer. She
had been diagnosed seven months earlier and after a successful surgery,
underwent chemotherapy “to prevent recurrence.” Despite this, her
post-treatment CT scan showed that the cancer had spread to her liver. It was
so surprising to her team that they pursued a liver biopsy, which
unfortunately, confirmed metastatic disease.
She was devastated and scared—unclear what her future held.
Reviewing her records, I was not optimistic either. Her tumor had proven itself
to be quite virulent, and unfortunately, there weren’t great standard of care
options. At the time, I worked outside of Boston but suggested she seek out
clinical trials there, since none were available where I was. She had hoped to
stay local and initiate a treatment closer to her family, and given the
seriousness of her condition, I felt that would be appropriate.
“What am I looking at, doc?” she asked.
“Well, it’s not a curable situation and given that it grew
despite chemotherapy, I think you have months, not years.”
“You mean, I could be dead in six months?” she asked.
“I don’t have a crystal ball and don’t pretend to read the
future.” I said. “But this is a serious situation and most patients typically
live less than a year.”
She sat there shocked for a while, as did her family. Her
daughter started to cry and I felt powerless to do anything. So, I sat with
them, not saying anything.
“Well, what next?” she finally asked.
Since she felt well right now, I suggested we try endocrine
therapy. Perhaps we could stabilize her disease in order to give her time,
without exposing her to the toxicities of chemotherapy. I explained my
rationale to her, assuring her I would follow her closely to ensure she did not
experience rapid development of symptoms due to her cancer. She asked many
questions and ultimately, agreed to this approach.
I saw her every three weeks; after six weeks, she noticed
her energy had improved. In addition, her appetite, which had been diminished
during chemotherapy, had returned and she was, in fact, putting on weight. I
marveled at how well she tolerated treatment, and after three months, we
repeated imaging. To my shock, her tumor had disappeared—her liver was normal
with no signs of the cancer that had previously been seen. She was in
remission.
She was stunned with this news, and overjoyed nonetheless.
“Do you still think I’m going to die though?”
“I think I was wrong,” I responded. “I don’t think you’re
going anywhere right now.”
I’d like to think it was a brilliant recommendation on my
part, based on the role of hormonal pathways in endometrial cancer. But that would
be false. My recommendation was based on a single-arm, phase 2 trial that
showed a good response rate, regardless of tumor grade or hormone receptor
status. It was driven by my desire to treat her with agents that would maintain
her quality of life, not detract from it. Yet her response far exceeded what
even I hoped for, and I could not explain why she responded so well. To me, it
was nothing short of a miracle.
As we move forward in oncology, my hope is that miracles
like this happen more often, guided not by chance but by a better understanding
of cancer biology. See, the hope for precision medicine remains a real one that
I firmly believe in, and I think this will be the way forward for others who
come after Judy.
*Name changed to protect privacy
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