In February 2015, there was no indication that my life was about to radically change. I was a practicing attorney and happily raising two young children with my husband. At 40 years old, I was healthy—or so I thought—and had no physical symptoms to alert me to the devastating news that was about to come.
A serious car accident had brought me to a hospital with neck and head injuries, but my main concern was for my then 6-year-old son who was with me at the time and had sustained a concussion. I was given a body computed tomography (CT) scan to make sure I had no internal injuries. And, although the test showed there were no broken bones or other trauma related to the car accident (I was later diagnosed with a concussion), it did show a 3.75-cm mass in my left lung, which neither I nor the attending physician in the emergency room was very concerned about at first.
The physician asked about my smoking history—I’m a never-smoker—and any recent changes to my weight—there were none—and whether I was experiencing any shortness of breath or persistent coughing. Again, the answer was no. In fact, I had just been on a family skiing trip the day before the car accident and felt fine. My biggest concern at the moment was that my son and I had narrowly escaped a near-fatal car crash. The last thing on my mind was that I could have lung cancer.
Going Into Denial
When I saw my family physician a few days later, I still wasn’t too worried about the mass in my lung. But when my physician read the hospital report and saw the size of the tumor, she suggested I have it biopsied. The pathology report showed I had anaplastic lymphoma kinase (ALK)-positive stage IIIA non–small cell adenocarcinoma. At first, I didn’t believe the report could be true.
Aiming for Better Survival Odds
After meeting with an oncologist, I was reassured that even with my late-stage disease, there was still a chance, albeit a small one, for a cure. She proposed an aggressive course of treatment, including concurrent neoadjuvant cisplatin and etoposide and radiation therapy, followed by surgery.
Although the surgery successfully removed what remained of the primary tumor, a pathology examination of the surrounding tissue found malignant cells in a lymph node in my mediastinum, which meant I was at high risk for recurrence. I had just gone through the hell of chemotherapy, radiation, and surgery, which at least, I consoled myself, bought me more time to decide on the next step. Still, the news was shattering.
Over the next decade, more and more fatal cancers will become curable or at least manageable. I hope I will be among those fortunate survivors who get to see that day.— Laura Greco
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My oncologist suggested I have four rounds of a doublet of pemetrexed (Alimta) and carboplatin, and it was successful in keeping me disease-free for 15 months. During that time, I began to feel optimistic that maybe the cancer wouldn’t recur after all. But in September 2016, I began having pain in my neck that traveled to my head. A magnetic resonance imaging of my upper body found 10 tumors, between 1 and 2 cm, spread all over my brain, and a CT scan discovered 3 smaller nodules in my chest. Now, I have stage IV disease, and my chance of living 5 years is about l%.1 Even if I turn out to be among the lucky 1%, with two young children—ages 6 and 9—I want to see graduate from high school, 5 years isn’t enough time. I need better survival odds.
My oncologist recommended a new ALK inhibitor alectinib (Alecensa), and within 3 weeks, the therapy reduced the brain tumors to half their original size and by 75% after 6 weeks, and they have continued to shrink, although none have completely disappeared. Unfortunately, my latest brain scan showed disease progression in one of the brain lesions. I opted to have stereotactic radiosurgery to treat it, and I’m continuing my current course of alectinib.
Contemplating the Next Step
To ease the stress in my life, to focus on my health, and to concentrate on spending time with my young family and on patient advocacy activities, I have gone on permanent disability. My husband and I have decided that making family memories for our children is a priority, and we take more trips now and worry less about saving for the future. We recently returned from a trip to Alaska, where I hiked 6 miles up a glacier. Take that, lung cancer!
I’m grateful that newer therapies such as alectinib are allowing me to live a fairly normal life, and I know that other ALK inhibitors, such as lorlatinib (PF-6463922), will be available when my cancer progresses. But giving terminally ill patients incremental time of a few months or even a few years is not good enough. Living with incurable cancer is like having a guillotine over your head. You know that any moment could be your last. We need faster research and more effective therapies for cancers like mine.
I also appreciate the efforts of all the medical oncologists and researchers who are devoting their lives to treating and curing cancer. Their work is allowing patients like me to live years beyond our original prognosis, and I’m hoping their achievements give us many more productive years. But what we really need is to turn deadly cancers like metastatic lung cancer into chronic diseases that can be managed for decades. I know that is the direction research is taking cancer and expect that over the next decade, more and more fatal cancers will become curable or at least manageable.
I hope I will be among those fortunate survivors who get to see that day. ■
Ms. Greco lives in Wilton, New York.
1. Cancer.Net: Lung Cancer: Non-Small Cell Statistics. Available at www.cancer.net/cancer-types/lung-cancer-non-small-cell/statistics. Accessed July 25, 2018.
Editor’s Note: Columns in the Patient’s Corner are based solely on information The ASCO Post received from the survivors interviewed and should be considered anecdotal.