Lowly pill beats can­cer

Cut­ting-edge Van­cou­ver trial uses a blood-pres­sure pill to fight off Tr­ish Keat­ing’s can­cer; it is now al­most un­de­tectable

Vancouver Sun - - FRONT PAGE - PAMELA FAYERMAN

Af­ter four can­cer re­lapses in the past five years, movie cos­tume designer Tr­ish Keat­ing knew that with­out a mir­a­cle, she had just months to live.

Her re­prieve came a few months ago in a most un­likely form: a blood-pres­sure pill that no one had ever used, or even con­sid­ered, for can­cer.

“I was months away from death. So this is re­ally like a mir­a­cle. And so hard to be­lieve,” Keat­ing said Mon­day in an in­ter­view at her home be­fore join­ing her walk­ing group for a two-hour trek.

Keat­ing is healthy now, but she has scars and lin­ger­ing side-ef­fects from five years of can­cer treat­ments, which be­gan when 60 cen­time­tres of her colon was re­moved af­ter a colonoscopy de­tected Stage 3 can­cer.

Re­cur­rences in other parts of her body were at­tacked with ra­di­a­tion, surgery and chemo­ther­apy.

Last fall, her on­col­o­gist, Dr. Howie Lim, de­liv­ered the harsh news that she would prob­a­bly not sur­vive.

But at that time, the B.C. Can­cer Foun­da­tion was rais­ing money for its new per­son­al­ized onco-ge­nomics re­search pro­gram, which se­quences the can­cer genes of pa­tients with un­con­trolled or in­cur­able can­cers. While stan­dard pathol­ogy tests iden­tify can­cer types, the new pro­gram is de­signed to tell doc­tors a lot more about the ab­nor­mal genes and bi­o­log­i­cal en­gines be­hind an in­di­vid­ual pa­tient’s can­cer. With that in­for­ma­tion, ex­perts can check drug data­bases to find some­thing tai­lored to the pa­tient’s dis­ease.

Us­ing gene-se­quenc­ing in­for­ma­tion gleaned from the tu­mour re­moved from Keat­ing’s spine, ex­perts at the BC Can­cer Agency’s Michael Smith Genome Sciences Cen­tre matched it to a blood-pres­sure med­i­ca­tion that blocks ab­nor­mal pro­teins iden­ti­fied in the tu­mour sam­ple.

Five weeks af­ter start­ing the blood-pres­sure drug, Keat­ing had so­phis­ti­cated PET-CT imag­ing that re­vealed a pro­found im­prove­ment. At the two-month mark, just re­cently, an­other scan showed she had “barely de­tectable” can­cer.

It was an amaz­ing turn­around given that Lim sus­pected that Keat­ing’s last surgery, to re­move a tu­mour on her spine, would only re­lieve her pain, not cure her. Sure enough, only a few months later, can­cer cells were found in lymph nodes through­out her body.

“When I told her she was pal­lia­tive, that our best op­tion was to con­sider more chemo­ther­apy to pro­long life­span, by two to three years, she felt I was giv­ing her a death sen­tence,” Lim said in an in­ter­view.

Then it was de­cided to of­fer Keat­ing par­tic­i­pa­tion in the new pro­gram.

Keat­ing said she knew the blood-pres­sure med­i­ca­tion was ex­per­i­men­tal when it came to can­cer. It was a “risk worth tak­ing be­cause the al­ter­na­tive was just more poi­son­ing,” she said, re­fer­ring to the toxic ef­fects of chemo­ther­apy drugs.

With per­son­al­ized oncoge­nomics “we are try­ing to fig­ure out the blue­print of pa­tients’ can­cers, the (pro­tein) pathways driv­ing growth,” said Lim. “Ev­ery­one’s can­cer is dif­fer­ent, ge­nom­i­cally, so it’s help­ful to try to in­di­vid­u­al­ize the treat­ment.”

Lim said he doesn’t want to sug­gest that ev­ery­one will ben­e­fit from per­son­al­ized oncoge­nomics. It is still ex­per­i­men­tal, he cau­tions, and not all pa­tients have “durable” re­sults.

He is writ­ing up Keat­ing’s case for pub­li­ca­tion in a med­i­cal jour­nal so that doc­tors around the world can ben­e­fit from the blood-pres­sure drug dis­cov­ery and per­haps use it on other pa­tients. (He is with­hold­ing the name of the drug un­til his pa­per is peer-re­viewed and pub­lished.) “We’ve never tried this med­i­ca­tion be­fore nor has any­one else to my knowl­edge. Yes, we hit a home run. But it takes a lot of steps and we could never do this with­out the Genome Sciences Cen­tre.”

Lim said the pos­si­bil­i­ties of per­son­al­ized can­cer treat­ment are ex­cit­ing, but doc­tors and sci­en­tists must man­age ex­pec­ta­tions so hopes don’t spi­ral out of con­trol.

“In gen­eral, in on­col­ogy, you make an ed­u­cated guess about what treat­ment to of­fer. Ge­nomic treat­ment helps us guess bet­ter,” he said. “But we don’t know if ev­ery pa­tient should have it. We have seen pa­tients where it hasn’t helped. So in our re­search we are try­ing to an­swer what is the util­ity, and how of­ten will it change treat­ment?”

Lim said he shares Keat­ing’s shock, awe and hap­pi­ness, es­pe­cially since up un­til re­cently he was mostly giv­ing her bad news.

“It’s been re­ally em­pow­er­ing to fi­nally of­fer some hope,” he said. “It’s very true that some amaz­ing things have hap­pened. I am shocked that this heart med­i­ca­tion has worked so well,” Lim said.

He said Keat­ing’s blood pres­sure has been closely mon­i­tored over the past three months to en­sure the med­i­ca­tion, which Keat­ing be­lieves she may be on for life, doesn’t lower it too much.

The first “mys­tery” pa­tient to have his can­cer genome se­quenced was the late Dr. Don­ald Rix, a bio­med­i­cal in­dus­try gi­ant and B.C. phi­lan­thropist. His iden­tity was re­vealed on the same day that a can­cer foun­da­tion gala helped raised $5 mil­lion for the per­son­al­ized onco-ge­nomics pro­gram. That meant that the costs of se­quenc­ing Keat­ing’s can­cer and that of hun­dreds of other pa­tients can be cov­ered through the clin­i­cal trial.

WAYNE LEIDENFROST/PNG

Movie cos­tume designer Tr­ish Keat­ing had four can­cer re­lapses over the past five years.

WAYNE LEIDENFROST/PNG

Us­ing gene-se­quenc­ing in­for­ma­tion gleaned from the tu­mour re­moved from Tr­ish Keat­ing’s spine, ex­perts at the BC Can­cer Agency’s Michael Smith Genome Sciences Cen­tre matched it to a blood-pres­sure med­i­ca­tion that blocks ab­nor­mal pro­teins iden­ti­fied in...

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