Cholangiocarcinoma Research is Expanding, But Many Questions Are Still Unanswered

Research into treatments for cholangiocarcinoma is branching out, but there are still more questions than answers.
BY BETH FAND INCOLLINGO @fandincollingo
PUBLISHED: MARCH 28, 2016
“MELINDA BACHINI (center), whose cholangiocarcinoma has responded to immunotherapy, mingles with attendees at the Cholangiocarcinoma FoundationAnnual Conference. PHOTO BY BARR PHOTOGRAPHY (COURTESY OFTHE CHOLANGIOCARCINOMA FOUNDATION”
MELINDA BACHINI (center), whose cholangiocarcinoma has responded to immunotherapy, mingles with attendees at the Cholangiocarcinoma Foundation Annual Conference. PHOTO BY BARR PHOTOGRAPHY (COURTESY OF THE CHOLANGIOCARCINOMA FOUNDATION)
Back in 2009, Melinda Bachini thought her job as a paramedic explained all her physical complaints – an irritable stomach from eating at odd times, exhaustion from working 24-hour shifts, right shoulder pain from lugging medical equipment.

The mother of six was dumbfounded when it turned out her symptoms were the result of a grapefruit-sized tumor in her liver. It took a while, but her doctors figured out that the mass was cholangiocarcinoma, a cancer she’d never heard of in her life. Even after treatment with surgery, Bachini was told she faced a 76 percent chance that the bile-duct cancer would recur.

When it did, in her lungs, Bachini was faced with another challenge: She wanted to join a clinical trial, but first had to convince the governor of her home state, Montana, to sign a bill requiring health insurers to cover routine patient costs associated with participating in such trials.

It was a frustrating diversion, but a fateful one. After the bill was signed and she had undergone chemotherapy, Bachini learned about a trial of a treatment that uses a patient’s own immune cells to fight cancer. In adoptive T cell therapy, researchers harvest immune cells that are naturally programmed to fight the patient’s cancer, multipy them in a lab and then reinfuse the microscopic army back into the patient’s body.

Bachini joined the trial at the National Cancer Institute and spent a month in the hospital as her immune system geared up. When she went home, she recalls, “things started improving right away. My chronic cough went away. I could walk my dog. Day by day, everything was better – it was incredible.”

The treatment didn’t cure Bachini’s cancer, but it shrank her tumors and kept the disease at bay, without any other therapies, for 18 months. Then doctors at the NCI treated her again, focusing this time on T cells targeting a specific mutation in the protein ERBB2IP, which they knew was present in her tumor. With only recent mild tumor growth, she’s been doing well for the past 28 months.

A six-year survivor of cholangiocarcinoma, Bachini is an exceptional responder, even among the 11 others in the trial. Typically, patients with advanced cholangiocarcinoma face a very poor prognosis.

But Bachini, who now works as an advocate with the Cholangiocarcinoma Foundation to offer fellow patients hope, says her experience has convinced her that “every day holds the possibility of a miracle.”



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