Treating and Managing Metastatic Disease

Reasons for Hope: Options are available to keep disease at bay.

Not too many years ago, when a patient received a diagnosis of cancer that had spread beyond the primary site, doctors had little to offer. Now, they have an increasing number of therapies, emotional and financial support and an improved quality of life. Years of research are yielding dividends in the form of more active drugs and more effective treatments to deal with metastatic disease. Many metastatic cancers are moving toward becoming manageable chronic diseases, and for a few types of cancer, cures are even possible.

At age 30 and having never smoked, Anne Marie Cerato received a diagnosis of stage 3 lung cancer in April 2009. The Toronto resident underwent chemotherapy and radiation together, followed by surgery, but the cancer came back in May 2011. Cancer cells had also spread to her other lung. Radiation and surgery were no longer options—doctors told her to wait until she was symptomatic, at which point they would treat her with chemotherapy.

But for Cerato, “going home and sitting and waiting and watching was not good enough,” she says. She began investigating her options and found a clinical trial for an investigational drug, now known as Xalkori (crizotinib). She spoke with her oncologist, who referred her to a nearby center participating in the trial. Analysis of her tumor cells revealed that they carried an uncommon mutation in the ALK gene, which produces a protein leading to growth and spreading of cancer cells that is blocked by Xalkori. She enrolled in a phase 3 trial where she received the experimental treatment. Cerato has been taking the drug for a year. “My scans are clear, everything is stable, and so far there is no evidence of disease in my lungs, which is great,” she says.

Cerato says that while receiving a diagnosis of metastatic (stage 4) disease was devastating, in some ways it was also liberating.

“It gave me permission to realize that my life would never really be normal,” Cerato says, “and allowed me to choose to live my life for myself and not for anyone else.”

One action she found therapeutic was getting tattoos, which was “a way of exerting control over my own body,” she says. While Cerato says she knows Xalkori isn’t a cure, “It has given me a completely clean slate and lots and lots of hope because I’m responding so positively and others are too.”

[My diagnosis] gave me permission to realize that my life would never really be normal and allowed me to choose to live my life for myself and not for anyone else.

The goal of treatment for late-stage cancer varies, depending on the type of cancer. In some cases, a cure may be possible with current therapies, even when the cancer has spread beyond the primary site. In other cases, although a cure may not be attainable, newer and better therapies are extending the time patients can live with their disease while maintaining a good quality of life. A few cancers are even becoming chronic diseases that can be stabilized and managed with a succession of different treatments.

[Read "The Molecular Revolution"]

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