By Claudia Cornwall
A growing understanding of Canada’s top cause of premature death has led to a new wave of screenings, treatments—and hope.
Prue Boyd, 65, of Nanaimo, B.C., developed a gastrointestinal stromal tumour—or GIST, as it’s called—in her stomach in January 1999. Though she was a nurse, she didn’t know much about this kind of cancer. As she started to learn more, she realized she was in for quite a fight. Her GIST was aggressive. The only option was surgery to remove the tumour, but the chance of that being successful was only 50 percent. Still, she had the surgery, and afterwards the physicians were optimistic—they’d got the whole tumour, they told her. But by December, the cancer was attacking her liver.
The disease had returned, and it was nearly certain it would continue to spread—and quite quickly. Despite the bleak odds, Boyd wanted to prolong her life; she went under the knife again in April 2000. At year’s end, the cancer was in her abdomen. Boyd very likely had little time left.
Nevertheless, hoping for something new, her doctors sent her to the B.C. Cancer Agency in Vancouver. Boyd recounts, “I just happened to be there when they got word there was going to be a drug trial later in 2001.” When asked whether she wanted to be in it, she didn’t hesitate in accepting. She began taking the drug Gleevec in July 2001. “So far, it’s doing its job,” she says. Her tumours have shrunk and no new ones have appeared.
Eight years after her initial diagnosis, she says, “I’m alive. I feel wonderful.” Now retired, she gardens, works out at the gym four times a week, travels and enjoys her two children and four grandchildren.
“Gist and Gleevec is an amazing story. It is jaw-dropping,” says Dr. Calvin Law, a surgical oncologist at the University of Toronto’s Sunnybrook Health Sciences Centre. “I love happy stories and this is one of them.” Originally, the drug was developed to fight chronic myeloid leukemia, or CML, which is caused by a genetic mutation that stimulates cancer cells to multiply wildly. “Gleevec is like a key that locks down the mutation,” explains Law. It just so happened that GIST had the same mutation, the same keyhole.
Before Gleevec was developed, 50 percent of GIST patients who could not have surgery would die within 15 months. With the drug, of the patients who can’t have surgery, 50 percent live almost five years. “We often spend billions of dollars to get a two or three percent increase in survival. This is way out of the park,” says Law.
In April 2007, a trial to test what happens when Gleevec is given to patients after surgery (but before the disease has had a chance to recur) was stopped. “There was such a significant decrease in disease recurrence that an independent monitoring committee felt it wasn’t fair to give people a placebo. Everyone was switched over,” says Law.
Michael Wosnick, executive director of the National Cancer Institute of Canada, says cancer’s not a death sentence anymore. He points out that in the 1940s, in the institute’s early years, only 25 percent of people newly diagnosed with cancer survived; now, 60 percent do. “We still have a lot of work to do. But cancer shouldn’t be the dreaded C word,” he says. Some cancers may be found to be easily cured, others might not. Still others likely will be like diabetes—chronic diseases that patients live with and manage. Like Boyd’s GIST: Controlling her condition is a simple matter of taking Gleevec four times a day.
“The improved outcomes are due in part to the fact that people are starting to heed messages about healthier lifestyles,” Wosnick says. “But they are also due to understanding, at a cellular and molecular level, the causes, enabling us increasingly to personalize medicine. This is far from the old ‘hit the broad side of the barn’ kind of approach. The more we understand what makes cancer tick, the more we can design treatments to exploit a unique feature of cancer cells.”
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