But a new and unique clinical trial at Georgia Regents University Cancer Center is targeting the way her pancreatic cancer eludes the immune system and giving her hope for better survival.
Pancreatic cancer is “one of the deadliest cancer types” and one of the few major cancers whose death rates have been rising over the last decade, according to the American Cancer Society’s Cancer Facts & Figures 2013. Most patients die within a year of diagnosis and only 6 percent survive for five years, according to the report. In large part it is because patients often don’t suspect they have the cancer until it has advanced, said Dr. Samir N. Khleif, director of the cancer center and lead investigator of the experimental therapy, known as CT-011.
“It is discovered late because it is deep in the abdomen so there are no signs the majority of the time that indicate you have a tumor until it is pretty late,” he said.
It was while they were doing a CT scan on Tilton to rule out kidney stones as the cause of the blood in her urine that they happened to notice her pancreas was dilated. A blood test showed elevated amounts of a pancreatic cancer biomarker but it took two endoscopic ultrasounds and fine needle biopsies of the pancreas before they turned up cancer and she was diagnosed on Nov. 1.
“If I hadn’t had that infection I would never have known,” Tilton said. After surgery that found her cancer had spread to four lymph nodes, she was offered the standard therapy of chemotherapy and radiation but “I was not a big fan of radiation,” Tilton said. “I was told that the treatment really wasn’t all that promising. It would not cure the cancer.”
Instead, she chose the chemotherapy and the clinical trial of immunotherapy using a monoclonal antibody. Typically, T cells in the immune system would use a protein called programmed death 1 or PD-1 to kill a tumor cell but the tumor has a way to bind up that protein and inhibit the T cell, Khleif said, The therapy prevents that initial tie-up, he said.
“You’re preventing the binding from happening,” Khleif said. A second effect comes from the chemotherapy killing tumor cells and thus shedding markers that the freed-up immune cells can key upon, Khleif said.
“When you enhance that immune response then you are activating the immune response further so it works all as a package, which is a very nice synergistic package,” he said.
Tilton is the first patient on the clinical trial and was happy to find it in her backyard.
“This was just so convenient to have a trial here so close,” she said. “We live in Aiken. (But) it’s still better than driving up to Duke or Emory.”
“Or Houston,” said her husband, Lee.
In fact, the GRU cancer center is the only center offering it right now but there has been interest from other centers and it is under discussion, Khleif said.
Tilton said she is “doing really well” so far on the clinical trial and she feels it is offering her “a better chance” for longer survival.
“I like the fact that this drug hopefully will help my own immune system fight the cancer,” Tilton said.
“Hopefully, that will be the outcome.”