'I was given three years to live, now I'm cancer-free'
In 2003, Judy Perkins, now 56, was diagnosed with a small, early-stage breast cancer and had a mastectomy. And that, she thought, was that. However, a decade later, she had devastating news. Her cancer was back. It was now at stage 4, or metastatic, meaning it had spread to other parts of her body including her liver.
"I pressed my oncologist to give me an estimate of the time I had left. He guessed three years," says Perkins, an engineer from Florida. "My husband understood the gravity of the situation. My sons, Chris and Charlie, then 13 and 15, had the initial shock as well."
Over the next two years, despite undergoing chemotherapy to extend her life, Perkins' disease advanced inexorably. She developed a "bunch of tumours", including a cluster the size of a tennis ball in her liver and others in her chest, belly and lymph nodes.
"My quality of life had deteriorated rapidly," she says. "I was on morphine and getting to the point of wondering what death would be like."
Perkins's experience may sound bleak, but it is not unusual. One in eight women - and almost one in 800 men - will develop breast cancer in their lifetime and between 20 and 30 per cent of them will see the disease return. More than 57,000 people are living with metastatic breast cancer in England alone.
The disease can become metastatic up to 30 years after treatment and this spread is what makes the disease so deadly. What's more, as the NHS states, starkly: "Secondary (breast) cancer ... is not curable." Three in four women diagnosed with metastatic breast cancer will die within five years. This month, metastatic breast cancer took the life of 1990s supermodel Tatjana Patitz, at the age of 56.
Yet today, Perkins is not only alive and well, but also completely clear of cancer. How? In a triumph of experimental medicine, Perkins is the first person in the world to have been cured of metastatic breast cancer with immunotherapy.
Immunotherapy is revolutionising cancer care. For example, 20 years ago, metastatic melanoma had an average survival of around seven months with virtually nobody cured. Today, thanks to immunotherapy, survival rates are at around 40 per cent.
But other cancers, including breast cancer, have lagged behind. In trials only around 10 per cent of metastatic breast cancer patients have seen complete eradication of the disease.
One reason why is that an immune system attack happens when the body recognises an alien presence, such as a virus. Samik Upadhaya, assistant director of scientific affairs at the Cancer Research Institute in the US, says that cancer cells are similar to normal human cells, so generally don't trigger the same assault.
However, the more genetic mutations cancer tumours have, the better the immune system recognises them as an enemy. "We call tumours 'hot' or 'cold' depending on their mutations," Upadhaya says. "Melanoma is 'hot' while most breast, prostate and pancreatic cancers are 'cold'."
Scientists are focusing on therapies which make tumours more obvious to immune cells, and thereby enhance the immune system's natural killing power.
And, with around 22,000 cancer patients in hundreds of clinical trials for immunotherapy, Upadhaya says, "I expect to see great things in the next five years."
Perkins' treatment began in August 2015, when scientists harvested some of her own tumour-fighting immune cells. They were multiplied in a lab, and in December she was injected with 80 billion of them. She was also given pembrolizumab, an immunotherapy drug which takes the biological "brakes" off immune cells, allowing them to attack cancers more aggressively.
After a few days, Perkins' tumours had shrunk enough for her to come off pain medication. By May 2016, five months after her treatment, scans showed she was cancer-free, a result she describes as "miraculous".
Late last year, news broke of another success story from the US. Author and poet Stephanie Gangi, 66, who lives in New York, was first treated for breast cancer in 1999, but her cancer rebounded. It spread to her sternum in 2014 before, in 2021, a tumour the size of a grapefruit appeared on her adrenal gland.
But today that giant tumour has gone, along with all other signs of Gangi's cancer, thanks to an experimental cancer vaccine treatment. In this trial, scientists injected Gangi's adrenal gland tumour with a drug designed to boost levels of immune cells called dendritic or "professor" cells. These destroyed the tumour and then taught her immune system to recognise and attack other tumour cells throughout her body.
"This is the first time we've seen such an amazing response," says Upadhaya.
The ultimate hope is that the vaccine will train the immune system to fend off any future recurrences, by picking off stray cancer cells before they develop into tumours.
But with these treatments still in trials, what about now?
Nicholas Turner, consultant medical oncologist at The Royal Marsden NHS Trust and professor of molecular oncology at The Institute of Cancer Research says that 10 to 15 per cent of metastatic breast cancer patients, with a non-hormonal type of breast cancer called HER2 positive, are already being cured by drugs in use in the NHS.
Recently approved drugs for this type of cancer, such as Enhertu, are likely to increase that percentage. "It's probable that these new treatments are curing more people," says Turner. "It's just that we haven't been treating people long enough to know if their remission is permanent."
Early detection could also make a huge difference. Previous studies have shown that if metastatic breast cancer is caught extremely early some patients can be cured using current treatments. However, says Prof Turner, "By the time you have metastatic tumours that can be seen on scans there are literally billions of cancer cells in the body. Even if just a few of them escape treatment, they will eventually cause the cancer to come back." The hope is that in future, tests known as "liquid biopsies" will pick up tiny amounts of DNA shed by cancer cells into the bloodstream even before visible tumours have formed.
Routine liquid biopsies may also become key to curing other cancers that are often found too late, such as pancreatic and ovarian cancer. "It is a rapidly evolving field," says Turner.
Last week, Gangi had what she describes as a "nice and boring" scan showing no signs of cancer. "I have some resistance to tempting fate with any definitive proclamations," she says. "But I am hopeful, and I feel great."
A decade after her treatment, Judy Perkins has watched her sons grow up and is leading an active life involving backpacking and skiing.
"This treatment has been used for well over a decade now. Almost everyone who has had a complete response has remained cancer free," she says. "I'm not wasting time worrying about whether my cancer is coming back. I feel cured. I feel awesome."
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