It was the picture (see below) that, to me, said it all: a 96 year old woman -- one of the first patients in the world to receive a brand new cancer drug--, and a large tumor on her neck had melted completely away. But it was the smile on her lips that you couldn't avoid noticing.
Let's set the stage: You have spent the last 5 days in a large convention center at the Annual Meeting of the American Society of Clinical Oncology in Chicago running from presentation to presentation and meeting to meeting. You have heard more information presented in more rapid fire sequence than any human being can possibly absorb. You have logged 22 miles (literally) in the process. You are a bit tired and run down, sitting in the last presentation of the last session on the last day of the meeting and you are craving to return home. Then the lecturer shows a picture that reminds you why you do what you do.
The topic of the session was a new drug to treat cancer. It is called MEDI4736 and is in the general class of immunotherapy drugs which have generated so much excitement at this meeting and elsewhere. These are drugs which have been reported to stabilize and/or shrink melanomas and now other cancers by allowing the body to once again recognize cancer cells as "outsiders". There has been considerable success in using these drugs to treat melanoma, and now a study is being presented which expands the use of this new drug in early trials against a variety of cancers. In fact, the drug has shown some surprising results, stabilizing and shrinking some cancers in patients who had received prior treatment and where most of us would have thought immunotherapy drugs would have little or no success.
Then the data are presented which show that in fact some of these "non-immune" cancers do respond to the new drug, including head and neck cancers, pancreatic cancers, and esophageal cancers among others. The data are impressive--especially for an early stage study. Lots of data slides with lots of numbers flashing past quickly, but the over 1000 cancer researchers and clinicians in the room (it was standing room only) are entranced. Then up comes the picture.
A 96 year old woman had HPV-negative head and neck cancer with a large, unsightly mass sticking out of the side of her neck. A companion picture 28 days later shows the mass is almost completely gone. But what draws your attention on the second picture is a very faint, Mona Lisa-like smile on the part of her face visible on the picture. Then the investigator presenting the data confirms for all that the smile was genuine.
That was the moment that hit my heart. There was so much in that picture and in that smile. I wasn't alone in my quick assessment: another doctor who provided the commentary on the presentation made the same observations that I suspect all of us were thinking. I took a quick photo of the slide which is attached below.
Here was a 96 year old woman with a terribly disfiguring cancer who had failed prior chemotherapy. We normally don't even dream of treating patients of this age with standard treatment, let alone brand new drugs that have been tried in only a couple of hundred patients worldwide at most. But she took a chance at participating in a clinical trial of a brand new drug about which little was known about its impact on the disease or its side effects. Theoretically those side effects could have severely affected her or even been fatal (unlikely with this class of drugs as it turns out, but possible). The researcher was willing to include her in the trial despite her age. And, it was a new drug that the researchers weren't certain would even work in this disease. They were exploring to answer that question. Then the tumor goes away, and she does fine.
I don't know how long this woman responded to the drugs or if her response is continuing as I write this. What I do know that for this older woman, when most would have said there is nothing to offer or that she was too old or too frail to get a brand new investigational drug, something that happened that at least for a brief period of time changed her life.
As it turns out, this drug on very early analysis appears to have a positive benefit for some patients in a number of different cancers. There is much more work to be done to find out more information, but as a start the findings presented at the meeting were both interesting and exciting.
Way deep down, the picture said it all. It tells all of us to have hope, to continue exploring our research and our trials to find new treatments, to offer better care. But one could not, cannot and should not ignore the smile. That's the reason so many of us do what we do.
Hopefully, we will see many more smiles in the years to come.
Note: Unfortunately, because of technical issues, I was not able to put the picture into the blog. I have provided a link to the picture which is part of a comment I made on Twitter at the time the picture was shown to the audience.