Five Thousand Miles from Home, Anna Achieves Remission for Advanced Lung Cancer
Anna had advanced lung cancer that wasn’t responding to treatments. She started on a clinical trial at MSK that targeted her cancer on a molecular level. Today Anna is back home in Brazil with no evidence of disease.
Hear from our doctors, who say that the FDA approval of larotrectinib delivers on the original promise of precision medicine.
- Anna Muniz had Hodgkin lymphoma when she was a teenager.
- Sixteen years after treatment, she learned she had stage IV lung cancer.
- Anna wasn’t responding to treatments in her home country of Brazil, so she took a test to have her tumor analyzed for genetic mutations.
- Anna tested positive for a TRK mutation, which MSK lung cancer specialist Alexander Drilon happened to be studying.
- Anna connected with Dr. Drilon, and she agreed to participate in a clinical trial for a new medicine he was testing.
- The medicine, larotrectinib, works specifically on the TRK mutation — regardless of cancer type.
- Anna flew to New York to take part in the trial, and today, her scans show no evidence of disease.
In 2013, 16 years after undergoing treatment for Hodgkin lymphoma as a teenager, Anna Muniz found a lump on her neck.
Anna, a market researcher, underwent a biopsy near her home in São Paulo, Brazil. She was stunned to learn that the disease she thought was in her past had come back in a new way: as stage IV lung cancer.
“I felt very sad, of course,” Anna, now 33, recalls. “I was afraid people would lose faith in my cure, and also, I was afraid of losing my own faith.”
Having had chemotherapy before, Anna knew what to expect when she began the treatment again. Six months into her regimen, when the cancer hadn’t subsided, doctors switched her to another chemotherapy drug and started her on radiation therapy.
“We expected that to work, but unfortunately, the cancer was still there,” she says.
Anna’s situation perplexed her doctor, who recommended that Anna submit a sample of her tumor for genomic analysis. This type of test looks for genetic mutations that could make cancer particularly aggressive or resistant to treatment. If Anna had certain mutations, she could potentially take a medicine that targets those specific mutations, thus destroying the cancer.
The test was not covered by Anna’s insurance, but she and her husband were desperate for clues — and a glimmer of hope.
Anna’s test revealed three genetic mutations. Although medicines were being developed to target them, they weren’t readily available. So Anna underwent a third round of chemotherapy, which made her very ill.
“At this time, I was not hopeful,” she says. “We were feeling it could be the end of the road.”
But Anna and her husband held onto their faith. And unbeknownst to her, nearly 5,000 miles away in New York City, a doctor was looking for people just like Anna.
A Doctor’s Mission
Alexander Drilon is a lung cancer specialist who is also Clinical Director of the Early Drug Development Service at MSK. His latest research is on TRK fusions, which are mutations in certain genes that promote cancer’s development. One of the three mutations Anna had was a TRK fusion.
Together with his colleague David Hyman, Chief of the Early Drug Development Service, Dr. Drilon was studying a medication called larotrectinib (Vitrakvi®; LOXO-101) that can stop the chain of events that encourages cancer to grow.
“If you can knock out the protein made by the TRK fusion, then you can potentially knock back the cancer substantially,” Dr. Drilon says.
Larotrectinib attacks tumors at a genetic level and can therefore combat different types of cancer that share the same genetic errors. In clinical trials, it was benefiting many patients.
“With larotrectinib, there’s a very good chance of making the cancer shrink, decreasing symptoms, and keeping the cancer at bay for a long period of time,” Dr. Drilon says.
Larotrectinib is unique for a number of reasons. For one, it has the potential to help many people with cancer, including children. Medicines for pediatric cancers are often slower to develop than those for adult cancers.
Larotrectinib is also very well tolerated, even over long periods of time. When people need to take a drug for months or years, it’s important that there aren’t many side effects, Dr. Drilon notes, saying, “This drug fits the bill.”
A New Plan for Anna
In December 2015, Dr. Drilon received a call from Anna’s doctor in Brazil, who had been researching TRK fusions. They spoke about Anna’s situation and Dr. Drilon’s clinical trial.
“I told her this would be a good fit because we have this new medication that is paired very well with TRK fusions,” Dr. Drilon recalls. “I said, ‘If we could get her up here, I think this would help her.’ ”
Anna flew to New York City to take part in the clinical trial with Dr. Drilon. Her first dose of larotrectinib was in March 2016. Larotrectinib is given as a pill, so Anna didn’t have to stay in the hospital to receive it. And the medicine didn’t make her sick like the others had.
While she had a small recurrence after many months, the area was radiated and she went back on the medicine thereafter. Today, Anna’s scans show no evidence of active disease.
“We have achieved something truly amazing with Anna,” Dr. Drilon says. “Larotrectinib has allowed her to live her life in a meaningful way again. If her cancer had not been tested for a TRK fusion, things may have turned out very differently.”
Due to the clinical trial schedule that closely monitored each participant, Anna has had to fly to New York each month to pick up her medicine in person. The travel proved strenuous for Anna and her family, but she says it was well worth it.
“Of course I was a little concerned, but I knew I would go,” she says. “I wouldn’t have had any other opportunity for treatment.”
Anna has since returned to work and is buying a home with her husband.
“We want to keep our lives going,” she says. “Today I face treatment as part of my life, but not the center of my life. I try to live my life as it is, with its limitations and its beauty.”
Over the past few years, she has developed a special relationship with Dr. Drilon.
“I admire him a lot because he is a brilliant, dedicated doctor,” Anna says. “He gives you hope. I’m very lucky because life has given me the opportunity to experience the humanity of people. People did what they could to help someone they didn’t even know.”
Alexander Drilon has received honoraria for consulting and serving on the advisory board for Loxo Oncology and participates in research that is sponsored and supported by Loxo Oncology. David Hyman has received grants from Loxo Oncology.