New Hope Through Genomic Medicine
If looking at the statistics alone for her type and stage of cancer, few would have predicted that Dawn Timmer would experience the health and vitality she is today.
But thanks to the grace of God and the wonders of genomic medicine, her latest scans have shown her body to be clear of cancer.
“Dawn was a very sick lady, with a low possibility that she would respond to treatment. To go from that to having scans with no identifiable disease is remarkable,” said Casey Williams, PharmD, part of Avera’s genomic oncology team. “Not every patient has this same response, but what we’re seeing is very exciting.”
Dawn, of Jackson, Minn., woke up one morning in May of 2010 with terrible pain in her left side and nausea. It was first suspected as a ruptured ovarian cyst, and then perhaps diverticulitis. “I battled pain the pain for two weeks, then on a Saturday morning I woke up and couldn’t stand it anymore,” she said. Her husband took her to the ER where the medical staff found fluid in her abdomen and around her liver.
Brought by ambulance to Sioux Falls, she was diagnosed with stage III ovarian cancer by Luis Rojas, MD, Gynecologic Oncologist at Avera Cancer Institute. The cancer had spread from her ovary into the peritoneum, which is the lining of the lower abdomen. She was only 43 at the time of her diagnosis.
Dawn needed a hysterectomy, but first she needed chemotherapy to reduce the amount of disease, which would allow for a better surgical outcome. When she able to undergo hysterectomy a few months later in August, things went well. “Dr. Rojas said it was amazing how much of the cancer had been killed,” Dawn said.
Follow-up chemotherapy was completed by February of 2011. Other than surgery to treat two hernias in April, she enjoyed two years of remission.
But then in February 2013, Dawn woke up with the same type of pain. “It was terrible back pain, like someone stabbing me with a knife.” A CT scan showed a growth in her abdomen, where it had all started.
She had more surgery and chemotherapy, and had been done with that round of treatment for a few months when she suffered a gallbladder attack in March 2014. “When they went in to remove my gallbladder, they found a couple spots that were suspicious, and that’s when Dr. Rojas suggested genomic testing.”
In the meantime, Dawn continued to struggle, ending up with a bowel blockage last June due to a fluid pocket which had developed in scar tissue.
“I was really excited about the genomic test. I thought if I would have a better chance, this would be it,” Dawn said.
The test revealed that Dawn would respond best to a combination of three chemotherapy drugs typically used to treat breast cancer. “It was exciting that we could find out exactly what my tumor would respond to.”
Because genomic medicine is so new, there were some delays due to insurance coverage. Two drugs were approved, and the third drug was provided through assistance from the pharmaceutical company.
“My treatment plan changed in July, and since then, everything has been good and my CT in December was all clear,” Dawn said. “Dr. Rojas calls me his miracle patient.”
Neither Dawn nor her doctors know if she is “cured,” or if the cancer will return. But the fact that Dawn showed this level of response beats the odds, Williams said.
In the meantime, Dawn is just thankful for the quality of life she now enjoys with her family – her husband of 25 years, Perry, and their three children, Cassidy, 19; Colton, 17; and Destiny, 11.
“Through it all, the biggest thing that’s given me peace is my faith in Christ. I know that the signs he gave me were God signs,” Dawn said, referring to the pain that alerted her to go to the ER in the first place, and also the gallbladder attack that helped doctors discover the additional spots of cancer. “Support of family and friends has been amazing, and I feel that God led us to Dr. Rojas.
“I just feel blessed that I’m still here,” Dawn says. “God has given me additional days to be here on earth. It saddens my heart to hear of people who have lost their battle, but I feel there’s something I’m supposed to be doing… that’s why I’m still here.”
The Exciting Potential of Genomics
Genomics at Avera is a complex science that involves multiple experts locally and across the nation and world.
Yet for patients, it’s a new glimmer of hope that begins with a blood test and tumor biopsy, and ends with a recommendation for the best possible ways to treat their particular type of tumor.
The genomics program came to Avera Cancer Institute in January 2014 when Brian Leyland Jones, MB BS, PhD, and his team began the Molecular and Experimental Medicine program.
“We have seen over 300 patients to date,” said Casey Williams, PharmD, BCOP. Many have been breast and gynecologic patients, although the team works with patients who have all types of tumors.
“We have had some outstanding results,” said Leyland-Jones.
The team has treated patients who now have no obvious disease – termed a “complete response” to treatment. They have helped patients whose only option would have been palliative care to keep them comfortable at end of life, who are now enjoying quality time with their families.
That doesn’t mean these patients are forever cured of cancer, nor does it ensure long-term survival. “None of us are promised that,” Williams said.
And while genomics gives patients a better chance of responding to treatment, there are still those who do not respond as well as hoped. “We’re not to the point where we can say we have cured cancer. But hopefully, we’re moving the bar forward, and that’s very exciting,” Williams said.