When faced with a diagnosis of stage 4 lung cancer, it can be hard to have hope. The survival statistics for this disease are dismal, as Maureen O’Grady, 62, learned in 2009 when doctors estimated she had about one year to live. But Maureen did have hope, and that hope may have saved her life.
Hope inspired her to pursue aggressive treatment, first with chemotherapy and targeted therapy. And, when those treatments failed, it inspired her to pursue immunotherapy. In 2010, Maureen participated in a clinical trial of a new immunotherapy drug called nivolumab at Yale’s Smilow Cancer Hospital under the direction of Scott Gettinger, M.D. Nivolumab belongs to a class of immunotherapies called checkpoint inhibitors. By “taking the brakes off” the immune system, checkpoint inhibitors enable a stronger attack against cancer.
Until very recently, lung cancer was thought to be unlikely to respond to immunotherapy. But early results with PD-1 checkpoint inhibitors have begun to change that view. Nivolumab (trade name Opdivo®) was FDA approved for the treatment of non-small cell lung cancer in March 2015.
We talked to Maureen about how she kept her positive attitude and what immunotherapy has meant to her.
CRI: How did you first find out you had cancer?
Maureen: It was early 2009, and I had a cough. We thought it was just allergies, but the cough lingered, and I noticed a speck of blood in the mucus. So the next day, January 21, 2009, I went to a walk-in center. The doctor ordered a chest X-ray and they found a mass in my right lung. They told me to get a CAT scan right away. Several tests and appointments later, I was told I had stage 4 lung cancer. The cancer had originated in my right lung and had traveled to my liver and adrenal glands. Then, while I was on treatment, a growth appeared on my heart.
CRI: What were you told about the prognosis?
Maureen: They told me that I was incurable but treatable, and that I was young enough and in good enough shape to tolerate the most aggressive chemotherapy. At the time, that was cisplatin, which has very harsh side effects.
CRI: How did you decide where to have treatment?
Maureen: I got diagnosed in the Fairfield County area, and the doctor there told me I had stage 4 cancer, and that I had 12 to 14 months to live. He didn’t give me much hope at all, and he didn’t seem very invested in me. So, after the shock wore off that I had cancer, I looked for another oncologist. I knew that I couldn’t change the diagnosis, but at least I could change the way I was treated. That’s when I went to Yale and found Dr. Scott Gettinger. I began treatments with him on February 17, 2009.
CRI: What was the chemotherapy like?
Maureen: The side effects were everything they promised they’d be. With cisplatin, besides the usual side effects of nausea and vomiting, there’s also pain, thinning hair, facial acne, teeth turning yellow. During the transfusions sometimes I required morphine for pain. Basically, while I was on that drug, all I did was get the infusions and rest in between treatments. It did reduce tumor growth in some areas, but it was really taking its toll on me.
I understood that it was going to improve my immune system’s ability to fight cancer, and that made more sense to me.
CRI: At what point did you and your doctor decide to stop the chemotherapy and pursue immunotherapy?
Maureen: I was on a couple of other lines of chemotherapy, probably two more. There was also an oral targeted therapy, Tarceva, and I was on another clinical trial. But it wasn’t until May of 2010, I believe, that we decided that most of the approved chemos weren’t working. At that point in time, Dr. Gettinger told me that in June he had two trials beginning, and he sent me home with the information on both of them. It was up to me to choose which one.
I selected the immunotherapy trial. It was called anti-PD-1 therapy. I understood that it was going to improve my immune system’s ability to fight cancer, and that made more sense to me. So that’s the direction we chose.
CRI: What was the treatment like?
Maureen: My infusions were once every two weeks, with scans every eight weeks. Even before I had my first scan I was starting to feel much better. I didn’t have any side effects. The chemo was leaving my body, and I was starting to feel like myself again. I was getting stronger. I was looking better. And the first scan showed that I had a dramatic response to the treatment in all areas of the disease. So we continued with treatment. The next set of scans showed even further reductions and no new growth.
CRI: What were you thinking as you were getting these results?
Maureen: It was like having a second chance. I was diagnosed with stage 4 lung cancer. I was told I had twelve to fourteen months to live. I thought that I was going to die. That I was going to leave my family behind. It’s quite an emotional roller coaster. So I was thrilled beyond words that they actually found something that worked.
I was cautiously optimistic. I didn’t want to get crazy happy, because I didn’t want to be let down again if it stopped working. There was nothing to fall back on.
CRI: What did your husband do when he heard the results?
Maureen: We just hugged each other. We all hugged each other—the doctor, my husband, the nurse who always treats me, and anyone who knew. Smilow is like family.
CRI: What’s the status of your cancer now?
Maureen: The tumors have shrunk down to essentially nothing. There’s a little bit left on scans, but whether it’s calcifications or scar tissue, they won’t know unless they go in and look. But everything has remained stable through the end of the trial in June 2012.
CRI: That’s wonderful.
Maureen: It is wonderful. There are so many milestones I‘ve been blessed to witness and attend thanks to immunotherapy. My oldest daughter, Lauren, got married and had twin boys, and they’re now four. I get to watch them grow and adore them every day. She got engaged while I was on chemo, and I didn’t think I was going to make it to her wedding. Dr. Gettinger said, “I’ll have you dancing at her wedding.”
My youngest daughter, Kristen, is engaged, and this time I can be involved in the wedding plans. And my husband and I just celebrated our forty-first anniversary. There’s been so many things, from class reunions and anniversaries, and it’s just been a remarkable time enjoying life’s precious moments.
CRI: Is there anything else that you want to share or tell other patients?
Maureen: Keeping positive and keeping hopeful is the best mindset you can have when you go through something like this. I hope that, by sharing my story, I give hope to other patients.