As an army spouse, Diane Altenburg, 67, is used to serving others. She sits on the board of the National Military Family Association, has volunteered for the Red Cross and the Well-Baby campaign, and still finds time to visit her five children and ten grandchildren. So it was not unusual for her to take up the cause of breast cancer once she herself came down with the disease.
Diane’s service to the breast cancer community began with her consulting on the creation of a new state-of-the-art breast cancer center at Walter Reed National Military Medical Center in Bethesda, MD. “I sat on committees, talked to other patients, was kind of the patient advocate for the breast cancer center,” she says.
Later, when she developed a second breast cancer, she participated in a clinical study of a new breast cancer vaccine designed to prevent recurrence. Calle NeuVax™ (nelipepimut-S, made by Galena Biopharma), the vaccine consists of a fragment of the HER2 protein given along with an adjuvant molecule called GM-CSF. HER2 is a protein found on approximately 85% of breast cancer cells. Targeting this protein—for example, with the drug Herceptin® (trastuzumab)—has been shown to be an effective way to treat the 20% of women with HER2-positive (3+) breast cancer. Unfortunately, the 65% of women who fall into the lower categories of HER2 positivity (2+) or (1+) are not eligible to receive Herceptin; strategies to prevent recurrence in these patients are greatly needed.
The NeuVax vaccine is designed to stimulate the body’s immune system to attack any remaining cancer cells that were not killed by conventional methods. Cells in the immune system called “antigen-presenting cells” detect the NeuVax antigen and then present it to T cells, which in turn are stimulated to hunt down cancer cells bearing this marker.
Diane was one of 200 women who participated in a phase 2 trial of NeuVax in 2005. That trial, which determined that NeuVax was well tolerated and demonstrated preliminary efficacy to prevent recurrences, was completed in 2012. The treatment is now being tested in a large phase 3 study that will accrue roughly 700 patients.
It was a routine mammogram, both times. I hadn't felt anything at all. I've had it twice, one on each side, about four years apart. I had radiation the first time, then chemo and radiation the second time. I had two lumpectomies, one on either side. My second bout had gone a little into my lymph glands and we did a sentinel node biopsy. Then they took out five or six lymph nodes.
I had just finished chemo and radiation, and I wanted to do something else. I thought, “What else can I do to help my daughters, my nieces, to make sure that they don't have to go through this?” So that's why I got involved in the clinical research. It was my way of doing outreach, I guess you could say.
I'll be honest with you, I don't do the walks and I don't put the pink T-shirts on and I don't go “hoo-ha ra-ra.” I am very low-key on what I do. I will talk to anybody, but I don't go out there and parade it. That's just not in my personality. But my oncologist said, “You’re a great person to get involved in this vaccine trial.” And so I did.
First of all, you have to be as free from cancer as possible, so it's about a month or six weeks after your last radiation treatment. You have to do initial blood work to establish a baseline. Then you are given the immunization, which is under the skin of your front thigh. You have to come back about two or three days later.
This immunization causes a rash, a welt on your thigh. And that shows that your body is reacting to it. I did that every month for six months, followed by boosters every six months. I always say the hardest part was driving to Walter Reed because of traffic.
I tell them how easy it was. Any time you do a trial, people get very upset about it because it's an unknown. They don't know what the repercussions or what the after-effects will be. I try to reassure them that it's not going to knock you out. I tell them how easy it is and what a gift you will give to your relatives down the road.
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