Runner Judith Hettage experienced repeated pain in her left lower leg while walking the daily path around Davy.
However, some trips to an orthopedic surgeon left her frustrated and without explanation.
But ultimately, the main Hettage doctor ordered a scan of calves showing tumors, leading to the diagnosis of a rare soft tissue cancer called synovial sarcoma. Her initial treatment at Dana-Farber Cancer Institute in Boston, including chemotherapy, radiation therapy and surgery, appears to have been successful, with Hettage regularly following up with quarterly scans.
However, 10 years later, what began as a synovial sarcoma in her cow ended up spreading cancer cells to the lungs. “I felt that was the death sentence,” Hetraj said. “In three months I had 13 tumors in my lungs.”
The 65-year-old Hetlage has hopes for what could be a medical breakthrough.
She is enrolled in pioneering clinical trials that have impacts far beyond the rare forms of cancer. Through her partnership with the Memorial Cancer Institute and the Moffitt Cancer Center, she is taking part in T-cell receptor therapy (TCR-T) trials. This treatment is an immunotherapy that harvests a patient’s T-cells, a type of white blood cell that helps the body’s immune system fight disease. After removal, T cells were genetically modified to recognize specific proteins within cancer cells and returned to the patient’s immune system to search and destroy diseased cells.
Great meaning possible
This is the first engineered cell therapy for solid tumor cancer approved in the US. If effective for trial participants, the range of TCR-T cells can be expanded to solid tumor cancers of the head and neck, lungs and skin for use beyond hematologic cancer. Cancer patients whose disease is resistant to traditional chemotherapy drugs or have metastasized within the body can benefit.
For rare types of Hetlage cancer, chemotherapy is the standard treatment after the spread of the disease. She had begun chemotherapy while waiting for her to be accepted into the exam.
It has been more than a decade since the FDA approved a new treatment for synovial sarcoma, according to the National Cancer Institute.
“There is a very high need for new treatment options for patients,” said Dr. Sandra D’Angelo of Memorial Sloan Kettering Cancer Center, who led a small first trial of 44 TCR-T in synovial sarcoma. Treatment reduced the tumor in 19 participants, preventing tumors from growing for an average of 6 months. According to a report by D’Angelo of the National Cancer Institute, in the case of two participants, the tumors left and did not return during the three-year study period.
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Initially, Hetlage type cancer was not included in the current national trial of TCR-T for solid tumors. However, the FDA cleared the hetrage to participate. She began treatment three months ago.
“We took her cells and activated them so they were aware of her cancer,” said Dr. Atif Hussein, Hetlage’s oncologist and director of the Memorial Haematology & Oncology Fellowship Training Program.
Hussein said he injected Hettage with “super immune cells” and gave him a second dose about two weeks later, empowering the immune system, which had exhausted and emptied the bone marrow before treatment. This process, called lymphatic depletion therapy, allows supercells to find homes for their immune system.
A similar approach has been successfully used in the treatment of hematological cancers, but has never been used in solid tumors. At least 30 clinical trials are currently underway for engineered TCR-T cells in a variety of solid tumor types, including melanoma, lung cancer and colon cancer.
How to qualify
Patients must qualify for the commemorative TCR-T trial by having a specific immune type. Hussein said that dozens of patients with other types of cancer did not have the appropriate immune type to qualify, but Hettage did. “Hopefully there will be more people who will qualify for this study,” he said.
So far, it is too early to know if treatment works for hetlage.
At the cancer survivor event at the Memorial Cancer Institute, Hettage, a former occupational therapist mother who lives with her three daughters and now Fort Lauderdale, told other cancer patients, “I’m not a survivor. That’s not the end. I’m giving up.”
Hussein is optimistic about the outcome of Hettage. “I’ve been in oncology for 26 years and have rarely seen anyone who’s very positive and strong. She empowers herself and fights hard.
Hanging in hope
Hetlage says she meditates, eats healthy foods, and walks 6-7 miles a day. “I think your head has to get into the game,” she said. “You have to do your best you can while they serve your medical purpose.”
“Everyone else I knew that this (cancer type) wasn’t on this planet yet,” she said. “This is something I have to fight for the rest of my life.”
Hussein said T-cell receptor therapy represents hope in the fight against cancer if it can treat solid tumors. He predicts that new cell therapy will be tested in patients over the next few years, representing the next wave of cancer treatment.
