After routine chemotherapy loses steam, ovarian cancer survivor Beth Hoover finds a reprieve with targeted therapy and a clinical trial . A Eureka Moments story.
It is Beth Hoover’s job to make sure the drug formulations her department prepares for research animals are accurate. If the dosages are wrong, it skews the results of the study and wastes time and money.
The 48-year-old resident of Lima, Ohio has done this kind of research science for 25 years at Charles River’s Safety Assessment site in Spencerville. She works on compounds well before they acquire a name, rarely knowing whether they are cancer drugs that will ultimately stall in the clinic or end up on a retail pharmacy shelf.
Then one day she found herself needing a cutting-edge solution to a dire diagnosis. Suddenly the work she did became personal.
About a year ago, around the time she and her husband, Steve, were starting to plan a much anticipated trip to Ireland, Beth was told she had Stage 3C ovarian cancer. She had been having a lot of lower back pain, which various doctors initially thought might be kidney stones or a urinary tract infection. But then a CT scan picked up some masses, and a test which measures the amount of CA 125—a protein antigen produced by ovarian tumors—came in at 1,360 (normal is less than 35).
The James Cancer Hospital in Columbus, Ohio made the clinical diagnosis, but surgeons saw the wreckage—an aggressive tumor that had escaped the ovaries, wrapped itself around her intestines and impacted her appendix. Technically speaking, it was a high-grade serous carcinoma tumor, the most common, but also the most malignant form of ovarian cancer. Serous tumors accumulate a lot of fluid—doctors drained about 3 ½ liters from Beth’s abdomen.
For nine hours, doctors worked on Beth, removing her uterus, ovaries, Fallopian tubes, cervix, appendix and 10 inches of lower intestine. They scraped her bladder, remaining intestines and other organs clear up to her diaphragm looking for traces of cancer.
Finally, they installed ports in her abdominal wall and upper chest. Doctors used the ports to deliver sequential, and sometimes simultaneous, cocktails of four different chemotherapy drugs over five months to reduce the risk of the cancer returning.
To help alleviate the side effects of chemotherapy, Beth took 10 different drugs. She also needed one other subsequent surgery to deal with complications from her cancer and the chemo. Her parents, who also live in Lima, took care of her during the treatment and her husband, a special education teacher, stayed with her during all of her hospitalizations.
It was a hellish six months—the longest of her life—and in the end she was rewarded with a normal CA 125.
The victory, unfortunately, was short-lived.
From conventional to targeted treatments
About a month ago, her CA 125 levels shot back up, and her doctors discovered new spots on her lung and liver. Moving quickly, they suggested Beth enroll in a Phase III trial for women who carry mutations in the tumor suppressor genes BRCA1 and BRCA2, and who have exhausted more conventional treatments.
The trial, sponsored by the National Cancer Institute, is designed to evaluate how a first-in-class targeted therapy (approved three years ago for ovarian cancer) performs alone, or in tandem with an experimental drug, against conventional chemotherapy. The targeted drug, which exploits tumor DNA repair pathway deficiencies to preferentially kill cancer cells, was worked on pre-clinically at two different Charles River Safety Assessment sites. The experimental drug blocks some of the enzymes needed for tumor cell growth and shuts down blood flow to the tumor
Targeted therapies attack specific genes or proteins on cancer cells. They are a powerful weapon against cancer but scientists think they could be even more powerful when combined with other drugs. This study might help answer their questions.
Being enrolled in this study of 450 women gave Beth her second wind. She takes two pills in the morning and two more 11 ½ hours later. As a chemist, she understands all about the half-lives of drugs. Given the pace at which her system is metabolizing and excreting the morning dose, and the start of the late afternoon dose, she figures this drug is fighting for her almost 24 hours a day.
Beth expects to be on this drug for the remainder of the year. She is struggling with fatigue, the only real side effect she has experienced so far, but she has a remarkably pragmatic attitude about her situation. “This is not a downer,” she says. “This is no different than taking a blood pressure drug. I am trying to put this out of my mind and go about doing what I need to do.”
This means continuing to work full-time, where she has developed a deeper connection and understanding about the impact of the work she and her team does every day. As for the long-awaited trip to Ireland, that has changed a bit.
Beth and her husband are now planning a trip to Spain, Portugal and Morocco in June. She’s already worked it out with her doctors to keep up with her therapy abroad. “I learned how short life is. If you are going to do something you may want to do it now because you may not have that opportunity.”