Glynda’s Story: A Chance to Advance Treatment for Aggressive Cancer
(January 11, 2021) — Inspired by the kindness, proficiency and dedication of her health care team at Georgetown Lombardi Comprehensive Cancer Center, Glynda Brown, a 52-year-old Maryland resident, felt determined to “pay it forward” and make a positive difference for future patients by participating in a clinical trial after she was diagnosed with triple-negative breast cancer.
Brown wants other women diagnosed with the cancer subtype to consider participating in clinical trials that examine the newest and most promising treatments. As a Black woman, she recognizes that her message is especially relevant to women of color, though it may be complicated by the history of clinical trial testing using Black participants, including the infamous Tuskegee syphilis study.
But Brown says medical research, law and society have changed.
“I understand the mindset of fear about research,” she says. “Back when these abuses occurred, we didn’t have the right to question or determine our own course for medical care. Now we have the right to be advocates for our health and treatment.”
It was her journey to Georgetown Lombardi that demonstrated to Brown just how important advocacy can be.
A Dream Comes True — Unfortunately
In the middle of the night one day in April, Brown dreamed that she had breast cancer. She woke up and her hand went to the precise place in her right breast where a lump existed. In the morning, she called her gynecologist, but the office was closed due to COVID-19. She then arranged for a telemedicine conference with her internist, a MedStar Health physician (MedStar Health is Georgetown University’s clinical research partner).
Her internist called after the scans to confirm a cancer diagnosis. “Georgetown was on the top of my list for treatment,” Brown says. In the following week, she had four appointments for a biopsy, MRI and sonogram, among other tests, all arranged by coordinators at Georgetown Lombardi. The diagnosis was triple-negative breast cancer — a more difficult-to-treat cancer — meaning that the tumor’s cells did not have estrogen, progesterone or HER2 receptors, which are proteins that specific cancer therapies can latch on to and damage the tumor. For that reason, triple-negative breast cancer, which accounts for about 10-15% of all breast cancers, has limited treatment options. It also tends to grow and spread faster than other breast cancers and disproportionately affects younger Black women.
Brown got busy. “I did quite a bit of research, as is my way, around cancer in general and my cancer, specifically.” She read about the new trend of using immunotherapy to boost the body’s natural response against cancer cells. It has worked in other cancers, and clinical trials have been testing the concept in breast cancer. One immunotherapy drug was approved last year by the FDA to treat triple-negative metastatic breast cancer which had previously been only treated with chemotherapy. Additional clinical trials are underway to test other immunotherapies for breast cancer.
The following week she met with breast surgeon Eleni Tousimis, MD, and medical oncologist Claudine Isaacs, MD.
Same Mindset in Doctor and Patient
When Brown and Isaacs met, they were thinking the same thing. As a clinician and researcher, Isaacs is associate director of clinical research and leader of the clinical breast cancer program at Georgetown Lombardi. Isaacs also helps lead a nationwide team of researchers in a wide-reaching and novel set of breast cancer clinical trials, collectively called I-SPY 2.
I-SPY 2 conducts clinical trials in a revolutionary way. While a typical trial tests a drug or a combination of drugs for years, I-SPY and its newer iteration, I-SPY 2, test a particular breast cancer drug just until a biological marker (such as a surgical biopsy) reveals whether the drug has a strong likelihood of being effective.
“The success of the I-SPY 2 trial is not simply the result of a single innovation in trial design,” Isaacs says. “It is the result of a painstaking deconstruction and re-engineering of the entire clinical trial enterprise, from protocol development through registration.”
Isaacs has been working with I-SPY and I-SPY 2 for a decade, and among many different treatments, she is part of a team testing immunotherapy in triple-negative breast cancer. In 2019, she and other I-SPY 2 investigators published a study in JAMA Oncology that found chemotherapy combined with a specific immunotherapy drug, pembrolizumab, provided a very promising treatment. The results were subsequently confirmed in a large, definitive phase III trial.
“The I-SPY trials are very forward-thinking, and they engage everyone from the researchers and molecular scientists to patients,” she says. “This is a way to quickly test treatment ideas to get at a molecular mechanism that may work. The trial design accelerates advances in our approach to find treatments that allow us to recommend the right drugs for the right patients.”
Brown was about to ask about joining a trial testing immunotherapy when Isaacs suggested it.
Paying It Forward
After completing three months of chemotherapy combined with intermittent doses of immunotherapy, Brown then received eight weeks of chemotherapy treatment by itself.
Based on scans, her tumor shrank significantly. The most definitive analysis of progress came after her double mastectomy that followed the chemotherapy.
“The pathology showed no sign of cancer in any of the tissue or lymph nodes. I am cancer free!” Brown says.
“Glynda is tremendously strong, resilient and inspirational,” Isaacs says. “She is excited to be part of the clinical trial, and personally understands how important this may be to many other patients. That’s impressive.”
“This cancer has been a blessing to me,” Brown says. “I’ll be better afterward than I was before. My body will be stronger. But, more importantly, my one little case presents an opportunity to effect change for women diagnosed with triple-negative breast cancer in the future.”
She adds that her commitment to the I-SPY 2 trial was aided by “every person I met at Georgetown — the support, the efficiency, the care was superior, better than I could have imagined,” Brown says. “I am kicking cancer’s butt… with the help of so many people.”