Staying Alive
words by mary ann littell / photograph by john emerson
Lillian Pliner, MD, assistant professor, medicine, UMDNJ-New Jersey Medical School (NJMS), with patient Barbara Herreras
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n 1999, a soft lump, “like a pillow,” appeared behind Barbara Herreras’ right knee, prompting her to see an orthopedic surgeon. When he diagnosed it as a Baker’s cyst, a benign condition involving an accumulation of synovial fluid behind the knee, she stopped worrying.
“I assumed it would eventually go away,” she says.
The lump was initially painless, but over the next several months, it increased in size. She sought a second opinion with another orthopaedic surgeon, and was shocked when he said he was almost certain it was a tumor. He referred her to Joseph Benevenia, MD, interim chair of orthopaedics, UMDNJ- New Jersey Medical School, for biopsy and treatment. The diagnosis turned out to be deadly: myxoid liposarcoma, a rare malignancy affecting fat cells.
“Dr. Benevenia told me the tumor was so large that if they could not shrink it, my leg might have to be amputated above the knee,” she recalls. “I was devastated.” A former dancer, Herreras, age 65, still held a full-time job, jogged and hit the gym regularly.
Radiation therapy successfully shrank the tumor, and it was excised. “I knew there was a 20 percent chance it could recur, but I didn’t focus on that,” she says. “I was thankful not to lose my leg.”
Unfortunately, the tumor metastasized throughout her body, appearing in the abdomen, lungs and clavicle. She underwent chemotherapy, but approved treatments did not help. The tumors continued to reappear, and over time, Herreras underwent 16 surgical procedures to remove them. “They call this process ‘cherry-picking’ — take the tumors out and move on,” she says. “But they kept coming back.”
In March 2007, Herreras’ oncologist, Lillian Pliner, MD, suggested that she consider participating in a clinical trial. “Dr. Pliner said there was an experimental medicine that might help me,” says Herreras. “It took me about two seconds to say yes. What other options did I have?” The medicine was Yondelis, manufactured by Johnson & Johnson.
Yondelis is used to treat patients with locally advanced or metastatic soft tissue sarcomas who have failed standard treatments. It has been approved in many countries and is currently awaiting FDA approval. “We’ve had patients from the Midwest, upstate New York, Pennsylvania and even as far away as India,” says Pliner. “Even though the trial is closed, we’re continuing to make it available through expanded access because we’ve seen how effective it is. Expanded access provides for use of promising drugs not yet approved by the FDA for patients who fail to benefit from approved treatments. Not many centers opt to offer expanded access, so these patients come to us.”
Since entering the trial Herreras has had 20 cycles of Yondelis, administered every three weeks via overnight infusion, and has had no new tumors. “I’m fortunate to have responded to this medicine, and I can’t say enough about the care I’ve received here,” says Herreras. “We’ve been able to keep this cancer under control so I can live my life.”
“Our patients have access to the same cutting-edge therapies being tested at Memorial Sloan-Kettering, Harvard, M.D. Anderson and other world-class cancer centers,” says Pliner, who did a fellowship in hematology/oncology at Sloan-Kettering and started her research career studying breast cancer. Several years ago her focus moved to soft tissue sarcomas and head and neck cancers, “because that was where the need was.” She is currently involved in several studies. Some are cooperative group trials, obtained through such organizations as the National Surgical Adjuvant Breast and Bowel Project (NSABP) and the Eastern Cooperative Oncology Group (ECOG), while others are industry-sponsored. Other companies sponsoring cancer trials at NJMS include Sanofi-Aventis and Novartis.
“We’ve been successful in recruiting patients through our strong surgical oncology programs,” she says. “For example, many patients entering our head and neck cancer trials have been treated at UMDNJ-University Hospital’s Division of Otolaryngology / Head and Neck Surgery, the largest such program in New Jersey.”
Chemotherapy alone is not effective in treating head and neck cancers, explains Pliner. “The definitive treatments for these cancers are radiation, surgery, or both. So we are examining how chemotherapy works with these modalities. Induction chemotherapy, which is given before radiation or surgery, has been shown to improve patients’ survival.” She cites the success of the V-324 Study, a Phase III trial for patients with inoperable, locally advanced head and neck cancer. Patients in the study received three cycles of Docetaxel, Cisplatin and 5-Fluorouracil, followed by radiation plus chemotherapy (carboplatin). “We’ve had great success with this treatment and have prolonged the lives of many patients,” says the oncologist. The trial was sponsored by the pharmaceutical company Aventis.
It’s success stories like this that make her “rewarding, challenging” work worthwhile, says Pliner. “The big challenge is teaching patients about the importance of clinical trials. I tell them they have options: they can go for standard treatment or enter a clinical trial. I have to be able to assure them that standard treatment is the best there is, but the other might be something better.”