Former Intelligence Officer’s Toughest Battle

Photo by Max Taylor for PhRMA

Dian “C.J.” Corneliussen-James has never been an average person.

During her 24-year career as an Air Force intelligence officer, she analyzed Soviet satellite activity during the Cold War, supported airlift operations in Panama and in Iraq, and served as the intelligence lead on the Joint Chiefs of Staff for the Somalia Conflict. Still, tougher battles remained.

In 2004, after retiring from the Air Force, C.J. found a lump under her arm only three months after a clean mammogram and was diagnosed with stage 2 breast cancer. Over the next 22 months she would undergo cancer treatment, then be diagnosed with systemic lupus and finally metastatic breast cancer.

“When I was diagnosed with metastatic breast cancer, they told me that my odds of being alive in five years were less than 5 percent,” she said. “I had a very rapidly growing tumor in my lung and nobody expected me to live very long.”

Metastatic breast cancer occurs when cancerous cells travel to other parts of the body, most commonly the lung, liver, bones or brain and establish new tumors. While only 6 to 10 percent of initial breast cancer diagnoses are metastatic, 30 percent of patients diagnosed with earlier stage breast cancer will eventually develop metastatic breast cancer, otherwise known as stage 4 breast cancer, and die from it. A patient diagnosed with stage 2 breast cancer has a 93 percent chance of surviving five years after diagnosis. In contrast, the five-year survival rate after stage 4 breast cancer diagnosis, when the cancer has spread, is just 22 percent. The life expectancy of a person diagnosed with metastatic disease is generally about 2 to 3 years.

Medicines in Development: Cancer 2014 Report

Living today, eight years after her diagnosis, C.J. defies expectations.

“I’m very fortunate that I have lived this long with metastatic breast cancer, and I’m certain I would not be alive if it wasn’t for modern medicine,” she said.

Coping With Setbacks

Why hasn’t there been a cure for cancer? Each kind of cancer presents researchers with unique challenges. There has been remarkable progress against many cancers, and, since 1991, the death rate overall has dropped 20 percent. However, progress varies widely across cancer types and substantial unmet medical needs remain. According to a study in the Journal of Clinical Oncology, due to each cancer’s innate complexity, medicines for each can take an average of 1.5 years longer to develop than medicines for other diseases. This is a challenge when it comes to finding therapies for hard-to-treat cancers, such as melanoma, lung and brain cancer.

For example, melanoma is responsible for the large majority of deaths from all skin cancers. However, once it has metastasized, the 5-year survival rate falls to just 15 to 20 percent. Treatment options, while effective for some, can have serious side effects. Often the patient, even after having received chemotherapy, radiation and other therapies, will die within a year of stage 4 diagnosis.

Medicines in Development: Cancer 2014 Report

Between 1998 and 2011, no new medicines were approved to treat metastatic melanoma. It was not for lack of trying. Since 1998, a total of 96 investigational medicines in development for melanoma were “discontinued,” “suspended,” or had “no development reported.” Yet, those trials were not for nothing; in the last three years, the U.S. Food and Drug Administration (FDA) approved five new medicines.

Hard-to-treat cancers are stubborn adversaries, each for different reasons. One reason that lung cancer is challenging is that there’s a particularly high number of genetic alterations associated with the disease, making it difficult to determine which genes and proteins to target for drug development. Brain cancer is another area rife with challenges – including the unique “blood-brain barrier” the body has developed to keep chemicals in the blood from getting into the brain. Many medicines, including some chemotherapy drugs, are not able to pass through the “blood-brain barrier,” further narrowing the potential therapeutic arsenal.

Stepping Stones

There are presently 771 cancer medicines and vaccines in either clinical trials or awaiting review by the FDA, encouraging patients of all cancer types and stages, such as C.J.

“Far more medications are needed for those in the stage 4 breast cancer community so that all of them can live long productive lives.”

Medicines in Development: Cancer 2014 Report

Cancer researchers dueling breast cancer’s complexity continue their inquiry across cancer’s broad spectrum. Today, they are particularly excited about the development of personalized medicines. These are prescribed to individual patients based on certain biological markers, such as genetic makeup, allowing doctors to tailor therapies to those who are most likely to see a benefit, avoiding unnecessary and costly treatments or procedures. Targeted therapies often have fewer side effects because they are designed to interfere with specific molecular targets involved in cancer cell growth or progression, whereas traditional chemotherapy acts against all rapidly dividing cells, including healthy ones.

Today, researchers know more than ever about the root causes of many cancers. Each breakthrough, though, is joined by dozens of disappointing roadblocks along the way. However, researchers learn from each setback, and then use those findings to refine other lines of research, making them more likely to succeed.

After her metastatic breast cancer diagnosis, C.J. and a handful of other professional women with the disease formed METAvivor, a non-profit organization to provide awareness, fund research and support patients with metastatic disease. She knows that she’s lucky to have the energy needed to pursue this cause when so many others with stage 4 breast cancer do not.

“When people try to estimate how long a patient will live, that’s just statistic-based,” she said. “A patient is an individual. You can far exceed that time limit or not. It’s important that every patient should get the chance to survive longer.”

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