Beth Calabotta received her initial diagnosis of breast cancer in 2008 at just 40 years old. She went through rounds of chemotherapy, radiation, and surgery, only to have a local recurrence in 2014.
Her cancer became metastatic in 2015. “Between 2015 and 2016, I really have not found treatment that has worked for me,” Calabotta told LifeZette. “They’ve all failed within about eight weeks. I’ve tried a whole bunch of different things, including two different clinical trials. It didn’t work out for me.”
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She decided to relocate from her Missouri home when she heard about some successful developments — not to one of the nation’s most well-known major, massive cancer centers — but to Avera Cancer Institute in Sioux Falls, South Dakota.
Dr. Brian Leyland-Jones from Avera gave a presentation at the San Antonio breast cancer conference last year. Calabotta thought his results sounded promising. So she got on a plane during one of the few days she didn’t feel too sick — and made the 600-mile trek.
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She’s not the only patient to relocate her care for the help that the Avera center can offer. “To go from 10-percent odds to 80-percent odds is something that has attracted a lot of people from far and wide,” Calabotta said.
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She added she feels lucky to be there. “I probably could have died in an airport. I feel really lucky that I got to Sioux Falls, and I feel really encouraged by the quality of care that I’ve received here — it’s top-notch.”
“To go from 10-percent odds to 80-percent odds is something that has attracted a lot of people to come see them from far and wide,” said one breast cancer survivor.
The Avera Cancer Institute provides some of the most aggressive cancer treatments on the market today. The standard treatment for cancer mirrors exactly what Calabotta experienced: surgery, chemotherapy, radiation.
But developments in the last 20 years in genomic sequencing have enabled physicians and researchers to pinpoint specific alterations in the genome that exacerbate tumor growth. Each patient has his or her own set of alterations. The goal of precision medicine, or targeted therapy, is to create a medicine that targets the genomic driver behind cancer growth and shut it down.
Hundreds of clinical trials test medicines meant to shut down cancerous genes. “Most of the major cancer centers, after seeing this sequencing and determining the alterations in the patient’s tumor, are then funneling these patients into clinical trials where the dominant [genetic] driver is usually matched with a single drug, two at most,” explained Dr. Brian Leyland-Jones, vice president of the molecular and experimental medicine at Avera Cancer Institute Center for Precision Oncology.
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Without clinical trials, none of these precision medicines could get approved. They are essential to the process for finding better and more effective treatments for cancer. However, most patients have several drivers behind their tumor growth, so a single drug may not be sufficient.
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The Avera Cancer Institute aims to create a cocktail of medications that shut down all of the patients’ genomic alterations behind their cancer. “We usually try to put together triple combinations, sometimes four drugs, to basically suppress all of the genomic drivers of that patient,” Leyland-Jones said.
Avera has its own genomic sequencing team, lab, and pharmacy. Patients can come to the center for a one-time evaluation, receive genomic sequencing to identify the alterations responsible for their cancer, and meet with pharmacists to discuss specific treatment regimens. The experts at the Avera lab even grow the individual patient’s tumors in the lab to do drug testing in parallel to project how the cancer might respond. They’re also working on developing mouse models in concert with their patients, so that they can more accurately predict how successful a treatment will be.
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“If a patient comes in and sees us once, we’ll do a complete review of everything that we see in the patient’s tumor,” said Leyland-Jones, “and we’ll work with their oncologist locally, making suggestions of treatment regimens and giving some guidance on how to modulate the drugs. And if that regimen were to fail, [we would suggest] what drugs to try next in terms of hitting all the oncogenic drivers.”
The center even tries to keep costs for patients to a minimum. They receive sponsorship from the Benedictine Sisters of Yankton, South Dakota, and the Presentation Sisters of Aberdeen, South Dakota, who cover much of the costs of the center and their patients.
Not every cancer patient can make it to South Dakota. But Leyland-Jones said there are things every patient can do to experience greater success.
“If you have a cancer, you should be sequenced at diagnosis. There’s no question about it. This is going to be routine in five years’ time. It’s going to be as routine as pathology and having a CT scan. If you have a tumor, have it sequenced, and come to a center like this one, which is prepared to put together a combination of drugs to close down all of your own particular alterations.”
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