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denise z: ovarian cancer

Can you live a productive life with cancer?

"You don’t think that you can just have cancer in your body and be okay. But as long as it doesn’t grow, and it’s not anywhere that’s causing you issues, then you can."

Ovarian cancer has a stubborn habit of coming back after treatment. Denise Zackman’s cancer was no different. After having a hysterectomy in 2007, she was diagnosed with stage 3b ovarian cancer. She was treated on two separate occasions with intense chemo and surgery; however, the cancer returned. By the time of her third recurrence, at age 39, Denise was ready for other options.
Through an online support group, she learned about immunotherapies that were being tested at the Abramson Cancer Center of the University of Pennsylvania. In 2011, Denise enrolled in a clinical trial of a new two-step immunotherapy regimen. The first step consists of a vaccine made from her own dendritic cells that have been previously taught to recognize her tumor cells. These tumor-specific dendritic cells are then injected back into her lymph nodes, where they help to stimulate her immune system to attack cancer cells in her body.
In the second part of the immunotherapy regimen, T cells are removed from her blood, grown in a lab (where they multiply), and then reinfused back into her body. The idea is that this army of T cells will be effective at eliminating cancer because they have been “trained” by the dendritic cell vaccine to recognize her cancer cells.
When TheAnswertoCancer (TheA2C) spoke to Denise in January 2014, she was just wrapping up the second part of the study. Denise said her doctors were “over the moon” with her response to the treatment. The 40-year-old mother of two currently has stable disease and is focused on maintaining a normal life for her children.

TheA2C: After you had your hysterectomy, what treatment did you receive?
Denise: I had the very typical Taxol-carboplatin chemotherapy regimen. I was treated locally in Virginia, but I sought out a second opinion at Johns Hopkins. They recommended that I also do what's called intraperitoneal chemotherapy, which is where they pump the chemo into your abdominal area in hopes that it will kill the cells that are in there. I had six treatments of that.
Later, I had another big surgery, and another round of chemo. I had a spot come back on my chest wall and another surgery for that but no chemo. So that was all between 2007 and 2011.
TheA2C: How did you find out about immunotherapy?
Denise: I found out through some Internet forums. Team Inspire is a pretty large message board. It's just a lot of women with ovarian cancer sharing their stories along with some pretty in-the-know people on there that share new therapies and approaches that are coming up. So I found out from there and then inquired at Penn individually. At that point I was in my third recurrence, so I was kind of looking for a new treatment.
TheA2C: So you enrolled in the clinical vaccine trial at Penn. What was the experience of getting the vaccine like?
Denise: You have an ultrasound tech, a radiologist, a doctor, and a nurse in the room with you because they're injecting directly into your lymph nodes in the groin area. The ultrasound tech monitors the ultrasound, and the radiologist guides the doctor. Between the two of them, they agree on a suitable lymph node on either side of the groin to inject into. But it's fast and has some pain but nothing that’s unbearable by any means.
TheA2C: What was the effect of the vaccine on your cancer?
Denise: By the end of the first part of the study, my tumor burden had decreased by more than 50%, which was a wonderful response, obviously. And a subsequent scan showed that I was pretty much stable. I think I have about five small tumors that they're watching. So they measure each one individually, but they consider your status based on the whole. So some can grow a tiny bit, but if the others shrink more than they grow, then you're considered stable. And now I'm repeating the second portion of the trial.
TheA2C: What does this part of the trial consist of?
Denise: It’s T cells now. So after they vaccinate you with the dendritic cells and your tumor, your body produces T cells. And T cells are an improvement to the dendritic cells in that they have a little bit more of a memory, and I think they are supposed to last longer so that the assault on your cancer is drawn out. And the protocol’s a little different in that you get three days of some intense chemotherapy to start out with. And then once you're pretty much drained, they infuse you back with up to 20 billion of your own T cells that they had already harvested previously. That's the part I had about a week and a half ago. So I'm still recovering. My white cells are still on the mend.
TheA2C: Does that experience take a lot out of you?
Denise: The three-day chemo does. That's the hardest part of the whole trial in terms of not feeling well. You feel run down, almost like you have the flu. But you do start to recover. It doesn't feel like it at the time, but it's not that long before you're starting to turn the corner and feel better.
TheA2C: Is this form of treatment something that you would recommend to a friend or a family member who was going through something similar?
Denise: Absolutely. Aside from that week where you're not feeling well, it's a very benign treatment. The most intrusive part for me is the travel. That disrupts me the most, but you don't have the typical nausea. You don't have hair loss. There's a little bit of fatigue, perhaps, but nothing debilitating. And then, of course, there are the positive results.
TheA2C: Is the idea that this treatment will keep your disease stable, even if it is not completely gone?
Denise: I believe so. I would hope for a remission. I'm not sure that that's a reasonable hope. But with my cancer at the size that it is now, and the fact that it really doesn't have a bad effect on my life in terms of symptoms, the doctors and nurses think stability is a good goal. I think they're very pleased with that. They were over the moon with the decrease and they are still very happy with my stability. You don't think that you can just have cancer in your body and be okay. But as long as it doesn't grow, and it's not anywhere that's causing you issues, then you can.
TheA2C: Do you know how your results compare to others’ on the trial?
Denise: I think they're getting really good responses with a good number of patients. I think what was a little different about me was that I had active disease at the time, so the drop-off [in the tumor size] was really remarkable. I think a lot of the patients who were having good responses were going in with no disease. So it was keeping them in that status. I know there are other women who have been in remission for quite some time.
TheA2C: How has going through this experience affected your outlook on life?
Denise: Overall, I think I've been successful at staying pretty positive. There are, of course, bad days because realistically you have to sometimes think about what could be the inevitable outcome when you're diagnosed with a late-stage cancer. But I do try sometimes to get through days without thinking about that.
It's been a part of our life for seven years. So it's strange, but it's kind of just there. My kids have always grown up with me having cancer. I go and I get treated. But we live a normal life. They go to sports; we have dinner every night. Thankfully I haven't been too outwardly ill, which makes it easier for them to deal with.
And I have had the support of family, my husband. My mom was able to travel with me to Penn, which is a huge help, so he can stay home with the children and go to work and kind of keep things as normal as possible at home. Then I have friends and other family that pitch in where they can. And in terms of this trial, when you get to your fourth recurrence, it feels pretty grim. So if you have something that is new and has these, thus far, promising results, it renews your hope a little bit.

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