When Ruth Wright isn’t reading or writing poetry, she’s mowing her lawn, planting flowers and taking care of her animals.
For the Rolla resident, it’s astounding she can do any of those activities. A year ago, Wright was involved in a minor car accident. She wasn’t seriously injured, but scans revealed she had breast cancer, again. This time, it was Stage 4 triple negative cancer that had spread to her esophagus, lungs, lymph nodes and brain.
Three years earlier, Wright underwent a double mastectomy to treat breast cancer. At that time, she decided against chemotherapy or radiation, and those decisions reduced the likelihood of permanent remission.
Once again, except for a single dose of spot radiation to target the cancer in her brain, Wright insisted she didn’t want chemotherapy or radiation because she was worried the treatments would compromise her quality of life.
“I’m 76 years old and was enjoying my life,” Wright said.
Wright’s oncologist at University of Missouri Health Care, Sindhu Singh, MD, listened to her patient’s concerns. Though Singh was ready to start Wright on the traditional regimen, the doctor agreed it could knock Wright down pretty hard at her age.
So Singh suggested an emerging cancer treatment called immunotherapy.
Every three weeks, Wright travels from Rolla to Ellis Fischel Cancer Center in Columbia for a 30-minute infusion of Keytruda, an immunotherapy drug known as a checkpoint inhibitor.
“Immune therapy does not attack cancer by itself,” Singh said. “It primes your immune system to fight cancer.”
A healthy immune system is designed to locate and fight disease, including cancer. But some cancer cells hide or sneak past the immune system’s defenses and apply brakes to the checkpoints, stopping the body from fighting off disease. Those cancerous cells can then grow into tumors.
“Once we give them these checkpoint inhibitors — like Keytruda — then those brakes are released, and the body’s immune system swings back into action,” Singh said.
Before caring for Wright, Singh had treated patients with immunotherapy and seen them achieve partial remission.
“In those types of cases, the cancer became a little bit smaller in size but never went away,” Singh said. “It stayed like that for many months or years.”
The first PET scan after Wright started immunotherapy showed the tumors shrinking. Three months later, the second PET scan indicated the tumors were even smaller. Over the last 12 months, her tumors have virtually disappeared.
“I used to think that there was no way to cure triple negative breast cancer,” Singh said. “Now, I’m more hopeful that with immune therapy that, yes, there are certain avenues.”
Since starting Keytruda, Wright’s only side effect has been fatigue. One of the benefits of immunotherapy is that there are usually fewer and less severe side effects compared to traditional therapies. Depending on the situation, Keytruda can be used by itself or combined with chemotherapy or radiation.
Singh believes immunotherapy will play a significant role in the future of nearly all cancer treatments. She adds, though, that doctors will still use traditional methods — surgery, chemotherapy and radiation — because people respond in varying degrees to immunotherapy.
Keytruda is not yet FDA-approved for the treatment of most breast cancers, but it is approved to use on many advanced forms of cancer, including melanoma and lung cancer.
A study published in the New England Journal of Medicine this year showed immunotherapy combined with chemotherapy could nearly double the length of time some patients with lung cancer survive.
When she first heard her breast cancer had recurred and spread, Wright learned she might only have about six months to live. It’s been a year since she’s heard those chilling words. Now, Wright has put her own words in a poem she penned to honor her doctor.
“Sindhu Singh, your life is a song thrust into the universe with love and energy.
The universe has sent it back to you, multiplied, with energy and love.
Thank you, Sindhu Singh, for including me in your song.”
Wright is grateful for a doctor who listened and a therapy that energized her immune system.
“You’re not promised tomorrow,” Wright said. “You’re not promised tonight. You’re not promised half an hour from now. But right now, I can sit on this park bench … feel a breeze and be happy as a clam.”