Dr. Brian Slomovitz is director of gynecologic oncology at Sylvester Comprehensive Cancer Center in Miami, Florida. For more information on gynecologic cancers, please call 305-243-1000 or to learn more about clinical trials offered at Sylvester, or CLICK HERE.
Alessandra Valerio was on vacation in Montreal with her husband and 15-month old son when a sharp, persistent pain in her side sent her to the emergency room. By the next day, she was in Miami discussing treatment for an aggressive, pregnancy-related tumor that had spread throughout her body.
“In that moment I was so afraid,” she says. “What was going to happen to me?”
Pregnancy is a prerequisite for Alessandra’s condition, called choriocarcinoma. It occurs when cells that would have otherwise formed the placenta become cancerous. In general, patients with choriocarcinoma have a good prognosis. But the small subset of women who do not respond to chemotherapy can die from the disease, says Dr. Brian Slomovitz, director of gynecologic oncology at Sylvester Comprehensive Cancer Center.
Two rounds and a combination of five chemotherapy drugs did not slow the growth of Alessandra’s cancer, placing her in the “chemo-resistant” category. “The cancer basically said, ‘no matter what you throw at me, we’re going to take over and do damage,’” says Dr. Slomovitz.
Just 26-years-old at the time of her diagnosis, Alessandra’s thoughts turned to her young son. “I thought, ‘If I die now, he’s never going to remember me,’” she says.
“Cancers can be very sneaky,” says Dr. Slomovitz, who collaborated with colleagues to determine next steps for Alessandra’s treatment. “They imitate the biology of the body and are unrecognizable by an intact immune system.”
The solution, it seemed, was held within a specific characteristic of her tumor that made it a compatible with immunotherapy, which engages a patient’s own immune system to recognize and attack cancer cells. The presence of a protein called PDL-1 can sometimes predict a response to immunotherapy, also known as a checkpoint inhibitor. Given that Alessandra’s tumor overexpressed PDL-1, Dr. Slomovitz and his colleagues believed she was a good candidate for immunotherapy.
“Before treating Alessandra, there were no reports in the literature at all of patients with malignant, chemo-resistant choriocarcinoma being treated with a checkpoint inhibitor,” says Dr. Slomovitz. “We treated her with a checkpoint inhibitor that helped the body identify and attack the tumor.”
After one round of the immunotherapy treatment, Alessandra’s tumor markers – the protein in the blood that indicates cancer – began to drop. After a second line of therapy, the imaging improved. “We treated her with this novel checkpoint inhibitor and it really changed the biology of the disease,” says Dr. Slomovitz.
The treatment was working, all without the side effects Alessandra experienced during chemotherapy. She could exercise, care for her son, and participate in life as usual. “It was a miracle,” she says.
“When you see a response you’re hoping for, there’s excitement and a need to spread the word,” says Dr. Slomovitz, who worked with colleagues to publish their findings from Alessandra’s case in the Journal of Clinical Oncology.
Because choriocarcinoma is a pregnancy-related cancer, it can be followed through the use of a simple pregnancy test in place of other imaging. Today, 14 months following her initial diagnosis, Alessandra is cancer free.
“It was the best decision to be treated here at Sylvester,” says Alessandra, who is currently in medical school and enjoying life in South Florida with her son. “If just one woman can be saved with this treatment, it’s worth it.”
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