February 11, 2009

Aggressive Treatment, Fighting Spirit Help UCSF Cancer Patient Beat the Odds

By Robin Hindery One of the first things you notice about Lori Nichols is her smile. It fills the space around her with light and warmth and draws people in closer, especially when it’s accompanied by her easy, musical laugh. “My life has been just wonderful,” Nichols tells you, and you believe every word, forgetting that since her diagnosis of stage 3 breast cancer in 1999, she has been engaged in an intense, daily battle to stay alive. Nichols, 49, has been a patient at UCSF’s Helen Diller Family Comprehensive Cancer Center since 2005, when the cancer she hoped was gone for good metastasized to her brain. For nearly four years, an aggressive, complex combination of cancer treatments has not only kept Nichols alive and – by all outward appearances – thriving, but has also given her doctors new insight into ways of treating the most dire cancer cases. “With this kind of treatment combination, we are looking into ways to treat patients who otherwise don’t have good options,” said Nichols’ primary oncologist Hope Rugo, MD, director of the breast oncology clinical trials program at the cancer center. “The more options we have, the better we’re able to treat the disease.” “To say the treatment has been successful [for Nichols] is an understatement,” added Patricia “Penny” Sneed, MD, a UCSF radiation oncologist who also has treated Nichols. “It’s keeping her going and allowing her to maintain her quality of life. It’s really an inspiring story.” Before coming to UCSF, Nichols had been cancer-free for two years, and when she called her previous doctors complaining of shortness of breath, they told her it was likely asthma, she said. Nichols didn’t buy it. “I gasped for air for a month before coming to UCSF,” she recalled during a recent appointment at UCSF Medical Center. “The doctors here were the only ones who figured out what was really wrong. UCSF saved my life.” Brain metastases are tumors that originate in tissues or organs outside the brain and then spread secondarily to the brain. They are common complications of systemic cancer, and approximately 20 percent to 30 percent of patients with breast cancer will develop them, according to the American Association of Neurological Surgeons. Since receiving her own diagnosis, Nichols has received a variety of treatment, including biweekly infusion chemotherapy for the past year and a half. She has bimonthly PET scans and MRI scans of her brain every three months to detect any new tumors and assess how her existing cancer is responding to treatment. She also participated in a phase II clinical trial of two cancer drugs directed toward treating breast cancer that has metastasized to the brain and is growing despite radiation. The trial was led by Michelle Melisko, MD, associate clinical professor in the UCSF Division of Hematology/Oncology. Nichols was ultimately taken off the trial when her cancer progressed, but for about a year her cancer responded extremely well to the drug combination. She resumed taking the drugs temporarily outside of the trial between November and late January, Rugo said. In addition to the standard treatments such as chemotherapy, Nichols has become the poster woman for a less common but increasingly popular treatment, Gamma Knife radiosurgery, in which her metastases are zapped with a surgically precise dose of gamma radiation, without a single incision. Since the machine arrived on campus in 1991, UCSF doctors have used it to treat more than 3,000 patients, nearly 40 percent of whom, like Nichols, have been diagnosed with metastases. The machine, designed to target the head and neck region, is also used to treat conditions such as epilepsy, Parkinson’s disease and abnormal blood vessel formations. The Gamma Knife is composed of a long table that slides in and out of a tunnel – similar in appearance to an MRI machine – where the treatment takes place. The tunnel houses 192 radiation sources that are potent enough to kill tumor cells, said Sneed, who co-directs UCSF’s Gamma Knife Radiosurgery Program. Nichols has had five Gamma Knife treatments at UCSF, eliminating about 60 brain metastases. “This has been my savior,” Nichols said of Gamma Knife. “When the doctors first told me I had brain cancer, they told me I only had six months [to live]. That was more than three years ago.” “It is clear that a combination of Gamma Knife and Lori’s medical therapy (such as the drugs in the clinical trial) have kept her alive,” Rugo said. Just as remarkable as Nichols’ longevity is her energy level: A single mother of two boys, she says she has never missed a day of work at her San Francisco-based law firm, and she is also a practicing real estate agent and an active fundraiser for the San Francisco chapter of the Leukemia & Lymphoma Society. “I never changed my life; I fit in cancer with my life,” she said. “Lori has taught me there’s a huge difference in your health when you have a positive attitude,” said Nichols’ friend Julie Bentley, who has accompanied her to countless medical appointments over the years. That sunny outlook has persisted despite a recent setback that would have sent most patients reeling: On Jan. 23, a routine PET scan showed signs that her cancer was progressing elsewhere in her body. Her doctors immediately started her on a new type of chemotherapy that hopefully will target both the brain and the body, and they will continue to closely monitor her condition, Rugo said. “For this cancer to come and bite me last week, I thought, ‘Hey! Wait a minute!’” Nichols said in an interview six days after the PET scan. “But we’ll just have to wait and see, and I’m not going to stop my life. There’s no way I’m writing myself off.” Despite the uncertainty ahead of her, Nichols said she believes she can still achieve her admittedly ambitious goal of total remission. And after spending even a short period of time with her, it’s easy to believe she has the will to succeed. “I don’t feel like I’m going anywhere,” she said, flashing that million-dollar smile. “I just feel like there’s going to be something – something big is going to happen. I’m being used for something. “I would love to be someone who’s a miracle, who can share what I went through,” she added. “I want to tell people out there, ‘Don’t be afraid if you have cancer. Call me.’” Photo by Susan Merrell

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