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Case Study

A New Playbook in the Fight Against Cancer

Published June 24th, 2021

The human body never stops. Our cells and organs are working all the time, in ways we don’t think about – until something goes wrong.

In 2017, Charles started having trouble swallowing. As time went on, things got worse, so Charles began looking for answers. In August, he underwent an esophago-gastroduodenoscopy (EGD), which revealed an ulcerated mass that was later diagnosed as HER2 positive esophageal cancer. Subsequent PET and CT scans showed that his soft tissue was thickening in and around his esophagus, and while the disease had metastasized in his lymph nodes, it had not appeared to spread elsewhere.

Following his diagnosis, Charles began a typical cancer treatment of chemotherapy and radiation. He completed his therapy at the end of September, and his post-treatment scans showed that he was making positive progress battling his disease. The decision was made in October to proceed with surgical excision of his esophagus and part of his stomach, in hopes to rid him of this cancer.

Over the next several months, Charles’ scans showed no signs of disease – but that all changed in April of 2018, when a CT scan detected several new small nodules in his lungs. Following this news, Charles began a surveillance protocol, which showed that the nodules were growing. After additional diagnostics in December 2018, it was confirmed that his esophageal cancer had spread to his lungs.

That is when Charles decided he needed to do something different.

In January of 2019, Charles reached out to Private Health Management to explore additional treatment options for his cancer. Private Health clinicians and researchers immediately began working in close collaboration with his treating oncologist to build Charles an individualized treatment plan.

Recent data had just emerged from a clinical trial that showed significant benefit for patients using an experimental combination of treatments that paired the typical treatment regimen for recurrent HER2+ esophageal cancer, which includes chemotherapy and a HER2-targeting drug called Herceptin, with an additional drug called pembrolizumab, or Keytruda. Pembrolizumab is a type of immunotherapy called an immune checkpoint inhibitor; these drugs take the brakes off the immune system and allow cancer-reactive T cells to attack tumors more effectively.

Although Charles did not qualify for the clinical trial, with the help of Private Health, he was able to receive this regimen under compassionate use. Charles began his treatment in March of 2019. CT scans taken in May showed that the tumors in his lungs were shrinking, and Charles completed his full treatment in June. Charles’ Private Health Care Team continued to work with his oncologists to develop a maintenance plan to manage his disease, but they also began to explore additional, alternative treatments that could further arm his immune system to keep Charles’ cancer from progressing.

Private Health is on the Cutting Edge of Emerging Cancer Fighting Technologies: Combining A Cancer Vaccine with Immunotherapy and Molecular Targeting in a Patient with Recurrent Esophageal Cancer

The cancer vaccine

With his cancer largely eradicated, Charles was an ideal candidate for a cancer vaccine. These innovative immunotherapeutic approaches have shown promising results in clinical studies when administered in cancers with lower, more manageable, disease burdens. In addition, studies have also shown that cancer vaccines are more effective when given in combination with an immune checkpoint inhibitor such as pembrolizumab. Leveraging their deep knowledge, Private Health researchers recommended and coordinated the creation of a personalized cancer vaccine for Charles.

Creating a personalized cancer vaccine

To create the personalized cancer vaccine, tissue taken from Charles’ prior lung biopsies was analyzed by whole exome sequencing to evaluate more than 22,000 genes. Mutations specific to the cancer DNA, called neoantigens, were assessed using an AI-guided algorithm to predict which would most strongly elicit an anti-tumor immune response if administered as a vaccine. Then, peptides containing the neoantigens were manufactured for incorporation into the vaccine, along with an adjuvant substance to help boost the immune response, called Leukine.

In January of 2020, Charles began receiving his personalized vaccine, which consisted of four injections in the first 14 days. Following this initial vaccine schedule, Charles has received his vaccine every month with the plan to complete a full two years of vaccines – all the while keeping the maintenance regimen that Private Health developed for him.

To this day, Charles’ condition has remained stable – a testament to the research, clinical counsel, and patient advocacy that Private Health provides.

Every day, Private Health works on behalf of our clients to increase access to life-changing cancer vaccines. Together with our partners and collaborators, Private Health will identify the best personalized vaccine option for your specific disease. In our immersion process, we search the clinical trial landscape for new therapeutic options, determine clinical eligibility, and help with the enrollment process. Alternatively, we offer several off-trial and compassionate-use cancer vaccine options that are less restrictive and allow combinational therapeutic approaches. At Private Health, your health matters.

* Name changed to protect privacy

* Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

About the Authors

Nicholas Young, PhD

Director, Research

Dr. Young is focused on designing treatment strategies for clients through a precision medicine approach that leverages the latest advances in science and therapeutic development. At PHM, Dr. Young is a member of the research team providing his expertise across many core areas including oncology. To help provide the best treatment solutions for cancer patients, the research team at PHM arrays the data supporting various treatment options, analyzes molecular profiling data, and proposes novel therapeutic strategies and clinical trials with careful consideration of individual clinical status and molecular profiling results.

Amber McDonald, MPA PA-C​

Senior Director, Clinical Services | Head of Oncology Services

Amber provides comprehensive case management and clinical guidance for Clinical Services and is the Head of Oncology Services. She is a certified Physician Assistant with extensive patient-care experience.