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Case Study

Going beyond the standard of care

Published October 8th, 2021

At 72, John was living a full life―good health, a happy family filled with children and grandkids, and a thriving business he built himself from the ground up.

In 2021 though, John knew something wasn’t right. After dealing with ongoing gastrointestinal issues and unexplained weight loss that was exacerbated by a COVID-19 infection, John underwent a CT scan and was diagnosed with stage IV pancreatic cancer. His specific diagnosis (adenosquamous carcinoma) is a unique form of pancreatic cancer, which is a particularly aggressive form of an already aggressive disease. According to the National Cancer Institute, over half of patients with pancreatic cancer aren’t diagnosed until it is already considered late-stage (stage IV), and stage IV pancreatic cancer has a five-year survival rate of only three percent. After speaking with the oncologist about treatment plans and disease prognosis, John and his family were determined to explore all available options to improve his chances of survival. They knew they needed to act quickly. His primary care physician suggested he talk to Private Health Management (PHM). A Personal Care Team consisting of an advanced practice clinician, a PhD research scientist, and a care management expert immediately began developing a personalized plan. The possible treatment paths included both traditional and less conventional approaches.

According to the National Cancer Institute, over half of patients with pancreatic cancer aren’t diagnosed until it is already considered late-stage (stage IV), and stage IV pancreatic cancer has a five-year survival rate of only three percent.

Getting the best of what’s possible in medicine requires unbiased advice and expedited access to the finest care. Through our extensive provider network, we connected John to a leading expert based in New York who recommended pursuing an alternative strategy consisting of rotating metronomic chemotherapy in combination with targeted agents informed by comprehensive molecular profiling of his specific cancer cells. Metronomic dosing of chemotherapy uses a lower and less toxic concentration administered at a greater frequency, which has been shown to selectively inhibit cancer-induced blood vessel creation and help prevent resistance when used on a rotating schedule.  PHM helped John establish care with an oncologist who was an expert in this novel treatment approach.

PHM consulted with John’s oncologist on the development of an individualized precision medicine regimen to layer onto his metronomic chemotherapy. While John was undergoing treatment, the PHM helped convene a Tumor Board made up of key opinion leaders in the fields of precision oncology, molecular diagnostics, and pancreatic cancer to review the case to determine the best therapeutic options.

Prior to this meeting, PHM worked to get additional molecular profiling data to help validate actionable therapeutic targets. An innovative test that assesses protein activity using a sophisticated approach called phosphoproteomics analysis, was used to measure the activation status of several cancer-promoting pathways in cancer cells.

PHM reviewed John’s clinical summary and the comprehensive data from molecular profiling. The test results indicated that John’s current therapy might cause concerning side-effects and suggested other targeted therapies might be more effective. After considering the data presented by PHM and the testing company, the Tumor Board reached a consensus on an individualized treatment plan that included drugs not previously used in his care.

Using this personalized medicine approach, John’s treatment is continuously monitored and altered when needed using a regimen specifically targeting his unique pancreatic cancer. When he was originally diagnosed, John was given just six months to live. Now six months into his treatment, John has had an incredible reduction in his disease burden and is enjoying an excellent quality of life. His tumor marker (CA 19-9) dropped from more than 10,000 at diagnosis to around 100, and his imaging tests continue to show disease regression.

Despite this remarkable progress, John’s Personal Care Team continues to explore additional measures to help keep his illness at bay. For example, based on his treatment response and current clinical condition, John has become an excellent candidate for a cancer vaccine. Paired with his ongoing treatment, the vaccine can add another layer of protection by training the immune system to recognize the cancer cells, which may reduce the risk that his cancer will progress in the future. John’s story is notable not only in how quickly his cancer has declined in such a short period of time, but also in how he has been able to return to a life he thought he had lost. John’s story is far from over, but thanks to PHM there is more of his story yet to come. PHM goes further to find the best of what’s possible in medicine.

* 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.

Jennifer Fernandez, MPAP, PA-C

Director, Clinical Services

Jennifer is a board-certified Physician Assistant.  She is UCLA and USC Keck School of Medicine trained with extensive emergency medicine and internal medicine.