Battling until the very last moment:
A fusion of Chemotherapy and Immunotherapy for Metastatic Breast Cancer to the Lung
“She means the world to me. My solemn commitment is to offer her nothing less than the finest care, ensuring that she experiences a life brimming with joy and that she remains with us for as long as fate permits.”
This narrative is the story of Mrs. Atipa Bouplung, a devoted mother who holds an irreplaceable place in her daughter's heart. At an age when she should be relishing her retirement years, an initially benign tumor that evolved into cancer, spreading to her lungs, forced her to endure multiple surgeries. Against advice from many to surrender, her family remained unwavering in fighting alongside her.
“In 2010, she faced a breast cyst, and seven years later, another tumor emerged on her opposite breast. She confided in me about experiencing an unprecedented, unexplained chest pain while on the phone. Following a comprehensive medical evaluation, she received a diagnosis of stage 2A triple-negative breast cancer, with the tumor measuring approximately 1.9 centimeters in size.”
Mrs. Atipa underwent a lumpectomy, subsequently enduring rounds of chemotherapy and radiotherapy at a medical facility, with routine follow-ups scheduled every 4 to 6 months. However, in November 2021, her physician observed a slight elevation of tumor markers, prompting a whole-body scan that unveiled the presence of an ovarian tumor. Mrs. Atipa opted for the surgical removal of her ovaries and uterus. Following a pathological examination of the tissue, the doctor conveyed the welcome news that the tumor was, in fact, benign, a moment of profound relief for all concerned.
The stealthy metastatic cancer in the lung
“The doctor identified a spot in the lung, and I am uncertain what it might be...” June, Mrs. Atipa's daughter, recounted her words, reflecting on the distressing call she received from her. At that moment, a tinge of discouragement was discernible in Mrs. Atipa's voice.
In April 2022, shortly after opting for the removal of her uterus, Mrs. Atipa experienced intense chest pain in the middle of the night. Seeking relief, she visited a nearby clinic where she received a prescription for a muscle relaxant. Unfortunately, her condition was not better. During her subsequent follow-up appointment, she discussed her condition with her doctor. Additional tumor marker tests yielded normal results, and the breast ultrasound also appeared normal. However, an X-ray revealed an unexpected and concerning finding.
“An X-ray examination revealed the presence of fluid in the chest and a minute shadow in a lung. Despite the regularity of her 4-6 month follow-up appointments, encompassing breast ultrasounds, X-ray scans, and blood tests, all of which had previously shown no signs of concern, it now reared its ugly head. It is conceivable that the cancer had remained deeply concealed and undetectable until this point. At the time of its detection, it had already metastasized to one of her lung. She expressed deep disappointment and released a heartfelt cry of anguish.”
With unwavering determination, June made the resolute choice to return to Thailand in her quest to secure the most effective treatment for her mother. She delved into a comprehensive exploration of medical literature, engaged in discussions with fellow cancer patients, and immersed herself in the study of medical journals. Along the way, she stumbled upon the concept of immunotherapy, a novel approach to cancer treatment that involves enhancing the efficiency of immune cells in identifying and eradicating cancerous cells. It is important to note that immunotherapy distinguishes itself from conventional chemotherapy and targeted therapy, as it directly targets the cancer cells without an intermediary step.
“We all have differing genetic variations, suggesting that immunotherapy could hold promise for my mother. Through extensive research, consultations with medical colleagues, and participation in online communities, I meticulously researched the list of doctors in Thailand who had contributed to breast cancer research or studied in prestigious international universities, and this led me to Dr. Sudpreeda at MedPark Hospital. Dr. Sudpreeda shared that without treatment, her life expectancy might be as short as six months, but with the appropriate treatment, she could potentially extend her life beyond two years. His reassuring words provided us with a sense of hope, and he pledged to stand with us in this battle to the very end.”
“Furthermore, he mentioned an ongoing clinical trial involving patients with PD-L1 negative cancer and a low TMB (tumor mutational burden) level similar to her condition, where immunotherapy had yielded positive results. We will give it a try. Hearing this, a spark of hope ignited within me. It was the very reason I chose MedPark as our destination. The doctors here not only prioritize their physical well-being but also their mental and emotional needs. I sought a healthcare provider who was not only committed to the fight but also willing to explore innovative alternatives alongside us. I believed this is the most valuable gift I can offer my mother right now.”
Dr Sudpreeda Chainitikun, a highly experienced medical oncologist with expertise in cancer diagnosis and treatment planning, demonstrates a profound grasp of the extensive research June has undertaken. Dr Sudpreeda is not only attentive to her insights but also actively engages in a productive exchange of information. He is committed to ensuring that patients and their family members are well-informed, taking the time to explain and address any uncertainties, thereby fostering a shared understanding of the treatment process. At present, Mrs. Atipa is faithfully following the prescribed treatment regimen, which involves both chemotherapy and immunotherapy.
“Stage 4 cancer, advanced cancer, last-stage cancer – no matter the terminology, it undeniably carries a sense of dread, wouldn't it? When someone you love must face this harsh reality, the pain and distress are immeasurable. However, what I want to emphasize is that it is not an irrevocable death sentence. There exists another treatment, avenues of hope. She means everything to me, and my foremost duty is to ensure she receives the finest treatment available, granting her the prospect of a joyful, pain-free, and healthy life while remaining by our side for as long as possible.” June passionately affirmed.
Immunotherapy: another hope for cancer patients
The immune system comprises white blood cells and biochemical components residing within various organs, all working in concert to safeguard the body from foreign entities or antigens, such as invading bacteria, viruses, fungi, and parasites. Notably, this defense extends to cancerous cells, which can form and develop strategies to elude detection by the white blood cells and other immune system elements.
In contemporary times, advancements in medical technology have enabled the exploration and integration of immunotherapy into cancer treatment approaches. Immunotherapy can serve as a primary or adjunctive modality for treating cancer, either in conjunction with chemotherapy, radiotherapy, or surgery, contingent upon the stage of the cancer and the assessment made by medical professionals.
Principle of immunotherapy in cancer treatment
At its core, immunotherapy operates on the fundamental principle of enhancing and equipping the immune system and white blood cells to boost their ability to recognize and eliminate cancerous cells, treating them as foreign invaders. This innovative approach has the potential to address a spectrum of cancer types, including lymphoma, breast cancer, skin cancer, liver cancer, lung cancer, head and neck cancer, bladder cancer, and kidney cancer. Nevertheless, it is crucial to note that the effectiveness of immunotherapy can vary across different cancer types, necessitating a case-by-case evaluation and the expert judgment of the treating physician.
In immunotherapy cancer treatment, the selection of immunotherapy agents is contingent upon the specific type of cancer a patient is dealing with. Following the administration of these agents, the doctor will closely monitor and comprehensively look after the patient. It is crucial to note that some patients may experience adverse side effects or reactions from immunotherapy, including skin rash, fever, diarrhea, colitis, pneumonitis, nausea, and elevated blood sugar levels. However, it is worth noting that these side effects tend to be less prevalent and less severe than those typically associated with chemotherapy.
In the case of Mrs. Atipa, she only has colitis and hepatitis as side effects. Dr. Sudpreeda further elaborated on her cancer treatment:
“Mrs. Atipa was initially diagnosed with metastatic triple-negative breast cancer, a particularly aggressive form of cancer known for its challenging prognosis when compared to other breast cancer types. Her treatment regimen included a combination of immunotherapy and chemotherapy. Remarkably, her response to this therapy was quite positive, resulting in a substantial reduction in the size of the cancer. Nevertheless, side effects did manifest through blood tests but are clinically unnoticeable. Subsequently, after several rounds of dosage adjustments, her condition returned to a normal state.”
“Even though the cancer shrank, it does not mean it has disappeared for good. It is still hiding inside our body, and it will come back when our body is weak. Administration of medication continues but at a lower dosage. For cancer treatment, we not only focus on the efficacy of medications, we also focus on patients’ quality of life. When dosage adjustment results in no side effects, her quality of life improves. She looks healthy and can travel with her family. In that regard, the treatment was successful. The patient can live happily with cancer.”
“It is vital to understand that even though the cancer shrinks in size, it does not equate to its complete eradication. It can persist within the body, waiting for an opportune moment to reappear. Consequently, medication administration continues, albeit at a reduced dosage. In cancer treatment, we place significant emphasis not only on the effectiveness of medications but also on the patient's overall quality of life. With downward dosage adjustment to forestall side effects, her quality of life improves significantly. She exhibits a healthy appearance and enjoys time spent traveling with her family. From this perspective, the treatment is successful, as the patient can lead a fulfilling life despite the presence of cancer.”
