In a remarkable demonstration of immunotherapy's potential, Judy Perkins, a stage 4 breast cancer patient who had exhausted multiple treatment options, achieved complete remission through an innovative T-cell therapy at the US National Cancer Institute (NCI).
The groundbreaking treatment, developed by Dr. Steve Rosenberg's team, utilized Tumor Infiltrating Lymphocytes (TIL) therapy, marking the first successful application in breast cancer - traditionally considered a "cold cancer" with lower mutation rates.
Breakthrough in Personalized Immunotherapy
The treatment process began with Dr. Stephanie Goff surgically removing a tumor from Perkins' right breast. In the lab, researcher Nikos Zacharakis isolated T-cells from the tumor tissue and identified those specifically reactive to the patient's cancer mutations. This highly personalized approach resulted in the production of "selective TIL" - 81 billion cancer-fighting T-cells tailored to Perkins' unique cancer profile.
"Inside my tumours were T-cells with the specific antigen receptors that were able to recognise my cancer's mutations," Perkins explained. The treatment targeted two distinct mutations - KIAA0368 and SLC3A2 - genes involved in protein processing and cellular transport, neither previously associated with breast cancer.
Treatment Protocol and Response
The therapy involved:
- High-dose chemotherapy to temporarily suppress the immune system
- Infusion of the cultured T-cells
- Seven doses of Interleukin-2 to support T-cell expansion and survival
Despite initial challenges, including rigors from the first IL-2 dose, the response was remarkable. "Even before I left the clinic, I had a glimmer of hope," Perkins recalled. Tumor shrinkage became evident quickly, and by May 2016, scans showed complete cancer clearance.
Long-term Impact and Implications
Dr. Francis Collins, NIH director, testified before a Congressional Subcommittee that Perkins "appears to be cured." While researchers prefer the term "durable regression," the treatment's success is particularly significant given that none of Dr. Rosenberg's responding patients have relapsed over a decade of follow-up.
Perkins has since returned to an active lifestyle, including completing a 1,200-mile sea kayak journey around Florida. Her case demonstrates the potential of personalized immunotherapy in treating traditionally resistant cancers.
Clinical Trial Challenges and Patient Advocacy
The success story highlights ongoing challenges in clinical trial recruitment. Perkins encountered resistance from her local oncologist, who initially discouraged trial participation. This experience has motivated her advocacy for better trial awareness and access.
Her advice for stage 4 cancer patients emphasizes:
- Seeking second opinions
- Self-education about specific disease conditions
- Treatment at comprehensive cancer centers
- Exploring clinical trial options
- Maintaining proactive engagement in treatment decisions
This breakthrough case opens new possibilities for immunotherapy in breast cancer treatment, particularly for patients who have exhausted standard treatment options.
