Targeted Therapy Gives New Hope to Pancreatic Cancer Patients

For people diagnosed with certain types of cancer, hope can be distressingly elusive. That’s especially true with pancreatic cancer, an insidious disease that offers few if any clues to its presence until it has already spread to other organs and the body’s lymphatic system.

Jayne Akhavan-Yazdi, 59, a neonatal nursepractitioner from Gainesville, Fla., was diagnosed with pancreatic cancer lastautumn. She knew what lay ahead; her father died from the same disease when hewas just 64, and she herself is a breast cancer survivor.

(Watch now: The Baptist Health News Team hears frompatient Jayne Akhavan-Yazdi and her radiation oncologist, Michael Chuong, M.D.,at Miami Cancer Institute. Video by George Carvalho.)

Mrs. Akhavan-Yazdi soon learned that surgerywasn’t an option – as is often the case with pancreatic tumors, because oftheir location – so her oncologist started her on chemotherapy. After a monthof treatment, however, her pain had grown even worse and a subsequent scanshowed her tumor was growing bigger, not smaller.

“I couldn’t even get off the sofa, I felt so exhausted and ill,” she says. “My care team in Gainesville told me surgery wasn’t an option and my fear was that additional chemotherapy might not be successful. I was devastated.”

Desperate yet still clinging to hope, Mrs.Akhavan-Yazdi enlisted the aid of her daughter, Suzie Black, a registered nursewith a cancer center in Ft. Myers. The mother-daughter duo researched and metwith pancreatic cancer specialists and surgeons at top cancer centers aroundthe country. None could help.

Then, a chance conversation Mrs. Black had with a work colleague in Ft. Myers led to her mother being referred to Michael Chuong, M.D., a radiation oncologist at Miami Cancer Institute who specializes in the treatment of gastrointestinal cancers. Dr. Chuong has gained worldwide renown in recent years for using magnetic resonance imaging (MRI)-guided radiation therapy on difficult-to-treat cancers.

“Miami Cancer Institute offers a trulycomprehensive assortment of radiation therapy technologies, all under oneroof,” Dr. Chuong says. “Whatever offers the best possible outcome for thepatient, they can find it here, from traditional radiation therapy to pencilbeam scanning proton therapy, Gamma Knife, Cyber Knife, and MRI-guided radiationtherapy.”

Miami Cancer Institute is one of just a handful of cancer centers in the country – and the only one in South Florida – with the ViewRay™ MRIdian MR Linac technology, which safely delivers extremely high doses of radiation directly to the tumor by allowing physicians to continuously acquire a real-time MRI scan during the entire treatment. When the patient breathes, the machine automatically recognizes that the tumor has moved – even by just a few millimeters – and will pause until the tumor has returned to the appropriate location before resuming treatment. This technology is so advanced that the treatment can be modified on the fly based on even miniscule changes in the location of the stomach and bowel in relation to the tumor. This ensures that the dose to these organs remains at an appropriately low level, Dr. Chuong says.

In the 18 months it has been in place,Miami Cancer Institute has used the MRIdian Linac to treat 170-plus patients – oneof the largest MRI-guided pancreas cancer volumes in the world. A fast-growingnumber of successful outcomes with MRI-guided radiation therapy has oncologistsaround the globe sitting up and taking notice.

According to Dr. Chuong, there is a lot ofexciting research coming out, showing that very high ablative doses ofradiation delivered via the MRIdian Linac can significantly prolong patientsurvival.

“We’ve had great outcomes with all sorts ofdifferent cancer types – pancreas, breast, lung, liver, prostate, esophagus,and others,” Dr. Chuong says. “Even patients with limited Stage 4 metastatic diseasewho typically would have been regarded as incurable could potentially havelong-term disease control – and may even be cured – using ablative doses thatcan be safely given to certain tumors only with an MR Linac.”

Mrs. Akhavan-Yazdi’s initialconsultation with Dr. Chuong on February 4^th of this year gave her thehope she had so desperately been seeking in the four months since herdiagnosis.

“Dr. Chuong’s office called in themorning and asked if I could see him that afternoon,” Mrs. Akhavan-Yazdirecalls. “We live five hours away in Gainesville but of course I said, ‘Yes!’ Wejumped in the car and made it to Miami just in time for my appointment. Afterbeing at my lowest point just one month earlier, that one moment of hope madeit the most exciting day ever.”

“When I first saw Jayne, her prognosiswas quite poor,” says Dr. Chuong, who also serves as Proton Center Director,MRI-Guided Radiation Program Director, and Director of ClinicalResearch–Radiation Oncology at Miami Cancer Institute. “Her tumor was stillgrowing – even with chemotherapy – and was considered unresectable, meaning it couldn’tbe removed surgically.” He quickly determined she would be a good candidate fortumor ablation using the MRIdian Linac.

“Treating pancreatic cancers is a challengebecause they’re resistant to lower doses of radiation, and also because thepancreas is so close to the stomach and bowel, both of which are especiallysensitive to radiation,” Dr. Chuong says. “With the MRIdian Linac, however, wecan deliver an extremely high, ablative dose of radiation to the tumor while atthe same time delivering very little dose to nearby organs, resulting in mostpatients having little or no side effects whatsoever.”

With her daughter constantly by herside for support, Mrs. Akhavan-Yazdi began her daily outpatient treatment withDr. Chuong on February 14^th. The radiation Jayne received was morethan twice the dose typically used with any other type of machine, according toDr. Chuong. And her therapy took just five days, instead of the five to sixweeks usually required for other, more conventional forms of radiation.

It can take time to see any noticeableimprovement with radiation therapy, and Dr. Chuong didn’t expect to see much ofa change immediately following Mrs. Akhavan-Yazdi’s treatment. After her firstpost-treatment scan, though, he was pleasantly surprised to see that her tumorhad already started to shrink.

“I started feeling better straightaway,” Mrs. Akhavan-Yazdi says with a sigh of relief. “I didn’t have any sideeffects, I could eat again, and I had my energy back. It was wonderful.”

Her daughter, too, could see instantaneousimprovement. “You could see the difference in her color overnight, and thesparkle in her eyes was back,” Mrs. Black recalls. “As someone who works inoncology, it was a miracle for me to see Mum doing so well so quickly.”

Once she completed her treatment atMiami Cancer Institute, Mrs. Akhavan-Yazdi felt so good, she didn’t want towaste a moment not living her life to the fullest.

“Being as sick as I was, I hadn’t madeany plans beyond simply trying to get better but now that I was feeling so well,my husband and I decided on the spur of the moment to take a much-neededvacation to Hawaii,” Mrs. Akhavan-Yazdi says. “Just one month after mytreatment, we were aboard a ship cruising the Hawaiian Islands. It was sobeautiful. I even climbed Diamond Head Monument, which I never could haveimagined doing just a few weeks earlier.”

Since that trip, Mrs. Akhavan-Yazdihas traveled extensively around the United States and Europe, including theUnited Kingdom and Wales, where she grew up. She’s looking forward to moregreat adventures in the near future. “Christmas in New York would bewonderful,” she says with a twinkle in her eye.

She and her husband just celebratedtheir 40^th wedding anniversary in September, and in December she plansto mark her 60^th birthday in retro style with an ABBA-themed partyfor her family and friends. Her favorite ABBA song? “Why, ‘Dancing Queen,’ ofcourse!”

In the meantime, Mrs. Akhavan-Yazdi comesback to Miami every few months for follow-ups with Dr. Chuong, who’s extremely pleasedwith the progress he’s seen.

“Jayne has had a great outcome so far– she’s a perfect example of how we can treat the tumor without compromisingquality of life,” Dr. Chuong says. “She came to us desperate and seemingly outof options. Now, she’s had a dramatic turnaround. We’re seeing her tumor getsmaller and, despite the really aggressive doses of radiation we delivered, she’shad no side effects of any significance.”

“I was in and out in just five days, and I didn’t have any side effects at all. This treatment truly saved my life,” says Mrs. Akhavan-Yazdi, who was so grateful for the care she received from Dr. Chuong and radiation oncology nurse practitioner Sonia Adamson, ARNP, that she gave them each superhero capes she made herself. “I just want to tell everyone in my situation, ‘Don’t give up hope! This treatment is amazing, and it works – I’m living proof!’”