Elephants and Tea - Precision Medicine - 14

Biomarker Testing
FROM PATIENT TO PROFESSIONAL
A Perspective from the Patient
and Professional Worlds
BY MATTHEW HIZNAY
I
became a survivor on August 17, 2011. That
summer, I had developed a persistent, dry cough.
I eventually brought it up at my annual physical.
An X-ray led to a CT scan, which led to a biopsy.
I'd learn about a week later that it was lung adenocarcinoma.
stay, I walked out of the Cleveland Clinic
on my own, without oxygen. This was the
promise of precision medicine, which was
later confirmed at my first scans when I had
a complete response to treatment.
It wouldn't last forever, though. The cancer
I was a 24-year-old lifelong nonsmoker,
which immediately dispelled my notion
that only smokers get lung cancer. Although
I didn't want to know my staging at the
time, for fear of despair, I later learned it
was stage IV-metastasizing to both lungs,
my lower neck, a few lymph nodes in my
abdomen, and my breastbone. My biopsy
was to be tested for epidermal growth factor
receptor (EGFR) or Anaplastic Lymphoma
Kinase (ALK), which in 2011 were nascent
biomarkers. I can't remember whether they
were even called biomarkers then. But if I
were positive for either, I'd qualify for some
recently approved drugs that were more tolerable
than platinum chemotherapy.
I nearly died while awaiting the results of
the testing, which in 2011 took two weeks.
The fluid build-up caused by the metastases
had stopped my breathing. Thankfully, I'd
been admitted to the Cleveland Clinic after I
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was deemed too sick to begin chemotherapy
(I'd wanted to start hitting back in case I
learned I was negative for EGFR and ALK).
I was transferred to the intensive care unit,
where the timely intervention of Dr. Ren
Ashton resulted in a drain being placed
into my pericardium, thereby stabilizing my
heart. I was alive, albeit intubated, hooked
up to countless machines and lines, and just
waiting-waiting to live-waiting to die.
On September 9, 2011, Dr. Ashton, the
man who'd saved my life, walked into my
room, shook my hand (the ventilator tube
had been removed by now), and said, " Congratulations,
Matt-you're a mutant. " My
biopsy had tested positive for the Extramedullary
Leukemia (EML) 4-ALK fusion,
thereby qualifying me for the ALK inhibitor,
Crizotinib. This would be my first targeted
therapy. I began Crizotinib the next day.
Twelve days later, following a 21-day hospital
recurred in May 2012, after which I enrolled
in a phase-II clinical trial for what would become
the second generation ALK inhibitor,
Ceritinib. That bought me six months. By
November, the cancer was growing again,
and I was on carboplatin, which led to my
second complete response in March 2013. A
year later, the cancer gatecrashed my wedding
by returning one month before I said
my vows. This recurrence resulted in my first
experience with radiation therapy as well as
cisplatin, the drug I blame for continuing
side effects to this day. Later in the summer
of 2014, my oncologist, Dr. Nate Pennell,
proposed a re-challenge with Crizotinib,
after some cancerous activity in a vertebra
was picked up on a PET scan. This bought
me another half year until the cancer started
growing again. I then enrolled in a phase-I
clinical trial for what would eventually become
the third generation ALK inhibitor,
Lorlatinib. By July 2015, I'd had my third
complete response. To this day, I take my
Lorlatinib dose with my lunch.
I feel it's important to give my background
as a patient because it informs my profession.
I studied biochemistry and molecular
biology as an undergraduate at John Carroll
University. Early on during my illness, I was
accepted into graduate school at a unique
program headquartered at Cleveland Clinic's
Lerner Research Institute, which focused on
translational medicine aiming to improve
clinical bedside options with focused labo
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Elephants and Tea - Precision Medicine

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