Carol Palombit is facing her diagnosis of a particularly aggressive type of breast cancer with a sense of good fortune. She is the first person in the nation enrolled in what could be a groundbreaking clinical study -- offered only in Detroit -- that hopes to improve the prognosis of women like her, newly diagnosed with triple-negative breast cancer.
That type of tumor isn't as responsive to chemotherapy, and patients like Palombit have a poorer prognosis. And yet, she feels lucky to have family, friends and health insurance to get her through the treatment she needs.
"Nobody gets through life without a tragedy," said Palombit of Troy, a retired schoolteacher, runner, former aerobics teacher, mother of two grown children and a first-time grandmother. "This just happened to me at the right time."
As many as 1 in 5 women with breast cancer have a triple-negative tumor, according to the Triple Negative Breast Cancer Foundation and an organization called Living Beyond Breast Cancer.
Younger women, particularly African Americans, are more likely to have triple-negative breast cancer, for reasons not yet known.
Women with triple-negative tumors are more likely to have their cancer return because they lack receptors for three targets of chemotherapy -- the hormones estrogen and progesterone, as well as a human epidermal growth factor called HER2. That makes them less likely to respond to standard cancer treatments.
Palombit, 64, is the first of 40 women to be followed in a new federally funded study at the Barbara Ann Karmanos Cancer Institute in Detroit to test an approach called targeted T cell immunotherapy. The process was developed by Dr. Lawrence Lum, scientific director of the bone marrow transplant and immunotherapy division.
It takes a woman's own T cells -- the body's disease-fighting cells -- and grows them in a sterile laboratory with antibodies and a cancer drug until they "generate an army" of cancer-fighting killer cells, as Lum likes to call them. The aim is to create a boosted immune response, like a vaccine, to stop cancer in its tracks.
The boosted T cells are frozen and stored until a woman completes standard chemotherapy and is tested to see if the treatment has shrunk the tumor. Then, the patient gets four infusions of boosted T cells, followed by surgery to remove the tumor and obtain tissue samples. If there is no sign of cancer, the patient would need no further treatment, though she would undergo regular tests to check whether she remains free of cancer.
"This potentially could be a home run," said Lum, who earlier this year was awarded patents on his precise immunotherapy process. "Our goal is to double from 20% to 40% the number of women who are in remission."
The National Institutes of Health this year gave Lum nearly $3 million for a five-year study. Lum also has a separate four-year, $2-million federal grant to study the approach in women who lack the HER2 growth factor and whose disease has spread beyond the breast -- so-called Stage IV or metastatic cancer.
Nationwide, immunotherapy approaches hold hope for treating blood cancers such as leukemia, lymphoma and multiple myeloma, as well as an aggressive type of brain cancer called neuroblastoma. Because the boosted cells grow quickly once harvested -- from some 14 billion cells gathered to 160 billion in 10 to 14 days, the therapy may cost as little as $8,000, Lum said.
Side effects from the therapy are predictable, typically chills that begin "almost right on the clock" 55 minutes after the infusion begins, followed by fever, Lum said. Nurses give the drug Demerol to control the reactions, which typically subside in 5 to 10 minutes, Lum said. "With each infusion you feel like you have the flu," he said, a reaction that lessens with each round of immunotherapy.
Palombit says she is buoyed by the support and prayers she has received from family and friends.
She worked as a speech pathologist with autistic children in Farmington and Fraser, then taught kindergarten and second grade at Quarton Elementary in Birmingham. She retired in June, the day after she learned she had cancer. It was happenstance. She already had planned to stop teaching so she and Pete, her husband of nearly 40 years, who also is retired, could travel and visit their grandchild.
A self-described Type A personality, she considers cancer a blessing because it has made her slow down and appreciate life -- the smell of roses in her backyard, and the change of color of fall leaves along the Troy hiking path where she and Pete walk each day, except for a few days after she gets a
cancer treatment in Detroit.
"I'm a happier person," she said. "I have so much to be grateful for." Since August, when she began cancer treatment, she's seen children with advanced cancer, and a patient with an oxygen tank getting into a taxi on her own after completing cancer treatment.
In those moments, it's clear to her how fortunate she is.
"I've got everybody helping; it's very humbling," Palombit said.
As diligent as she was about getting yearly mammograms, Palombit skipped her own breast self-exams.
A mammogram in 2009 found no trace of a tumor. But within a year, the cancer grew to a lump in her left breast that she thinks she might have caught if she'd done monthly exams herself.
She tells women: Check your breasts. Get mammograms. See a
Detroit cancer specialist if you think anything is wrong.
"I feel very lucky," she said. "I'm lucky to have all the choices I have."
