A Big Battle at the Smallest Levels
By Jennifer Dublisky '11
Annamarie Widener will never forget the second day of 2001.
While celebrating the New Year with a girlfriend, Annamarie, then 38, leaned over
a table to hear her friend more clearly when she felt a lump in her breast. A regular
at giving herself monthly check-ups, the size of the lump alarmed her. She scheduled
a visit to the doctor. Two days later he told her, "You are too young to have breast
cancer. You don't have a family history—it's probably a cyst." He sent her home with
the recommendation to take vitamin E.
Still wary, Annamarie sought a second opinion from a general surgeon a friend recommended.
The surgeon scheduled an immediate biopsy and removal. A week later doctors revealed
that she had breast cancer rated as Stage 2B/3 estrogen negative Her2/Neu; level 3+—the
highest level of this form of cancer. "His immediate reaction saved my life," said
Annamarie. "The cancer would have taken over my whole body within months."
Doctors believed her aggressive form of cancer would not respond well to a standard
chemotherapy regimen, so they prescribed an aggressive course of treatment using multiple
methods. Thus began 18 months combining chemotherapy, radiation, and a new drug known
as Herceptin. With her two children—Jim, then a junior in high school, and Deanna,
in eighth grade—Annamarie, a Yardley, Pa., resident who works in payroll management,
had a challenging path as a wife and mother. She persevered through her treatments
trying to keep everything as normal as possible for her family. Despite the severity
of her breast cancer, the treatment went well but the threat of reoccurrence was always
with her. "You still have the fear that it could happen and you think about it every
day," she said. "Soon after my treatments my doctor asked me to build a five-year
plan for my family—'in case.'"
Part of that plan was getting her children through college. She and her son Jim, now
a 2006 graduate of Widener, made their first visit to the Main Campus shortly after
she finished chemotherapy treatments. "I remember visiting Widener University and
thinking that my son would be safe," she said. "It offered a family atmosphere where
all of the professors would get to know him. It comforted me knowing that he would
be receiving an education."
Cases like Annamarie's are far too prevalent. Breast cancer is the most common cancer
in American women—one in eight women will develop breast cancer—and the second leading
cause of cancer death for women. The impact of the disease has been felt by others
in the Widener University community. Dr. Barbara Kay Toner, 52, of Mount Laurel, N.J.,
died of breast cancer shortly after completing her doctoral work in Widener's Center
for Education in 2010. In November, Rebecca L. (Caltabiano) Cancila, 38, of Mullica
Hill, N.J., a 1996 nursing graduate, died after battling the disease.
Developing treatments that cure breast cancer is the goal of Dr. Bin Wang, a Widener
University assistant professor of biomedical engineering who joined the faculty in
2011. Wang's research is supported by a $450,000 grant from the Susan G. Komen for
the Cure foundation for a three-year project he started while teaching at Temple University
in 2010. His research strives to develop a drug delivery system to overcome resistance
to chemotherapy in breast cancer patients.
Chemotherapy, the most common treatment for breast cancer, is given intravenously
and is known to be very toxic, causing severe side effects. Some patients can become
"chemoresistant," meaning that once a tumor is treated with the drug, it builds resistance
and therefore cannot be treated effectively with chemotherapy again. "The scary truth
is that there is nothing currently available to breast cancer survivors who have to
face recurrence and become chemoresistant," he said.
Wang and his research team are currently growing cells to treat with chemotherapy
so that they become resistant. He will then use nanoparticles—microscopic particles—to
deliver drugs to the cells. (Nanotechnology is the use of particles consisting of
a small number of atoms or molecules—a scale normally measured in nanometers, or billionths,
of a meter.) "We always deal with something we can see; however, there are different
phenomena that can happen when you study something so small," he said. "In my research,
I have found that an injection of medication through nanoparticles goes through cells
into the tissue and can stay in the blood for a long time, protecting the drug while
traveling to the affected cell."
Currently, doctors use liposomes—essentially tiny, manmade bubbles—which are filled
with chemotherapy drugs and then injected into the body to identify the tumors and
release the drug. The downside of this method is that drugs often damage other parts
of one's body, specifically "good cells," said Dr. Curtis Miyamoto, chairperson and
professor of the Department of Radiation Oncology at the Temple University School
of Medicine. "There is always a race to get more chemotherapy into the cancer without
hurting the person too much, which is why the potential for this kindof delivery system
is very great."
Initial response rates of breast cancer to chemotherapy are often encouraging; however,
a majority of patients often see tumors progress seven to ten months later. "These
cancer cells eventually become resistant to normal doses of traditional chemotherapy
and continue to grow and ultimately kill the patient," Wang said.
If the cancer is discovered late, recurrence can become more common in breast cancer
survivors, causing many affected cells to become resistant. Wang said once a cell
is resistant, chemotherapy is no longer effective and the five-year survival drops
to well below 50 percent of patients.
A targeted delivery system, like the one Wang is proposing, would be more effective
and not only benefit those who become resistant, but also anyone being treated with
chemotherapy. "Ideally in 20 years we will be able to inject nanoparticles and kill
all tumor cells," Wang said. "They will be like small robots in our bodies defending
our good cells, and only harmful cells will be destroyed."
Dr. Sabitha Pillai-Friedman, assistant professor of human sexuality at Widener and
a certified sex therapist, is a breast cancer survivor who speaks frequently with
other survivors. She said that most breast cancer survivors suffer from anxiety about
recurrence. "This fear can be more intense for women who do not have a lot of treatment
options," she said. "A targeted multi-drug delivery system to overcome chemo-resistance,
like the one that Dr. Wang is working on, would be a gift to women with those types
of cancers."
Pillai-Friedman believes that a targeted delivery system of chemotherapy can benefit
all breast cancer survivors. "Most patients that I treat in my practice are emotionally
devastated by the side-effects of chemotherapy," she said. "Side effects such as hair
loss, drastic weight changes, and skin problems contribute to altered self-image.
This method of delivery could reduce side effects, subsequently reducing the emotional,
psychosexual, and relationship problems that breast cancer patients and their partners
face."
Miyamoto also sees great potential in Wang's research. "This is going to make a difference
in people's lives," he said. "The way we treat cancer will change because of people
like Dr. Wang. He is trying to make a difference that will impact the future."
Annamarie, now an 11-year survivor, is in complete remission. After she made it through
the first five years and beat the statistics, she revisited her five-year plan. "I
am fortunate not to have had a recurrence, since the likelihood that I should have
was high," she said. "In the beginning every morning you wake up thinking I'm a cancer
patient—you realize you are not immortal, but the further you go away the easier it
becomes."
Her son Jim vividly recalls his mother walking onto Memorial Field at Widener for
his commencement in May 2006. "I considered myself lucky to have my mom at graduation
after everything that she had gone through," he said.
Annamarie said attending his commencement "signified two things: My son was a college
graduate and...I survived."
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