Elizabeth Lacasia — “I have a future again”
An avid rollerblader and downhill skier and at the height of her professional career, Elizabeth Lacasia never imagined she would develop lung cancer. Indeed, it took a year and three different doctors in the Bay Area to arrive at the diagnosis — and only after ruling out acid reflux disease and allergies as possible causes of her symptoms.
Finding an effective treatment for her “bronchioalveolar carcinoma” proved even more elusive until 18 months later when she contacted Dr. David Gandara at the UC Davis Comprehensive Cancer Center. Gandara, a leading lung cancer expert, has brought much needed attention to the growing number of young women diagnosed with lung cancer.
By the time Lacasia came under Gandara’s care, she had already endured two surgeries — one to remove a lobe of a lung and another to remove a chunk of the other lung. But the cancer continued to spread. She also had been put on a clinical trial including a chemotherapy later identified as being ineffective against her type of malignancy. After eight months on the regimen, the disease had, in fact, progressed.
Gandara took a very different tack. “He was very interested in seeing me” she recalls. “He stressed conducting molecular and genetic testing in order to gather as much information about my unique disease as possible.”
“My oncologist stressed molecular and genetic testing to gather as much information about my disease as possible. I have had an incredible response to this drug regimen.
Lacasia liked Gandara’s approach, which began with a battery of molecular and genetic tests to determine whether her tumor would respond to drugs designed to target particular genetic mutations. The test panel also identifies which chemotherapies would be more effective in fighting her disease. Lacasia’s cancer was a “wild type,” meaning her cancer did not match any identified mutation for which targeted therapies are specifically effective. Nevertheless, Gandara determined she was a good candidate for an available clinical trial because of his experience with this rare lung cancer subtype.
Gandara said his patient is a "poster child" for the growing number of younger women who have never smoked but get lung cancer. But unlike the majority of that group of women, Lacasia’s tumor tested negative for the usually present EGFR gene mutation.
“Through an innovative UC Davis Thoracic Oncology Program clinical trial, chaired by Dr. Tina Li, Lacasia was treated with a novel schedule of the EGFR inhibitor erlotinib combined with chemotherapy,” Gandara said. “While ordinarily antagonistic if given together, this novel schedule enables the patient to get the best of both therapies. She remains in remission for about two years now.”
Li added that Lacasia was the first patient enrolled in the study at UC Davis. “She had had an impressive response to the new combination treatment,” she said. “Based on the results from patients like Ms. Lacasia, we are discussing development of a new trial to follow up on this encouraging result.”
Lacasia believes that participating in clinical trials is important because they yield critical new information on diseases like lung cancer for which data is lacking. “It’s imperative for patients to participate because it helps optimize future treatments for other patients diagnosed with this disease,” she says.
Best of all, Lacasia says, is that nearly three years after starting the therapy she is doing well, with no evidence of active disease. “I have had this incredible response to the drug regimen. I am alive today because of Dr. Gandara. I think I have a future again and have a lot to look forward to.”