Changing cancer treatment to meet changing genetics in tumors

MECHANICSBURG, Pa. (WPVI) -- Genetics is playing a bigger and bigger role in medicine, especially in cancer.

A tumor's genetic profile can predict how it will act, and often determines the best treatment. But genetics isn't necessarily a once-and-done measure.

For Tiffany Fagnani of Mechanicsburg, Pennsylvania, it began with twitches in her eye and arm.

"I thought I was having a stroke. I called 911," the then 36-year-old Tiffany recalls. "Then I went unresponsive."

Scans found masses in her brain and lung, and more.

"Little lumps and bumps everywhere throughout my entire body," she adds. "They gave me six months to a year and a half, at best, with treatment. Get your affairs in order."

Refusing to accept that there was nothing to do, Tiffany got a referral to Fox Chase Cancer Center. Soon, she had surgery for the brain tumor, and much more.

"Radiation treatment for the brain and a separate radiation doctor for the lung, targeted therapy based on the mutation pattern for the tumor," explains Dr. Christopher Manley, an interventional pulmonologist at Fox Chase Cancer Center.

Dr. Manley says tests showed an EGFR mutation - fairly common for lung cancer. Drugs targeting specific mutations not only work better, but they also provide other positives, too.

"We see less side effects than we would see with the traditional chemotherapies. Some of these therapies are given as infusions through the vein. Others are pills patients can take at home," he says.

As good as they are, the drugs may not work forever.

"Cancer is really smart, and it learns how to outgrow the targeted therapy," Tiffany notes.

The genetics of her cancer had changed. That's why close surveillance is essential.

"At Fox Chase, we routinely test samples with next-generation sequencing to look at the tumor DNA," Dr. Manley says. "Because there are so many specific profiles that can be targeted with a drug."

And there may be new drug options.

Tiffany got a newly-approved one seven years ago - and it's still working.

At the end of this past January, it was, "Four and a half years, no evidence of disease," Tiffany says proudly.

"Picking the right team, the right treatment plan is so incredibly important," she says.

Dr. Manley says quality of life is a top priority for Fox Chase care teams. They want patients living their lives, not in long or unnecessary treatments.