For more than a decade after Auger was treated at Dana-Farber for recurrent glioblastoma, the tumor that once threatened her life has not returned. It’s still a rare outcome for patients with this type of brain tumor, but one that Wen uses as an example of what is possible.
“I often show her case to fellows and visiting colleagues as an example of what occasionally can be possible,” Wen says. “It gives us hope and drives our desire to find better treatments so that more patients like Heather can be helped.”
“I’m his miracle patient, and he’s my miracle man,” says Auger, a 43-year-old grandmother.
Much of Auger’s admiration for Wen and her team in the Center for Neuro-Oncology at Dana-Farber/Brigham and Women’s Hospital (DF/BWCC) stems from the fact that their confidence in her recovery has never wavered, even when things looked the worst.
In 2006, Auger was a 30-year-old single mom with two young children when she started experiencing severe headaches and blackouts. Doctors near her home outside Worcester, Massachusetts initially cited stress as the cause, but when she insisted on an MRI it revealed a large tumor in her brain.
Treatment included immediate surgery — performed that July at Brigham and Women’s Hospital by Peter Black, MD, PhD — and an introduction to Wen, who came up with a treatment plan. After surgery, Auger underwent radiation and chemotherapy.
“Dr. Wen was always giving me pep talks,” she remembers. “When I felt down, he made me feel good.”
This support was vital when, shortly after Auger stopped chemotherapy, the tumor returned. She had already handled her son and daughter’s questions and fears; she now had to do it for the second time. Trouble with her memory and other side effects made this even more challenging, but her parents were there to boost her up and help with the kids.
Trial and triumph
The big picture, which Auger tried not to dwell on, was frightening. Into the early twenty-first century, patients with recurrent glioblastoma had a grim prognosis and few treatment options beyond largely ineffective and toxic chemotherapies. Survivorship was measured in months rather than years.
Then it was found that a targeted agent called bevacizumab (Avastin) could, in combination with a chemotherapy drug known as CPT-11, change those statistics. In a randomized, phase II clinical trial at 11 cancer centers, including Dana-Farber, 167 patients with recurrent glioblastoma were given either bevacizumab and CPT-11 or bevacizumab alone.
Response rates rose significantly for patients in both arms of the study, showing that bevacizumab could be effective in reducing tumor size and brain swelling as well as the need for large dosages of steroids to combat such swelling. As a result, side effects caused by the steroids also decreased; patients had more energy, and their quality of life improved. This trial led the FDA to approve bevacizumab for the treatment of patients with recurrent glioblastoma.
Auger was on the trial from 2006 to 2009, and the drug controlled the tumor. Her only treatment since has been checkups with Wen every few months, and she has had no further recurrences.
“Heather had an exceptional response to bevacizumab,” says Wen, director of the Center for Neuro-Oncology. “It is wonderful to see her doing so well, but we are also very grateful that her participation in this trial has helped countless other patients with glioblastomas.”
Riding the roller coaster
Today, while Wen and his colleagues seek more clinical options for glioblastoma patients, Auger remains thankful for the gift of time that Dana-Farber has given her. She still has trouble with her memory, and she will never consider herself fully cured. But she is focused on living life to the fullest.
“It’s such a roller-coaster; you just never know what you’re going to hear at your next appointment,” says Auger. “My kids are grown, and out of the house, and I have a four-year-old granddaughter. It makes me realize how short life is, and the importance of making the most of every day.”