Not Just Living, But Thriving with Targeted Therapy

When Bekah Cunningham completed the final mile of the Appalachian Trail in November 2019, it was the culmination of an incredible journey of far more than the nearly 2,200 miles she’d covered over seven months.

It was even more incredible considering that three years earlier, the then-29-year-old was told she had lung cancer and only had months to live. After her diagnosis, Cunningham sought a second opinion at Dana-Farber, where she went on a targeted therapy drug that changed everything for her.

She has since remained in good health and sought out new adventures, a new career, and a new home.

“I have not only been able to live but thrive in life,” Cunningham says.

Drawing on family and Dana-Farber expertise

Cunningham was already on a health roller coaster when she received her diagnosis in spring 2016. The hairdresser from Fairhope, Alabama, had been coughing up blood for months and developed repeat bouts of pneumonia and bronchitis. She also detected a lump in her breast that was initially misdiagnosed as a stage 2 triple-negative breast cancer.

Before starting chemotherapy, she wanted to freeze her eggs to preserve her chances of conceiving a child in later years. But after undergoing testing for the procedure, she received unfortunate news. Doctors had deduced that the lump in her breast was not caused by a primary breast cancer; it had actually metastasized, or spread, from her lungs. The official diagnosis was stage IV lung cancer.

Cunningham’s seven older siblings rallied around her. Her three brothers helped with her cooling cap, a device designed to prevent and reduce hair loss from chemotherapy. Her sister Betsy Yohn, a Southwest flight attendant, became Cunningham’s advocate and accompanied her to every appointment.

“I wouldn’t have made it without her,” Cunningham says. “Especially in those first months, Betsy spoke for me when I couldn’t. She was my rock.”

At Dana-Farber, Cunningham learned through genetic testing she was among the three to four percent of patients with lung cancer who are ALK-positive, meaning her cancer has a mutation in the ALK gene that enables cancer to grow unchecked. After starting out on an older medication, Cunningham was switched to a next-generation drug called alectinib.

“Alectinib is potent, targeted inhibitor of the abnormal ALK protein, and it is also very effective at getting into the central nervous system to treat brain metastases,” says Mark Awad, MD, PhD, director of clinical research in the Thoracic Oncology Treatment Center. “This twice-a-day oral therapy is excellent at controlling, preventing or delaying progression of ALK-positive lung cancer.”

Cunningham experienced some side effects as her body responded to the Alectinib. Her muscles ached and burned. She developed a widespread rash and became sensitive to sunlight. Her care team at Dana-Farber was well-versed in handling side effects and guided Cunningham through these challenges, which eventually eased.

‘Figuring out my new normal’

As her physical health gradually improved, Cunningham “had a hard time figuring out my new normal and who I was with this diagnosis,” she says. “I had a moment of reckoning: I can wallow in this, or I can take control of it and make changes. I needed to figure out, ‘How do I make a total 180-degree turn in my life and give myself space to figure it all out in a healthy way?’”

She found the answers on the Appalachian Trail. She embarked on her quest in April 2019 with her dog, Hank, for company. Family and friends connected with her at different points on the trail, and her mom served as her support crew along the way.

Cunningham took it very slowly at first. She logged only modest miles each day and took leisurely naps after lunch to recharge her energy.

“When I started, I wasn’t completely healed yet,” she says. “But literally every morning, I woke up feeling stronger and healthier, not just physically but spiritually and mentally as well.” 

As she hiked through each season, “I loved evolving with nature, noticing a different flower or bug or the tiniest change in the weather,” she says. “I felt so connected with life in a way that you can’t be in your normal routine because you’re so bombarded with things.”

With each passing day on the trail, it became clearer: “I couldn’t go back to my old life and be the old me,” Cunningham says.

A new chapter

Cunningham’s sister Susan Yohn, also a Southwest flight attendant, connected her with an international charter airline that was hiring. She signed on and over the next two years visited 17 countries, including Ireland, Germany, Turkey and Bulgaria.

“I really enjoyed the freedom and immersing myself in so many different cultures,” Cunningham says. “Traveling internationally gave me a confidence that I didn’t have before.”

When the opportunity arose in 2022 to join her sisters in flying for Southwest, Cunningham leapt at the chance. She moved to Denver for the job and is now enjoying the beauty of the Rocky Mountains and frequent visits with Betsy, who lives nearby. 

“The doors just opened for me to be here,” she says.

Cunningham has faithfully returned to Dana-Farber to see Awad for her regular maintenance scans, which remain clear a remarkable six years after starting on Alectinib — twice the median response.

“Her commitment to coming back to Dana-Farber for care from out of state is a testament to her spirit and her drive,” Awad says. “She has a wonderful outlook, and her energy and stamina are inspiring.”