Melissa’s story: success of Consultative Proteomics in identifying therapy for a rare cancer
During the summer of 2010, 24-year-old Melissa Weiss’s life started to fall apart. Up until then, the athletic middle school teacher worked out at the gym whenever she wasn’t teaching class in San Antonio, Texas. Then, her knees started hurting. “I got to the point where I couldn’t run, couldn’t do squats, anything – it was crazy. And I kept losing weight.”
By the time she returned to her parents’ Seguin, Texas home for the school’s Christmas break, the 5’6” Melissa was down to 108 lb from her already thin 120 lb weight. “I was tired, weak, I didn’t want to do anything. I literally sat on the couch and ate all Christmas break. I was basically bones and skin.”
In January 2011, Melissa developed blood blisters “like red dots” all over her skin and began to bruise easily. She had heart palpitations and couldn’t sleep at night. Her family doctor’s tests showed that everything was fine. But Melissa knew that something was wrong. She moved back into her parents’ house, driving back and forth to San Antonio to teach.
In February, Melissa suddenly gained 10 lb in water weight in 2 days; her hair started falling out from her head, but started growing profusely on her legs and in her armpits. In March, she consulted an internal medicine specialist who did more tests that suggested kidney problems. He recommended diet changes and said that the swelling would go down and she would be fine. After a few weeks, there was no improvement. Melissa kept getting worse. “I was so weak. I had to sleep on my back, I couldn’t sleep on my side or my stomach because I felt like I would literally crush myself.”
Her mother kept searching online to find out anything that would help, and Melissa kept seeing different doctors to find out what was wrong. Finally, in July 2011, she visited a San Antonio endocrinologist who thought that she could have Cushing’s syndrome because her face was swollen, she had a hump on the back of her neck, and she was growing hair everywhere. Cushing’s syndrome occurs when levels of the hormone cortisol, produced in the adrenal glands, are excessively high for a prolonged time. An MRI confirmed the cause: there was a tumor on the right adrenal gland and part of the right liver lobe. The doctor advised Melissa to go to a specialty cancer hospital for care. “He said that he had one patient 25 years ago, and that’s the only other patient he’d ever seen with this” said Melissa.
By then, Melissa was teaching her classes from a wheelchair. “It was really tough. If I laid on the floor, I was so weak that I couldn’t get up unless somebody helped me. I was totally dependent on my parents.” Because the cancer was so rare, Melissa went to The University of Texas MD Anderson Cancer Center in Houston for care and started chemotherapy in March 2011. Finally, the tumor had shrunk enough that it wasn’t over a major blood vessel in the liver and could be removed by surgery in November 2011.
By mid-2012, the cancer returned. It was now in the left side of the liver plus 2 spots on the left lung. “I was just devastated because after they took the original tumor out, my swelling started to go down and I started to feel better, a little stronger. I was so upset because I started to feel better after feeling so down for so long and so weak.”
At this time, Dr. Robert E. Brown, Vice-Chair of the Department of Pathology and Laboratory Medicine at the McGovern Medical School at UTHealth, was brought in for consultation. Dr. Brown offers a specialty consult service, called “Consultative Proteomics,” that is designed specifically to help those patients who have failed conventional chemotherapy. “Melissa’s case came to my attention via her cousin who is a colleague of mine. Ms. Weiss had adrenocortical carcinoma, a malignant tumor of the adrenal gland. She had been treated with a multitude of chemotherapeutic agents that were used appropriately in treating her tumor, but these did not work. Her tumor was “resistant” to the standard cytotoxic chemotherapy. She also had recurrent disease that had metastasized to her liver and also to her lung.” Dr. Brown ran his unique morphoproteomic analysis on a sample of the tumor in order to define the biology of the tumor with regards to its resistance signatures to the standard chemotherapy and, more importantly, with regards to a targeted therapy that could be applied by her oncologist.
With the additional information from Dr. Brown’s Consultative Proteomics report in July 2012, Melissa’s oncologist was able to construct a personalized therapeutic plan. This brought Melissa’s cancer under control, and her improved health enabled her to start up her family. By early 2013, Melissa was pregnant, working part-time, and working out out in the gym again. She walked the Firecracker 5K run in Seguin that summer, and Melissa and Dustin welcomed their daughter Paislie, born in October 2013.
But one spot in her lung was missed. It was finally confirmed in late 2013 and was surgically removed in January 2014. Dr. Brown again profiled the tumor and found that one of the previously suggested agents seemed to have slowed down the growth of the tumor. He also identified additional therapeutic targets that would perhaps warrant additional therapies and made that information available to her oncologist.
Scans in January 2015 showed no more cancer. At 29 years old, Melissa is very happy. “I’m a stay-at-home Mom now; I’m fully back to everything that I was. I’ve never felt better since way before I was sick. I can run, I can jog, I can do squats, I can do everything that anybody my age can do. It’s incredible to think about where I was compared to now.” She continues. “My health didn’t start turning around until my cousin told us about the morphoproteomic research. Before then, it was just like Bam! – you’ve got this tumor, Bam! – chemo didn’t do a whole lot; it (the tumor) grew, but then it shrunk a little bit and they take it out. Then it came back, and then I was fighting like crazy and it grew. Nothing fazed it until the morphoproteomic research.”
Dr. Brown is also pleased with Melissa’s success. “Needless to say, the results are very gratifying but it also helps us, gives us the energy and incentive to move forward and try to make this Consultative Proteomics service available to more people. I might add that, as a result of the profiling of her different tumors, we were able to create a schematic that would be available and adaptable to many, many patients who have adrenocortical carcinoma. So, actually, Melissa Weiss should feel good not only because her tumor has subsided and she is apparently free of disease at this moment, but also because she’s made a contribution to fellow patients who might be afflicted with the same type of tumor.”
MF McGuire, May 2015