Although she had a family history of cancer, Debra Miller didn’t expect her own cancer diagnosis in 2017.
The news left her terrified but determined. She knew she had to do whatever she could to survive. And for her, that meant putting her life in the hands of God and her doctors.
“I just decided that I’m going to put this in God’s hands, take it one day at a time, and do what [my doctors] told me to do,” Debra says. “That’s all I could do at that point. I came to the decision that I can’t do anything about this other than what they tell me to do.”
That decision led her down a multiple-year path of treatment. It eventually led her to a clinical trial for tumor-infiltrating lymphocyte (TIL) therapy at UPMC. The innovative treatment had shown promise in treating tumors for different types of cancer.
Once again, Debra didn’t hesitate. She joined the trial.
‘We’re Going to Stay Strong and Figure This Out’
Debra’s cancer story began with a gastrointestinal condition. The Warren, Ohio, resident felt sharp stomach pain one afternoon in October 2017. Eventually, the pain got bad enough that she went to a local emergency department for treatment.
Doctors ran multiple tests and diagnosed her with intussusception, a condition in which part of the intestine folds in on itself. She needed to be flown to UPMC Presbyterian in Pittsburgh for emergency surgery.
As the care team prepared to put her on the helicopter, Debra received more news. One of the tests had revealed a large mass on the left side of her abdomen. Doctors suspected cancer.
“I was terrified,” she says. “It really scared me when they said that — I didn’t know what to think.”
Debra flew to Pittsburgh, where surgeons repaired her intussusception. The next day, doctors confirmed the mass was cancer.
Debra had stage IV leiomyosarcoma, a rare cancer that forms in smooth muscles like those found in the intestines, stomach, bladder, blood vessels, and uterus. In Debra’s case, the cancer began in her abdomen and spread to her liver.
Although Debra had a family history of cancer — including a brother who died of brain cancer in the early 1990s— she had no obvious warning signs. She hadn’t experienced any pain.
“I was kind of numb because it felt like everything was happening so fast,” Debra says. “But my husband and I believe in God, and we said we’re going to stay strong and figure this out.”
‘They Thought I Would Be a Good Candidate’
Doctors told Debra her cancer was serious but treatable. She began chemotherapy in November 2017 at a cancer center in Youngstown, Ohio, near her home. She returned to Pittsburgh the following spring for surgery.
Between November 2017 and November 2020, Debra went through three rounds of chemotherapy and four surgical procedures at UPMC hospitals.
Although doctors removed the tumors in her abdomen and liver, the tumor in her liver kept returning.
In November 2020, Debra underwent a fifth surgery. Doctors hoped to remove as much of the tumor in her liver as possible and deliver chemotherapy to the area to kill the rest of the tumor. If that didn’t work, they told her she might be a candidate for the clinical trial of TIL therapy.
During Debra’s procedure, the surgical team determined the original plan wasn’t an option because of the size of her tumor. They recommended her for the TIL therapy trial.
“Because I had done so well with the other surgeries, they thought I would be a good candidate for this,” Debra says. “I seem to bounce back really quick from the surgeries, and I still had no pain.”
After discussing the clinical trial with her doctors and family, Debra decided to move forward.
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‘I Prayed Every Night for a Breakthrough’
Tumor-infiltrating lymphocytes (TILs) are specialized T-cells from the immune system that recognize and penetrate into tumors. They can kill cancer cells, but cancer also can suppress that ability.
In TIL therapy, doctors remove a patient’s tumor, dissect it, and identify the strongest cancer-fighting TIL cells. They then add a growth agent to the cells in an attempt to increase their number.
If the TIL cells are potent, doctors grow extremely large numbers of them — usually in the billions. They then infuse those cells back into the patient to fight the rest of the cancer.
“What makes it so unique is that we remove the immune cells from a patient’s body,” says Udai Kammula, MD, director, Solid Tumor Cell Therapy program, UPMC Hillman Cancer Center. “We activate them and grow them to incredibly large numbers, and we use those cells as the drug, as the treatment.”
TIL therapy has shown great promise as a treatment for certain types of cancer, like melanoma.
The UPMC clinical trial was testing TIL therapy in patients with metastatic cancer — late-stage cancers that had spread. Candidates for the trial had exhausted other treatment options.
“Our trials are really meant to offer hope for patients who’ve really had everything,” Dr. Kammula says. “And so this is something that we think provides an opportunity not only for patients, but to help develop better therapies.”
Debra had hoped the TIL therapy wouldn’t be necessary before her November 2020 surgery. But when she learned she would need TIL therapy, she became excited as she learned more about it.
“I prayed every night for a breakthrough, and then this happened,” she says.
‘I Tried to Keep a Good Attitude About Everything’
Debra began her TIL therapy at UPMC Hillman Cancer Center in February 2021. Surgeons removed the tumor, and the research team began the process of identifying and growing TIL cells. They determined that her TIL cells were powerful enough to fight the cancer and began growing them in large numbers.
Meanwhile, Debra went through intense chemotherapy that temporarily wiped out her immune system. Dr. Kammula compares the weeklong process to rebooting a computer when it has a virus.
After the chemotherapy, doctors infuse the TIL cells back into the patient.
The entire process of TIL therapy takes about a month. Debra spent the entire time at UPMC Hillman. She couldn’t have any visitors during her stay, but she talked to her family every day on the phone or on video.
Throughout the treatment, Debra at times experienced various symptoms — nausea, chills, and fatigue. Her hair fell out quickly from the chemotherapy, which she experienced during her previous chemotherapy sessions.
Although she never felt pain, the experience was still difficult.
“This was the hardest thing I’ve had to do on my body,” she says. “I don’t know if it’s because it was more of a mind thing than anything else. Nothing hurt when they injected me with stuff.
“I didn’t know what to expect because I had never been through it before. But once it was over, I tried to keep a good attitude about everything and be positive.”
‘Live One Day at a Time’
With her TIL therapy completed, Debra returned home in March 2021. She felt weak at first. But as her strength returned, she become more active.
“The faster I could get out and start moving, the better I felt, and it seemed like the more I recovered,” she says.
Debra had her first follow-up appointment at UPMC Hillman in late March 2021. The scans showed her tumors were getting smaller. A second follow-up in May showed the tumors were continuing to decrease.
Better yet, Debra hasn’t had any new tumors grow since the treatment.
UPMC’s TIL therapy clinical trial is treating many different types of tumors. And Dr. Kammula believes what the team is learning can help advance cancer treatments like immunotherapy, cell therapy, and gene therapy.
Debra says she would recommend TIL therapy to others in her situation, people with advanced cancers that haven’t responded to other treatments. And while she says she has her good days and bad days, she’s staying positive.
“I am thankful because when my brother had cancer, they have come out with so many medicines and ways of doing things since then,” she says.
“Had [my cancer] happened sooner, I don’t know that I would still be here. I’m grateful, and I just try and live one day at a time and keep a positive attitude. I think that more than anything has gotten me through this.”
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UPMC Hillman Cancer Center provides world-class cancer care, from diagnosis to treatment, to help you in your cancer battle. We are the only comprehensive cancer center in our region, as designated by the National Cancer Institute. We have more than 70 locations throughout Pennsylvania, Ohio, New York, and Maryland, with more than 200 oncologists. Our internationally renowned research team is striving to find new advances in prevention, detection, and treatment.