肺癌4期病人登上尼泊爾美拉峰
TheNewsLens
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一名肺癌4期患者參加一項基因治療臨床試驗，取得理想療效，他更回復昔日活躍好動的生活方式，登上尼泊爾的美拉峰。他其中一名主診醫生說：「數年前，醫學界根本想像不到這是有可能的。」
「統計數字上，能多活一年不大可能，兩年的話，幾乎是奇蹟。」61歲的安迪·林賽（Andy Lindsay）確診肺癌第4期三年了，去年10月15日早上8時，他成功登上海拔6476米的尼泊爾美拉峰（Mera Peak）。
林賽的醫療團隊包括波士頓馬薩諸塞州總醫院心贓及腫瘤科主任Tomas Neilan，他批准林賽登山可不是基於「讓一個快要死的人完成心願」，而是判斷他心肺功能正常，而且具有豐富登山經驗。在攻美拉峰前幾個月，林賽去了緬因州和新罕布什爾州登山，數年前到尼泊爾徒步旅行，安全健康的回來。
林賽之所以能夠做到這些看來同肺癌4期病人無緣的事，主要是因為尖端基因治療臨床試驗（gene therapy clinical trial）成功。該項治療針對特定肺癌組織的突變，能夠阻截身體供給腫瘤養份，令腫瘤縮小。這不能把林賽完全治好，但起碼他的掃描顯示，肺癌病情明顯改善，幾乎沒有症狀。
Tomas Neilan表示，基因治療的成效，改變了癌症專家治療較晚期患者的看法，無論腫瘤專家或病人都可以朝著「能回復較活躍好動生活方式」的方向努力：「這是把第4期肺癌變成與高血壓沒有分別的慢性疾病。」
沒有人知道這項臨床試驗成功能夠讓林賽存活多少時間，但現在他的健康顯著改善，可以再做一些自己喜愛的事情，例如騎單車沿海外線旅行、重回樂隊在咖啡室演奏，當然也包括跟朋友一起去尼泊爾登山。
那不是件易事。在高海拔地帶，氣壓比海平面低70%，即使最強健的登山客都會出現呼吸困難。此前也沒有數據顯示晚期肺癌病人在高海拔地區會有何反應，Neilan與林賽討論了可能出現的健康問題，並強調：「如果你向一大群醫生徵詢意見，應該會得出很多不同答案。」
林賽的另一名醫生是馬薩諸塞州總醫院腫瘤科的Zofia Piotrowska。她指林賽屬於表皮細胞生長因子（EGFR）基因突變的肺癌患者，在非吸煙肺癌患者中比較常見。當林賽在2014年確診時，他接受了第一代標靶藥物治療，反應很好，但不足一年就出現抗藥性。2016年，醫生再次發現他對當時所服藥物有抗藥性，林賽遂決定參加新藥EGF816的臨床試驗。在接受治療數天內，林賽的呼吸已見改善，數個月後，他重拾戶外活動，由於運動增加，身體也變得較強健。
Piotrowska醫生在林賽登山前表示，他的肺功能已接近平常人的水平，最大疑問在於一個曾處於晚期肺癌的肺部，在低氣壓環境下會有何反應，以及林賽如何處理這項艱鉅運動帶來的壓力。
林賽不敢輕率，在初段停停走走，有時僅僅跟得上登山隊的隊尾，甚至要讓隊員先走，自已慢慢跟著。當體力適應過來，林賽開始發揮耐力，去到海拔5181米時，他已經是全隊中走得較前的一員。
到最後一天，全隊人用繩子繫在一起。林賽沉醉於回憶說：「恨那個黑暗中升起的壯麗黎明來得太快，一抹醉人的深紅色照亮所有山峰，包括珠穆朗瑪峰。」
在最近一次掃描，醫生證實林賽左右兩邊肺部各有一個生長緩慢的小結節，但林賽暫時沒有任何症狀。他上月回到馬薩諸塞州總醫院，與數名肺癌第4期患者參加會議，聽取研究員講解往後的治療方向。
When the Lung Cancer Patient Climbs Mountains
The New York Times
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Andy Lindsay, a lung cancer patient, was among the climbers and porters heading up Mera Glacier in Nepal to Mera High Camp on a three-week trek this fall. Credit Margaret Fahey
On Oct. 15 at 8 a.m., Andy Lindsay stood atop 21,247-foot Mera Peak in Nepal, a wildly improbable place for him to be both athletically and medically.
Andy, a veteran climber and a friend of mine, had been living with Stage IV lung cancer for three years. “To live one year was statistically unlikely, and two years looked like a miracle,” he said.
He was able to make the climb thanks to the success of a cutting-edge targeted therapy clinical trial. It targeted his specific lung cancer mutation, shutting off the fuel to his tumor’s growth and shrinking the tumor. He wasn’t cured, but his scans were strikingly improved and he was almost symptom-free.
The trip illustrates a shifting landscape both for oncologists and cancer patients exploring a return to active lifestyles. Dr. Tomas Neilan, the director of the cardio-oncology program at Massachusetts General Hospital in Boston, and part of Andy’s medical team, said the recent success of these targeted therapy treatments alters the way specialists like him view and treat advanced cancer patients.
“They’re taking Stage IV cancer and turning it into a chronic disease no different than high blood pressure,” he said.
Andy, 61, of Ipswich, Mass., had a window of good health, a honeymoon of indeterminate time during which he could resume the activities he loved. He played in his coffeehouse band, traveled and took long bike rides up the coast. He also accepted a friend’s invitation to climb in Nepal.
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Jan and Andy Lindsay take a tea break in the Hinku Valley on the third week of their trek. Credit Sandy Walker
Over three strenuous weeks he and his wife, Jan, who is a registered nurse and an experienced outdoorswoman, trekked alongside eight other climbers and several guides, most of whom they’d traveled with in the past.
In announcing the trip on his Caring Bridge page to ask for donations to fund lung cancer research, Andy had said there was a slim chance he’d summit.
At the altitude he reached, there’s 70 percent less air pressure than at sea level to push air into the lungs. Breathing is hard for the fittest climbers. There was no data on what the high altitude would do to an advanced lung cancer patient: None were found to have tried.
“It’s a remarkable achievement,” Dr. Neilan said. “My colleagues are flabbergasted.”
He gave Andy the O.K. to go to Nepal not as a dying man attempting his last climb but as a person with a deep experience in the mountains who exhibited solid cardiovascular function and health. In the previous months Andy had climbed high peaks in Maine and New Hampshire. Years earlier he’d traveled to Nepal for a trekking trip without incident.
Dr. Neilan, a climber himself, said he found no data around altitude sickness — the most dangerous and common health risk for climbing in high mountains — and Andy’s conditions. But Dr. Neilan knew that at lower altitude even healthy younger climbers tended to have a greater likelihood of pulmonary edema and cerebral edema.
They reviewed a series of warning signs of altitude-related health problems ranging from coughing up blood to severe, unshakable headache. He gave his blessing but acknowledged: “If you polled physicians you might have gotten a lot of different advice.”
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Jan and Andy Lindsay climbing in October. Credit Sandy Walker
Another of Andy’s doctors, Dr. Zofia Piotrowska, a medical oncologist at Massachusetts General, said her team wanted to help him go where he wanted to go, knowing the trip’s meaning to him. However, if she thought the trip was a “medically very unsafe thing to do,” she’d have asked him not to go, she said.
When he was given his diagnosis in 2014, he was treated with a first-generation EGFR inhibitor, an oral pill that turned off the mutant protein on the surface of the cancer cell. His response was swift, but the remission lasted less than a year.
In 2016 he enrolled in his current trial after a biopsy showed his cancer had developed a specific mutation to resist the original drug he’d been on.
A newly developed drug known as EGF816 targeted his acquired resistance.
Within days of being treated, Andy noticed he was breathing better. He resumed his outdoor activities and adventures in the months to follow, doing more as his fitness improved.
Dr. Piotrowska said that before clearing him for the climb, she thought his lung function was pretty close to normal. The question nobody could answer was how lungs that were once filled with cancer would tolerate altitude. Also unanswerable was how he’d respond to the exertion and stress of the expedition, which included waking in darkness in subzero temperatures and a 16-hour climb on summit day.
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At the summit of Mera Peak — altitude 21,247 feet — Andy Lindsay pays tribute to his cancer team at Massachusetts General Hospital, where gene therapy for his Stage IV lung cancer enabled him to make the climb. Credit Sandy Walker
Andy admitted that he was pleasantly surprised that his doctors signed off.
His most recent scan had confirmed two small, slow-growing nodules, one on each lung. There were no immediate symptoms.
“It’s not like we were told to expect these spots to blossom forth while he was gone,” his wife said. “If we had, it would’ve been an absolute no go.”
A longtime ski mountaineering friend, Brian Lambert, invited Andy to join the trip. They felt he’d be in good hands: the lead guides were Jim Gudjonson, a longtime alpine guide on several of Andy’s previous trips, and Deryl Kelly, an Everest veteran and the head of Parks Canada rescue service who, as an E.M.T., would oversee the clients’ health on the mountain, along with a team physician.
The trip itself was a test. Though Andy went at his own pace the opening week, staying mostly to the rear of the rest of the party as he combined walking steps with periodic “rest steps,” he struggled.
He said he was within a day of letting the others advance on the summit without him when his stamina markedly improved. As they crossed the Mera glacier above 17,000 feet he found himself alongside the group’s faster members. Although it is poorly understood who acclimatizes well and who doesn’t, Andy said he found that he did better at higher altitudes. He likely also benefited from his superb technical skills in using crampons and ice tools on the high glacier.
And he joked that he might have another useful mutation: “I seem to love a sufferfest.”
In ascending on the final day — the climbers were tethered to one another with rope — Andy described the despair of a too-fast pace in the darkness melting in the uplift of a spectacular daybreak. The “beautiful crimson” lit up all the neighboring high peaks, including Everest.
Late last year, he was among several Stage IV cancer patients invited to a small gathering in Boston of top Massachusetts General researchers who outlined their thinking on future therapies. The researchers were clearly energized by the presence of the pioneering patients.
“This is an example,” Dr. Piotrowska said, “of something that none of us ever thought would be possible a few years ago.”
An earlier version of this article mistakenly referred to the therapy Andy Lindsay had as gene therapy. It is targeted therapy, which targets and inhibits the EGFR mutation, but does not alter the patient’s DNA.
文章來自: TheNewsLens / The New York Times
中: https://hk.thenewslens.com/article/87101
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