Considering the number of times Nita Jestila’s body has turned on her, it’s a wonder the 71-year-old Blue Springs grandmother can describe all her medical problems with a smile on her face.
She’s had breast cancer, twice.
She has 15 tiny titanium coils inside her brain that doctors inserted to stifle an aneurysm — “I’ve got a big, fancy brain,” she jokes.
And, most recently, the stomach pains she felt on her way home from a trip to Italy with her husband last fall turned out to be ovarian cancer — the most lethal of all cancers that can attack a woman’s reproductive system, the American Cancer Society says.
Sitting at her dining room table in Blue Springs where she likes to play dominoes with friends, Jestila detailed her medical history for public consumption because she wants people to know about the little beige-colored pills she takes at 8 a.m. and 8 p.m. every day. They are called PARP inhibitors and they’re causing a stir of excitement and hope in cancer circles.
The pills are used after surgery and chemotherapy in ovarian cancer patients like Jestila who have the BRCA gene, or so-called “breast cancer gene.” But new clinical trials found that the drugs markedly reduced the chance the cancer will come back in other patients as well.
They’re “a treatment breakthrough,” said Michelle Rowland, a gynecologic oncologist at Saint Luke’s Cancer Institute who is treating Jestila. In the past couple of years she’s had as many as 10, 15 patients at a time on a PARP inhibitor.
This year, about 22,500 women will be newly diagnosed with ovarian cancer, according to the American Cancer Society, and nearly 14,000 women will die from it.
The odds are stacked high against ovarian cancer patients like Jestila — as much as an 80, 85 percent chance of recurrence, usually within three years.
“What we know about ovarian cancer, really our best treatment is in the beginning,” said Rowland. “Once that patient has recurred, essentially we tell patients this is not curable, that now it has become more of a chronic disease. So we’re going to want to keep the cancer at bay as long as possible.
“So that’s really why there’s big news … because if we can keep more women from ever having a recurrence, those are the women we’re going to cure.”
The newest trial “for the first time reveals that there is something we can give all women with ovarian cancer that improves their … survival,” said Colleen McCormick, a gynecologic oncologist in Portland, Oregon, who worked on the study published in September in the New England Journal of Medicine.
It was the first study of a drug called niraparib for newly diagnosed patients who had finished chemotherapy.
“And we don’t know yet, because we’re still waiting on that data, but the hope ... would be that that would translate into improved survival,” McCormick said.
Ovarian cancer symptoms often ignored
“Want to see something ugly? It’s shocking is what it is.”
Jestila, a unit secretary at Children’s Mercy Hospital, has pictures of her cancer on her cellphone that she’ll show you if you can stomach it. Her husband, retired electrician Terry, points out that all those “white dots” that look like whiteheads scattered across a teenager’s face is the cancer that nestled on top of his wife’s internal organs.
She had no idea she had a belly bursting with cancer when she and Terry, her husband of 42 years, and another couple, toured Italy last November after her 70th birthday.
She walked miles through the Sistine Chapel, the Vatican and the Colosseum, spent a couple of days in Florence, then Genoa and came back to the States on a cruise ship, nagged only by the pain in an arthritic hip.
Then halfway home on the ship her stomach started aching. At home the pain persisted to the point that all of her domino-playing friends eventually knew about it. The shooting pain traveled to different places in her abdomen.
Terry watched his wife diagnose herself with an ulcer and hounded her to go to the doctor. Instead, she “quit taking the ibuprofen and started doing milk, taking care of this ulcer that I was sure I had developed,” she said.
But things got worse. She lost her appetite. She’d eat half a sandwich “and I felt like I’d had Thanksgiving dinner. I’d just be so stuffed,” she said. “And then I started getting swollen, losing weight. I lost 20 pounds, and my pants were getting tight.”
The symptoms of ovarian cancer “tend to be fairly subtle and tend to kind of sneak up on people and also tend to be things that are easily minimized — feelings of pelvic pressure, constipation, bloating, and just kind of not feeling super hungry, feeling full early,” McCormick said.
Demographically speaking, Jestila is a textbook patient. Ovarian cancer mainly develops in older white women, according to the cancer society. About half are 63 years or older.
“A lot of times people attribute these (symptoms) to ‘oh, I’m just getting older.’ A lot of us throughout our lives, throughout different months, are going to feel a little bit more poofy in our stomach than others. So people tend to kind of minimize those symptoms and say, ‘Oh they’re nothing I need to worry about.’”
She went in for a colonoscopy in January. It went well, except she was in pain afterward.
“It was from that moment on we knew the whole thing was orchestrated by God to get me there,” Jestila said, because the doctor who did the colonoscopy sent her to the emergency room, where a CAT scan indicated a more serious problem.
“Her old friend,” said Terry.
Jestila had breast cancer, the first time, in 1997. Except for a brief outburst of tears with Terry in the kitchen — it’s cancer! — she stayed calm. When a friend told her it was OK to cry, Jestila told her: “I will when I feel like it. But when God gives his peace I’m going to sit in it. I’m going to wallow in it.”
In 2002 Jestila and her family celebrated her being cancer-free for five years. They had a big party that June. She was diagnosed with breast cancer, again, in August.
The new cancer was bigger and faster-growing, and Jestila had both chemo and radiation. She also had 23 lymph nodes removed — 22 had cancer.
“it’s like the 23rd Psalm, and that one was the good shepherd,” said Terry. “We clung to that.”
Cancer cell disrupter
Given that Jestila had breast cancer twice, and now ovarian cancer, Rowland was concerned that she hadn’t been tested for the BRCA gene. Jestila is the mother of four.
“Of course the first thing we wanted was to get her treated (for the cancer), but we started talking right away that she needed some genetic testing because it’s very unusual to have two breast cancers and ovarian cancer and she might very well be a BRCA carrier,” Rowland said.
PARP inhibitors were first approved for use by the Food and Drug Administration for patients with the BRCA gene.
“PARP inhibitors are what we call a targeted therapy,” said McCormick. “The concept of targeted therapies, which you hear a lot about for newer treatments, is we’re trying to figure out something in some way that cancer cells do that’s different from regular cells and trying to target that mechanism.”
A PARP inhibitor’s job is disruption, blocking enzymes that let cancer cells repair their DNA. “In cancer treatment, blocking PARP may help keep cancer cells from repairing their damaged DNA, causing them to die,” the National Cancer Institute writes on its website.
A clinical trial last year called SOLO-1 tested the use of the PARP inhibitor olaparib on women with newly diagnosed advanced ovarian cancer who had a BRCA 1 or BRCA 2 mutation.
The results, published in December in the New England Journal of Medicine, found that patients who used olaparib as maintenance therapy had a 70 percent lower risk of recurrence, or death, than women given a placebo. Cancer in women with BRCA mutations “tend to be more responsive to PARP inhibitors,” McCormick said.
The study McCormick was involved, called PRIMA, with sought to answer: “What about everybody else?”
The results of the SOLO trial were great, but “not everybody in fact, not most people have BRCA 1 or BRCA 2 mutations,” McCormick said. “Are these drugs helpful or useful for everybody else?”
The answer was yes. The PRIMA study involving 733 ovarian cancer patients around the world looked at the PARP inhibitor niraparib. The finding: Niraparib reduced the risk of the cancer recurring, or death, by 38 percent in women who took it versus those given a placebo.
“The question that we’ve tried to answer for a long time is is there something we can give people that increases the length until people recur?” McCormick said. “We know that with ovarian cancer we can cure some women who have very advanced disease.
“About 20 or so percent of women will be cured with a combination of aggressive surgery and chemo. But we know that most women will eventually recur.
“And once somebody recurs, it’s not considered curable, and we are kind of in this cycle of re-treating, getting back into remission, re-treating, getting back into remission, with the interval in between getting shorter and shorter over time.
“So the goal of maintenance therapy is to try to see if there is something we can give after we’ve completed the big up-front treatment, is there something we can do to make that first window longer? Ideally can we make that first window indefinite so that we have more people who are cured?”
SurvivorNet, a website for cancer patients, quotes McCormack saying, “If your doctor does not bring up PARP inhibitors early on during the course of your treatment, you should absolutely ask. … Unfortunately, only 50% of women today who are eligible for PARP inhibitors actually end up receiving them.”
Rowland said patients like Jestila always wanted to do more after their chemotherapy and surgery.
“They would always come and say, ‘OK, I finished my chemo and I finished my surgery and you told me I’m in remission and now i just sit here and wait?’” she said. “And this offers us an opportunity to offer them something that can actually make a difference in their survival.
“So I think both from a disease impact and from a patient standpoint, it really has changed the face of ovarian cancer treatment.”
Jestila is in remission and her prognosis is good, Rowland said. She will continue taking the PARP inhibitors and see Rowland every three months for the next two years. Her “numbers” look great. After seven chemotherapy treatments, surgery and the PARP inhibitors, her counts are down from 10,000 … to 6.
She’s writing a blog about her “journey” to let other women know they are not alone.
And the stomach ache is gone.