Editor’s Note: As a support platform for medical science in the second season of The Human World, Tencent Medical Dictionary, together with industry experts, provides in-depth interpretation around the diseases involved in each episode, hoping to deliver warmth and power through warm medical science.
“I’ve had so many chemotherapy drugs, I’ve lost all my blood vessels, I can’t find any blood, and this thing doesn’t react at all, they are also gods, worthy of my cancer cells, niu!”
Yan Hongwei looked at the pathology results on his phone, a grim helplessness behind a reluctant smile.
Why do you get cancer? Oncologists around the world are currently unable to explain it. The studies that have been done are the tip of the iceberg.
The incidence of cancer is an estimable chance for the entire population, but once it hits each patient, it becomes 100%.
33-year-old female teacher who suffered triple-negative breast cancer
Yan Hongwei, born in 1984, is a college teacher in Shanghai.
After graduating with her doctorate, she and her husband, Wu Zaibin, whom she met on campus, bought a house with a mortgage in Shanghai, got married, and have a lovely daughter together.
Source: Yan Hongwei husband Weibo @forexlockscrew
If not for this serious illness, life could have gone on peacefully and happily.
In March 2017, 33-year-old Yan Hongwei was diagnosed with advanced triple-negative breast cancer at the Cancer Hospital of Fudan University.
Doctors gave her a total mastectomy and total lymph node dissection. But the cancer did not die out and soon metastasized to the lungs.
Triple-negative breast cancer is the most aggressive type of breast cancer, accounting for about 15% to 20% of cases, and is prone to lung, liver, and brain metastases, with a high overall mortality rate.
This is called “triple negative” because this type of breast cancer has negative expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2).
If a cancer cell is found to be positive for one of these three receptors, it is equivalent to finding the “weak spot” of the cancer cell, and doctors can use drugs that specifically target that “weak spot” (that is, targeted drugs) to deal with it.
– For example, for breast cancer patients with positive estrogen and progesterone receptors, endocrine therapy is more effective;
– For HER2-positive breast cancer, the choice of anti-HER2 targeted therapy works well.
Triple-negative breast cancer, on the other hand, is very tricky – it has none of the three most common “weaknesses” of breast cancer.
So endocrine therapy and targeted anti-HER-2 therapy are almost useless for it, and chemotherapy is the only way to go.
Yan Hongwei has been on chemotherapy for 36 of the 52 weeks in a year.
And the results of the 5th chemotherapy review were still bad news – the tumor on her body had grown and increased again.
Chemo is often easily tolerated, and regimens need to be constantly changed depending on how well the patient is tolerating it. But it wasn’t long before her doctor told her that the chemotherapy options available in China were limited.
Platinum, paclitaxel, trimethoprim, anthracycline …… all of these commonly used chemotherapy drugs, Yan Hongwei has used them all and is not sensitive.
The BRCA gene (breast cancer susceptibility gene) was also tested negative. This means that Olaparib, a targeted drug that is effective against BRCA mutations, is also not available to Yan Hongwei.
After returning home, Yan Hongwei had a dream.
“Daddy, what are you talking about?” My 3-year-old daughter ran over to me.
“We’re talking about …… after mommy and daddy go out to work.”
Wu Zai Bin looked at his daughter with infinite compassion, “You’re a little sad.”
Going to the US for cancer treatment, hope or futility?
They’re not the only ones.
When I say “going out to work,” I’m actually taking my wife to the U.S. Anderson Cancer Center for breast cancer treatment.
The family scraped together $24,000 for treatment in the US, but it was only enough for one visit there.
On this matter, Wu Zaibin thought things through.
“You go, the money will be spent, and the results won’t necessarily be too different from Shanghai. The main thing is to give an account of yourself and your children.” He felt that as long as there was a chance of survival, he should try his best to fight for it, so that he would not regret it in the future.
Before leaving for the United States, Yan Hongwei made a wish in front of the hospital’s wishing tree.
And then she also went to the police station to do something important: change her daughter’s name.
My daughter’s original name was Wu Siyan (Yan). “The harmonic is is that her father misses me.”
But since she got sick, the family felt that the name was unlucky, that “people need to be missed when they are gone”. The company’s name was changed to “Wu Yi Zhen”.
“It’s embarrassing for a teacher of Marxism to do something like that.”
After filling out the information, she asked the staff if she could change her name back later.
“I was just thinking, if I’m really gone, I’ll use this name. If I survive, I’ll use the new name.” The words were like a normal joke.
The U.S. Anderson Cancer Center is the world’s top oncology hospital. In 2016, of the more than 3,000 international patients this hospital received, more than 400 were Chinese cancer patients like Yan Hongwei.
For thirty-nine full days, Yan Hongwei had a routine blood test, a lung metastasis puncture, and saw his primary care doctor twice. Twenty-four thousand dollars had been spent.
“The expectation was to get a protocol, but I ended up waiting a month, didn’t get a protocol, and was sent back by the doctor.”
But just the day before she returned home, she received an email from Anderson Hospital: the puncture report showed that she was 70% positive for estrogen receptors (ER) in the metastases in her lungs.
This means that the cancer in her lungs may have changed and is no longer “triple negative” – she may be able to try endocrine therapy.
As if seeing the light in a desperate situation, Yan Hongwei returned home with joy.
What do the experts think about the different results in the US and at home?
.
The familiar room at Fudan University Cancer Hospital, where Yan Hongwei showed her doctor the U.S. report with great anticipation. But the doctor’s answer threw cold water on her.
The Cancer Hospital of Fudan University, where Yan Hongwei was seen, is one of China’s top specialty oncology hospitals. The company’s main goal is to provide the best possible service to its customers.
This almost upside-down result also led to a discussion between Hu Xichun, director of the Department of Medical Oncology, and Yang Wentao, head of the breast group in the Department of Pathology.
They suggest that this may be due to “too much tumor heterogeneity”. In layman’s terms, each tumor cell looks different and mutates as it divides and metastasizes.
If there are five lesions in the lung, two may be positive and three may be negative. However, the puncture needle is very thin and often only a small portion of them can be taken, and it is not possible to puncture all of them.
So the “70% ER positive” results seen at Anderson Hospital are probably just a “glimpse” of the whole picture.
Lastly, Hu Xichun decided to use FES PET-CT to scan Yan Hongwei’s entire body so that he could see whether each tumor was positive or negative for estrogen receptors.
The results came back the next day and were still negative.
Subsequently, the Cancer Hospital of Fudan University organized a multidisciplinary consultation for Yan Hongwei’s condition. The results were the same as before, and the diagnosis of “triple-negative breast cancer” was upheld.
Shao told Yan Hongwei that the next step in her treatment would be chemotherapy, and that Professor Hu would give her the FOLFOX regimen, a triplet of 5-fluorouracil + calcium folinic acid + oxaliplatin.
In hospitals like this one in China, the standard of care is no worse than abroad. Because of the much larger number of patients, the level of diagnosis and surgery by doctors in China is also more precise and advanced than abroad.
Sadly, the glow of hope is only just appearing to be dashed.
After spending more than 100,000 yuan in the United States to measure the results, is it just put down? Yan Hongwei was not willing to do so.
Targeted drugs more expensive than gold, the last straw?
.
A week later, Yan Hongwei decided to trust the diagnosis of the American doctor first. She was ready to go to Hong Kong to buy paboxinib, a targeted drug that is not yet available on the mainland.
Medical Codex Reads: The first CDK4/6 inhibitor piperacil in advanced breast cancer
This drug was shown to be effective in breast cancer patients with ER-positive estrogen receptors, but it was expensive. At that time, paboxinib was not yet available in this country.
On May 1, 2018, the Chinese government began to implement zero import tariffs on imported anticancer drugs and accelerated the import of innovative drugs to the market.In August 2018, paboxinib finally hit the mainland market, about three years ahead of the original approval process.
A box of 21 paboxinib capsules costs about 30,000 RMB. With a prescription from a Hong Kong clinic, Yan Hongwei paid 90,000 for three boxes, which is almost a year’s salary for her.
“It was only after I got sick that I realized, what is gold? The company’s main goal is to provide a comprehensive range of products and services to the public. Walking on the streets of Hong Kong, Yan Hongwei sighed heartily.
For the next two months, Yan Hongwei took one paboxinib a day and lived like a healthy person, expecting a miracle.
But the CT results from the sixth review once again knocked hope back: each lesion was still increasing in size, and the tumor had still progressed.
Many people are as puzzled as Yan Hongwei. But in fact, the answer is clear – it means that the estrogen receptors in her tumor are indeed negative, so the targeted drugs had no effect.
Even if it really is estrogen receptor-positive, taking paboxinib alone is not enough:
– Paboxinib needs to be paired with an aromatase inhibitor, such as letrozole, when used in first-line therapy (that is, in patients who have never been treated with other breast cancer drugs);
– when used for second-line therapy in patients who have failed endocrine therapy, it needs to be paired with fulvestrant (currently not approved for second-line therapy in this country);
– The above is for postmenopausal patients; premenopausal patients would also have to add ovarian function suppression.
So, if one does not carry the target gene or target receptor, it is not recommended to blindly try targeted drugs, with the result that there is likely to be no benefit but a high cost.
The road to fighting cancer is long and difficult
Yan Hongwei has tried almost everything to fight cancer cells, but time and time again it has proven futile. This is a true reflection of many cancer patients.
According to data released by the National Cancer Center, about 10,000 people are diagnosed with cancer in China every day, an average of seven people every minute.
While humans are still far from “conquering cancer,” oncologists cannot answer all of their patients’ questions, but they will do everything they can to control tumors and prolong their survival.
There are too many tears in the hallways of cancer hospitals.
But in the blink of an eye, they’re smiling again, committed to the next battle.
Like the fat aunt who wears exquisite makeup every time she comes to chemo. “As usual, I’m positive about it and don’t let people see that I’m sick.”
After the show aired, husband Wu Zaibin posted Yan Hongwei’s last few friendships on Weibo:
Source: Yan Hongwei’s husband Weibo @forexlockscrew
Yes, an optimistic Yan Hongwei is on a new journey – immunotherapy.
One study noted that triple-negative breast cancer patients had a 20% PD-L1 positivity rate for tumor cells and a 41% positivity rate for immune cells. This means that the immune drug PD-L1 inhibitors may have a therapeutic role in triple-negative breast cancer. However, patients must be reminded that no uniform norms and standards have been established for testing methods at home and abroad.
Let’s keep her in our prayers. May there still be a faint light in the black box of cancer.