McLeod study examines ways to treat brain cancer

FLORENCE, S.C. — Every day across the United States there are drug and treatment studies that take place in the ongoing battle against cancer — one such study is taking place at McLeod Regional Medical Center.

Four patients at McLeod are participating in a standard of care study to see how best to treat small cell lung cancer that has metastasized to the brain. McLeod has the second highest number of participants. Wake Forest is the highest with eight.

The test is being overseen by NRG, a collaborative group that is studying the care and not any particular drug.

One of the test participants is Bishopville Councilman Edward Byrd, 72, and by marriage, Patricia Lovely Byrd.

Byrd has a long history of public service with Bishopville that included a stint in the fire department and as a supervisor within the city government.

Byrd, last year, was diagnosed with small cell lung cancer after his wife came home from a hospital stay and his voice was hoarse.

“I had just gotten out of the hospital and he faithfully came every day to the hospital. I told him he didn’t have to come but he came every day anyway,” Patricia Byrd said. “When I got released and discharged and got home I noticed Mr. Byrd was coughing. It went beyond a cold and I said ‘You’re going to the doctor because that’s a cold the doctor needs to see.’”

After several visits to doctors to clear up his voice the cancer was found.

“They immediately started treatment,” Byrd said. “Me and the doctor talked about what was best for me.”

At issue with the test is how the brain is treated along with the lungs since small-cell lung cancer inevitably spreads to the brain. The test was to see if whole brain radiation was best or if surgically targeted radiation would achieve the same, or better, results with less cognitive decline.

The Byrds spoke at McLeod after he had concluded the test. He received whole brain radiation though some areas of his and other patients brains were spared to improve their quality of life.

“It’s about the same, but I’m here. That’s the main thing,” Byrd said of his mental prowess. “I can remember 20 years ago. I walk out of here and tomorrow I won’t remember any of your names.”

Byrd said that when he qualified for the test — not a given — the decision to participate was an easy one.

“You reach a certain age where you want to give back to the community,” Byrd said.

There were two other considerations — a South Carolina convention of council members he wanted to attend and fishing he wanted to do.

My name will still be mentioned — by blazing a trail as a trial participant

Byrd said he lost a good friend to cancer, though a different type, and that he tries not to let his diagnoses get to him.

“If you let it bother you, it can,” Byrd said.

“I do all the worrying. It’s not easy,” said Patricia Byrd, who is no stranger to caring for a cancer patient. “He had a younger brother who had throat cancer and I had the pleasure of taking care of him as well.”

Byrd said family support has been key in all aspects of trials, including fishing where he relies of friends and family to get him out on the water.

“I’m still a little weak, need somebody with me,” Byrd said. “Going fishing in Virginia next year.”

“I’m very proud of him and I have been right by his side 100% — like I always have been,” Patricia Byrd said. “When he’s sick I’m sick too but I try to stay strong. It’s hard sometimes watching him when he doesn’t feel good.”

“I’m praying he gets to see his siblings like a sister and brother in New Jersey. I really want to get him to see them,” she said of a trip they could take soon. “I want him to continue getting better and getting over it. For him to live the rest of his healthy and happy life.”

Both Byrds, married 35 years, are of one mind when it comes to the role faith plays in their journey.

“I pray everyday that I can make it through to see another one. A lot of people are blessed and don’t know it,” he said. “I want them to know this. Put Him first.”

“Most of all he keeps prayer first and God first,” she said.

For their trip back to Bishopville, the two had a plan.

“Dinner’s already ready, we might stop and get a snack. But right now Mr. Byrd needs to continue to rest and regain his strength.”

Becoming part of such a study is no small feat and requires a patient meet many criteria — most of which are beyond their area to control — just ask registered nurses Jennifer Floyd, Michelle Gandy and Betsy Harris whose job it is to shepherd the test subjects through the tests.

One of their primary jobs is to look at the available studies out there and figure out which ones the staff at McLeod could participate in and which of those would be the most beneficial to patients. They they take their pitch to the doctors who would be involved.

In the case of the Byrds, it was never about a cure.

“Small cell lung cancer is not curable,” Gandy said. “The best we can do is what we can do have them as much quality as possible.”

The test involves giving the patients a drug designed to help them maintain cognitive abilities while they are scanned twice a week to see if lesions, or more lesions, have formed on their brain since the last scan.

“He’s a good patient, he’s the one staying above the bar, right now,” Gandy said.

The nurses and families work closely together through the test with the nurses in charge of medical appointments, care and other aspects of treatments, doctors appointments, support — cancer related or otherwise — for the patients.

Both the nurses and Byrd said they have spent so much time together they have become family.

“He’s one of our newer ones, we still have some time left with him,” Gandy said. It’s not uncommon, we end the sessions ‘love you, love you too.’ We just really become invested in them and them in us. It’s a personal thing.”

“What appeals to us is we can give him a little bit more quality,” Gandy said.

“Right now the standard care of treatment is to radiate the whole brain. They either radiate the whole brain or they go under the srs — just hit the lesions,” Gandy said. “If they get the whole brain they’re still sparing the cognitive areas of the brain.”

While the nurses know how each patient’s story is going to end, what happens before that point is what they’re all about.

“We’re proud of it and what its done for our patients. One of our patients came in in a wheelchair and couldn’t walk, had some treatment, and was walking down the hall holding his cane over his head,” Gandy said. “He’s going the other direction but the study him some time to spend with his family.”

“They call it a seeding cancer,” Gandy said of small-cell lung cancer. “There are seeds (in the brain) you cannot see. There is no treatment. It’ll come back.”

“We see a patient population higher than many in small cell,” said radiation oncologist Dr. Virginia Clyburn-Ipock. “The fact that our patient population continues to smoke — it’s a neoplasam closely related to smoking.”

The question of this study is one that has already been answered more than once for other cancers.

“SRS (targeting the lesions) is already standard of care but for small cell metastasized lung cancer,” Clyburn-Ipock said.

“The purpose of the study is to see if whole brain (radiation) prevents future metastasis vs. how they do with radio surgery,” said radiation oncologist Dr. Reht Spencer. “Also with the whole brain component, though we’ve been able to do some specialized planning where we spare a portion of the brain — we don’t completely spare it but we partially spare it and that’s done to control the intelluctual function.”

Both physicians spoke out in favor of patients participating in medical studies.

“Patient could get superior treatment but, no data to back it up at this point,” Clyburn-Ipock said.

Spencer said there were results starting to roll in from the test but not nearly enough to yet say one approach is better than the other.

“Not a big downside in this study,” Spencer said.

“Not a permanent cure but its maintaining a good quality of life, but extending the good quality of life,” Spencer said of the treatments.

Others conducting the study are Dr. Billy Naso with Florence Neurosurgery and Spine, Dr. Rajesh Bajaj with McLeod Oncology and Hematology Associates and the MRI department.