Clinical Trial Saves the Life of Oklahoma Woman with Stage IV Cancer

It was 2020 and at 59 years old, Terri Snodgrass was feeling a bit tired. She was usually filled with energy, so Terri thought it was worth having a checkup with her new primary care physician.

A blood test showed that Terri’s platelets were low, so she was referred to a hematologist. The hematologist ran further tests and delivered the bad news to Terri — she had Stage IV pancreatic cancer.

Terri and her husband, Wayne, were shocked — Stage IV pancreatic cancer has a five-year survival rate of only 3%. Most adults with Stage IV pancreatic cancer only live for 12 months after the diagnosis. Terri was surprised that besides being a bit tired, she felt so well.

When an oncologist sent her home with some medication, Terri felt that she was being sent home to die, and she was unwilling to accept it.

“People would ask how I feel, and I said, I’m fine,” shared Terri. “I’ve never had cancer before — how am I supposed to feel?”

Terri was born and raised in Oklahoma. She and her husband live in Meeker, just north of Shawnee in Lincoln County, and she loves animals, diamond artwork, and coloring for relaxation. Terri is vibrant and outgoing, attracting friends everywhere she goes. She wasn’t ready to die — she had so much more she wanted to do. Terri was determined to find a way forward.

Making Important Decisions

Terri’s husband’s uncle beat cancer twice at OU Health Stephenson Cancer Center, so she transferred her care to hematologist/oncologist, Dr. Susanna Ulahannan, M.D., MMEd, associate professor in the Section of Hematology/Oncology at the University of College of Medicine and director of the Oklahoma TSET Phase I Clinical Trials Program. It was important to Terri that she could find treatment in Oklahoma, close to home.

“I refused to leave home,” Terri explained. “Why would I want to go anywhere else when OU Health Stephenson Cancer Center could do what I needed, right here in Oklahoma?”

Dr. Ulahannan conducted further tests and confirmed that Terri had metastatic pancreatic cancer. It was aggressive, and widely spread.

Terri also had a mass in the neck of her pancreas, and the pathology in January 2021 confirmed that she had poorly differentiated adenocarcinoma, a type of cancer often associated with the pancreas. However, Dr. Ulahannan found Terri’s case unusual due to the high number of mutations in her cancer’s molecular profile, which is not typical for pancreatic cancer.

She explained, “It is very unusual with pancreatic cancer, to have as many mutations in their molecular profiling as Terri had.”

Although cancers with Microsatellite Instability (MSI) often have a high number of mutations, Terri’s cancer was MSI-stable, not high, which is not the usual case with MSI cancers.

Common forms of adenocarcinoma include stomach, breast, lung, prostate, pancreatic and colorectal cancers. When the cancer spreads outside the organ it begins in, it’s called metastatic adenocarcinoma.

The cancer Terri had was serious and life-threatening. Dr. Ulahannan suggested that Terri’s best option would be to enroll in a clinical trial, as it would provide options currently unavailable. Terri agreed.

“This cancer was a death sentence for me,” she said. “So, I thought, why not try a clinical trial?”

Genetic Mutations

Genes are sections of DNA that determine characteristics like height, body type, hair color, eye color etc. They are the traits that make us unique. However, genes also play a part in a person’s risk for certain health conditions and diseases.

Genes mutate during cell division and there is a lot of room for error during this process. The errors mean that your cells cannot function as they should. A genetic mutation can occur because of:

• A change in one or more nucleotides of DNA
• A change in a lot of the genes
• The loss of one or more genes
• Rearrangement of whole chromosomes or genes

Tumor mutational burden (TMB-H) is the number of mutations found in the DNA of cancer cells. Terri had over 350 mutations in her tumor when she started the clinical trials.

Clinical Trials — New Treatments

Clinical trials are important for discovering new treatments for diseases. This includes new medicines and new diagnostics and improving screening technologies. New treatments are approved going through clinical trials, but it takes brave patients like Terri to advance the field and help patients have better quality of life and live longer.

According to the National Comprehensive Cancer Network (NCCN), access to clinical research is the best way to take care of a patient with cancer. Patients with cancer often receive a higher level of care just by being on a clinical trial because of the requirements for close monitoring and follow-up. Being part of a clinical trial gives patients options outside the standard of care, which can be significant with advanced cancer, and those that haven’t been successfully treated with conventional treatments.

Phase I clinical trials test new treatments and are usually the first study that includes people. They test the safety, best dose, side effects, and the timing of the treatment. They find the highest dose of the new treatment that can be safely given with the least amount of harmful side effects. Treatments are initially tested in labs and animal studies before they are tested on small numbers of patients in Phase 1 clinical trials. The trials include patients who have not been helped by standard treatments and they can also include healthy volunteers.

The Trials Begin

In November 2020, under Dr. Ulahannan’s guidance, Terri started her first clinical trial. It was based on her molecular profiling and was personalized to suit the mutations found in the cancer she was diagnosed with. The trial included Poly (ADP-ribose) polymerase (PARP) inhibitors. PARP inhibitors are a type of drugs that work to stop cancer cells from repairing damaged tumor DNA. Terri had a good response to the treatment and stayed on the trial for more than a year before the cancer started to grow again.

Terri then moved on to a second trial — an antibody-drug conjugate (ADC), targeted chemotherapy. ADCs are drugs designed to target and kill tumor cells while sparing healthy cells, and they increase the efficacy of anticancer medications. The trial did not benefit Terri, so it was stopped within three months.

Determined to help Terri, Dr. Ulahannan recommended a third clinical trial — a targeted therapy for advanced cancers, combined with chemotherapy. This new drug is involved in DNA damage repair and works to inhibit the growth of tumor cells. Other than some slight digestive issues for a couple of days, Terri experienced no side-effects from the regimen.

Terri was on the clinical trial for almost eight months with an excellent response and had a cancerous lymph node in her stomach removed at the end of 2023.

Outstanding Results

Testing prior to and during the two first clinical trials, revealed that Terri had over 350 mutations. After the lymph node removal and the third clinical trial, Terri’s test reported only one mutation. The tissue that was removed for testing showed treatment response and no cancer, and the PET CT scan also showed no active disease.

“The results are astounding,” Dr. Ulahannan remarked. “Terri’s case was complicated, and it’s miraculous with the extent of disease seen in January 2021, that she currently has no evidence of disease. She has had no treatments since August 2023.”

Terri and Wayne were delighted with the results. She’d been given no chance of survival beyond six months at first diagnosis, so the news that Terri was cancer free was more than they could have hoped for. The Stephenson Cancer Center tumor board made the decision that Terri could stop all treatment and will only require follow-up scans moving forward.

“I give all credit to God,” Terri beamed. “And I am so grateful to Dr. Ulahannan and the staff at the Stephenson Cancer Center — they really care about their patients.”

Plans for the Future

Terri and Wayne have made exciting plans for their future. They are going to buy a motor home and travel.

“The first place we’ll go to is Nashville,’ said Terri. “We want to travel around and visit people and spend time fishing. I couldn’t go into the sun while I was on chemo so I can’t wait to get out and go fishing.”

Clinical trials have given Terri a new lease on life, and she encourages others with cancer to consider them.

“All I can say, is do a clinical trial. If they can find a cure, you can help so many people,” she said. “If it wasn’t for clinical trials, they wouldn’t be able to find new cures or treatments for cancer.”

Dr. Ulahannan agrees that clinical trials are a vital part of finding new cures.

“We have limited treatments for our patients with great variations in outcome depending on tumor types,” shared Dr. Ulahannan. “We need to find new options — better options providing good quality of life for our patients, prolonging life, and with our ultimate goal to cure cancer.”

Clinical Trials at Stephenson Cancer Center

As Oklahoma’s only National Cancer Institute-Designated Cancer Center, Stephenson Cancer Center is one of the nation’s elite centers, representing the top 2% of cancer centers in the country. It is the largest and most comprehensive oncology practice in the state, delivering patient-centered, multidisciplinary care for every type of cancer.