In 2021, Brittany Hawkins received a surprising diagnosis that changed her life.
During April of that year, she noticed a cough that seemed to come out of nowhere, but she brushed it aside at first. It was in the middle of the COVID-19 pandemic, after all, and with seasonal allergies that normally bring a tickle to the throat, the then-36-year-old Kentucky mom didn’t think much of it.
But the coughing persisted for weeks, along with even more symptoms such as fatigue, shortness of breath, and what she believed to be ocular migraine.
She went in for a series of tests to pinpoint the root of the problem.
Her doctor performed a chest X-ray in June, and after the images were reviewed, her doctor said she needed to see a pulmonologist. That doctor ordered a chest CT scan to be done, and after reviewing it, he ordered a bronchoscopy.
Then something terrible happened.
“Between the time he was planning to do it [the bronchoscopy] and going to do it, I had a stroke,” Hawkins told Healthline. “So, in the hospital, when they were digging for things is when they found my lungs were just a mess.”
Hawkins then received the most inexplicable news.
She was diagnosed with stage IV non-small cell lung cancer, and her medical team thought she had only three months to live.
Hawkins said she was confused by her diagnosis. She’d never smoked, lived a healthy lifestyle, and wasn’t exposed to typical environmental risk factors.
Though Hawkins was scared and heartbroken by the news, she was also determined to find out the full extent of what was going on with her health and how to tackle it.
Her medical team turned to biomarker testing, which is a method of detecting the biomarkers (or the proteins, genes, and other substances) that provide information on a person’s unique cancer, according to the National Cancer Institute.
Hawkins was told her cancer was caused by an abnormal mutation of the RET gene, specifically the RET + KIF5B mutation. She also learned there are two FDA-approved drugs for this mutation, and she would be put on one that very weekend.
“I feel that was a turning point mentally for me,” Hawkins said. “It allowed me to take something that was huge and scary to something that we could tackle.”
Navigating a difficult diagnosis
Since the summer of 2021, Hawkins has made it her mission to help raise awareness of lung cancer, who may be at higher risk for it, and the lifesaving option of biomarker testing.
Each cancer case is distinct, it’s a variable disease that affects everyone differently, and by getting at the cellular root of the problem, Hawkins’s medical team was able to offer her a path forward.
The situation Hawkins has found herself in since July 2021 is still surreal.
She said she had “no inkling at all” that lung cancer might be in her future. She said growing up in Kentucky, where smoking rates are relatively high, “there’s a stigma” around lung cancer that it is “the one you do to yourself.”
As a result, she grew up with the sense that lung cancer is one of the few diseases you can “prevent” by “not smoking and making healthy choices,” and it would be a no-brainer then for her to avoid smoking altogether.
“So, yeah, it was never on the radar,” Hawkins added. “Even when I started having symptoms, it wasn’t on anybody’s radar either. The pulmonologists and specialists, they were not thinking [it may be cancer] at all.”
Each new piece of information that came her way in those early days of her diagnosis was a dizzying whirl.
Those “ocular migraine” episodes? They were mini-strokes. The coughing that she originally thought was due to allergies or the coronavirus was due to the cancerous mass in her lungs.
In addition to her lungs themselves, she had cancer in her bones and additional lymphatic spread. Following a round of immunotherapy and chemotherapy, she also contracted COVID-19.
Her prognosis was not looking good.
Targeting a specific gene mutation
Though she has a family history of cancer (her mother passed away from pancreatic cancer when Hawkins was only 17), she said that was her last close brush with the disease for roughly 20 years. It was also very distinct from what she would experience with her own health.
“That was a whole deja vu for my family, but our experience with treatment was based on everything we knew from then,” Hawkins explained. “With cancer, the medical care community in general and cancer care have come a long way in 20 years, and I’m very thankful that I have cancer now and not even 10 years ago because things have just advanced so much.”
“Part of that advancement is the biomarker testing,” she added.
Hawkins said she had no idea what biomarker testing even was when she began her journey.
Her oncologist Dr. Adam Lye of Norton Cancer Institute, is what she calls “a researcher at heart.” He wanted to figure out why someone so young and healthy has lung cancer.
“He knew there had to be a reason, and he would not stop digging until he found it,” she added.
Lye told her they would perform a liquid biopsy, took some blood, and sent it off to be checked for specific biomarkers. They came back negative, along with a bone biopsy from her hip.
“I was told that a lot of oncologists would stop there, and so at that point, had he stopped, I would just be on a regular chemo regimen and palliative care. The expected [prognosis] at that time was 3-6 months had he not kept digging, I wouldn’t have seen Christmas this year,” she said.
Eventually, her oncologist biopsied the main tumor in her lung, and it showed the RET gene mutation.
“There were three different tests, and we finally found [the cause]. That’s why I’m a huge advocate for biomarker testing,” Hawkins explained. “The liquid biopsy might not tell you. If you go after the tumors from the spread, that might not tell you. You really need to go after the tumor in the organ that the main cancer originated in to get that most accurate information.”
Her oncologist said that the specific mutation Hawkins has makes up “less than 2% of people with non-small cell lung cancer.”
He prescribed her pralsetinib, sold under the brand name Gavreto, right away. The biomarker testing that helped her pinpoint exactly what was wrong and what needed to be done saved her life.
“I have a seven-year-old, so I talk in fruit,” Hawkins said, laughing. “My tumor went from the size of a lemon down to the size of about a raisin now. All the spread to [my] lymphatic system, all the bone spread, all of that has cleared up.”
The effectiveness of biomarker testing
Dr. Edward Garon, a thoracic medical oncologist at UCLA Health, told Healthline that over the years, as we’ve learned more about lung cancer specifically, we know that there are “basically sub-groupings of the disease.”
The traditional understanding of lung cancer is that these subgroups consist of small-cell lung cancer and non-small cell lung cancer, but with non-small cell lung cancer in particular, there are “many different mutations responsible for the tumor being in the state it is in,” he said.
“There are specific drivers for which we have therapies that allow us to treat patients for their particular tumor,” explained Garon, who was not involved with Hawkins’s medical care.
He said targeted solutions that are provided by biomarker tests can get to the molecular root of mutations that cause a given cancer.
This has been a game-changer in the field.
“We now know there are many different drivers of a tumor,” Garon said. “It’s one of the reasons why it’s so important that [biomarker testing] allows us to prescribe many different treatment options.”
Dr. Vamsi Velcheti, FACP FCCP, professor of medicine at the NYU Grossman School of Medicine and Medical Director of the Thoracic Oncology Program at the Laura and Isaac Perlmutter Cancer Center, agrees that treatments for cancer “have come a long way in the last decade.”
Until that past decade, lung cancer treatments mostly consisted of chemotherapy, and most people with stage IV cancer did not have effective treatments for the long term, said Velcheti, who also was not involved with Hawkins or her medical care.
“We tend to realize that not all lung cancers are the same. If you understand the exact DNA fingerprint of the cancer, we can then actually tailor treatment according to the DNA changes in a patient’s cancer. Biomarker testing offers the opportunity to personalize treatment based on the cancer’s inherent vulnerabilities. You can actually fight those vulnerabilities, and you can actually match the patient to the right treatment.”
When it comes to where this kind of targeted testing and treatment goes in the years to come, Velcheti said “not all changes in DNA result in abnormal proteins and abnormal functional changes.”
In the future, it will be important to understand the functional elements of these mutations themselves. By having a better understanding of what causes these mutations and how they work, better treatment solutions can be made available to people living with cancer.
“With newer advances using artificial intelligence and looking not just at the genes but also the proteins and RNA, we can actually better predict the responses to drugs in certain patients,” he added of what is to come in advancements in this field.
“In the next several years, we will see artificial intelligence and more sophisticated algorithms to predict better matches for our patients to treatments,” Velcheti said.
You can fight cancer effectively
Today, Hawkins said she feels “fantastic.”
She said the symptoms that led to the diagnosis and part of the cancer itself “are completely gone,” and her side effects have been minimal. She’s grateful that she isn’t dealing with some of the more serious side effects people experience with traditional chemotherapy.
“If you have the right people, the right medical team in your corner, you can fight it effectively,” she stressed,
Hawkins said that learning to embrace the love and support of those around her helped her harness the power of her own voice, which she plans to continue to raise to advocate for others.
“I would like for people to know… there is a way through this,” she said.
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