Her quest for clinical trial options led her to Karmanos

"Clinical trials are important because they help determine what works."

In the fall of 2020, when Cathleen Janosko noticed she had an upset stomach and felt more tired than usual, she did not think much of it. After all, many people experience those symptoms from time to time.

But a few months later, when those vague symptoms turned into a deep-seated pain in her upper right abdomen, she knew something was not right.

Janosko, who lives in rural southeast Ohio, went to a local hospital for an ultrasound. Then her doctor called with the news: the scan showed a mass in her liver. Subsequent computed tomography (CT) revealed more masses in her pancreas and lower abdomen. The diagnosis was Stage 4 pancreatic cancer.

“I was devastated and very scared,” said 63-year-old Janosko. “I knew my cancer was life-threatening. I also thought of my parents. I had lost my father to lung cancer and my mother to uterine cancer.”

That was the beginning of Janosko’s cancer journey. Thankfully, subsequent testing and loads of late-night research on the specifics of her disease led her to the Clinical Trials Program at the Karmanos Cancer Center.

Today, nearly a year after enrolling in a clinical trial that targets the specific genetic driver of her cancer, Janosko has no visible sign of the disease. Her extraordinary outcome offers hope to future cancer patients—including those with late-stage pancreatic cancer.

A particularly deadly disease

Due partly to the pancreas’ location in the upper area of the abdomen, it can be challenging to diagnose the disease at an early stage. By diagnosis, for most patients, the disease has often metastasized and spread to other organs, thus eliminating surgical treatment options. This was the case for Janosko.

According to the American Society of Clinical Oncology, the five-year survival rate for pancreatic cancer is just 11 percent. The survival rate for patients with Stage 4 disease is around 2 to 3 percent.

For these reasons, Janosko’s local hospital doctors did not offer her much hope.

“They said there was nothing more they could offer besides chemotherapy, with no subsequent testing,” she explained. “They gave me just two to six months to live. That’s when I began doing my research.”

Janosko transferred to a larger area hospital where she began receiving chemotherapy. Doctors there also performed a genetic test on the tumor. The results exposed a targetable gene fusion called NRG1, which is rare in cancers.

“I had been researching all I could about the disease on various pancreatic cancer support group websites,” Janosko said. “I noticed many survivor stories had involved clinical trials. I also learned there are trials targeting NRG1 fusion in many cancers, including pancreatic cancer. The sites also noted the importance of getting into a clinical trial early to achieve the best results.”

Ten-and-a-half months of chemotherapy had reduced Janosko’s tumors slightly, but there was not much progress.

“I uploaded my medical information to an independent virtual tumor board that gives unbiased reviews of treatment options to patients with advanced-stage disease,” outlined Janosko. “They said a clinical trial targeting the NRG1 fusion would be my best option. After further online research, I learned the Karmanos Cancer Center in Detroit was the closest hospital offering this specific clinical trial.”

Targeted treatment

A clinical trial is a research study that examines new cancer-fighting drugs, surgical methods, diagnostic tests or disease prevention methods. Every day at Karmanos, researchers work tirelessly on these studies to find new and more effective therapies.

Patients enrolled in trials receive the latest treatments and are also closely observed for safety. Under informed consent, a patient can withdraw from a trial at any time.

Large academic centers and research institutes like the Barbara Ann Karmanos Cancer Institute offer the broadest portfolio of clinical trials. At any one time, Karmanos offers approximately 250 active trials.

This broad portfolio is what led Janosko to Karmanos.

In December 2021, she and her husband, John, drove nearly 300 miles to Detroit to meet with Najeeb Al-Hallak, M.D., M.S., medical oncologist at Karmanos. After reviewing her case. Dr. Al-Hallak said Janosko was a good candidate for the clinical trial she had identified.

“Cathleen’s lab results indicated a rare NRG1 fusion, which we think is a driver for cancer growth,” explained Dr. Al-Hallak, a member of the Gastrointestinal and Neuroendocrine Oncology and the Phase 1 Clinical Trials Multidisciplinary Teams at Karmanos. “Our particular clinical trial is very much targeted to that mutation.

“She was concerned about enrolling in the trial but realized it was her best option. She followed the science and made a courageous decision to enroll.”

“Enrolling in the trial was exciting but also scary,” Janosko admitted. “Dr. Al-Hallak said that although he hadn’t previously had a pancreatic cancer patient take this drug, he felt I was a great candidate for the trial.”

Cathleen and John make the four-and-a-half-hour trip every two weeks to Karmanos’ Detroit location, where she receives the experimental drug intravenously. She will finish the treatment in late 2023.

Janosko’s decision paid off tremendously. In February 2022, a positron emission tomography (PET) scan showed no visible tumors. The latest updated CT scan from October 2022 confirmed that her cancer is still in remission with no measurable tumors or metastatic disease. Janosko said she had not experienced side effects from the treatment.

“Her case is nothing short of amazing,” Dr. Al-Hallak said. “Scans show no visible cancer and Cathleen is in remission. She’ll continue receiving the drug through the two-year clinical trial period. I truly believe her case will have a very positive outcome.”

Dr. Al-Hallak added that the tumor genetic data opened further treatment possibilities for Janosko when none seemed readily available.

“For any cancer, patients should speak with their oncologist about getting a detailed genetic report of their tumor. Ask your doctor if those results might make you a good candidate for a clinical trial. It could save your life,” he advised.

Janosko also encourages other cancer patients to consider enrolling in a clinical trial.

“My results are nothing less than a miracle,” she said. “Dr. Al-Hallak and his team at Karmanos have always treated us with the best care.

“The ongoing cancer research gives me hope that doctors will be able to find more drugs that work for different cancers. Clinical trials are important because they help determine what works. Look for a medical team that addresses your specific cancer and doesn’t treat you like every other patient. My treatment was tailored to me, which has made all the difference.”

If you or someone you love has received a cancer diagnosis, it is important to seek an evaluation from cancer experts before beginning treatment. Call 1-800-KARMANOS (1-800-527-6266) to speak with a trusted oncology patient navigator or visit karmanos.org for more information.