Stanford Medicine Applies Innovative Technology to Fight Cancer

When non-Hodgkin’s lymphoma interrupted her life, Nicole Shaw thought she’d run out of options. The diagnosis came in 2014, as she was raising two kids, enjoying her job as a homeless shelter caseworker, and riding her motorcycle for fun. An MRI after a motorcycle crash led to the discovery of the aggressive and potentially deadly cancer of the blood that had taken hold in Shaw’s body.

She was just 45.

Six rounds of chemo and a round of stem cell therapy failed to send the cancer into remission. Shaw’s optimism deteriorated along with her body.

“They took me to death's door. It annihilated me,” she says.  

Shaw went to the Stanford Medicine emergency room in Palo Alto, California on one particularly challenging day. That brought a chance encounter that may have saved her life.

While reviewing her case, the attending physician asked Dr. David Miklos for his treatment recommendations. Dr. Miklos is the chief of bone marrow transplantation and cell therapy and leads numerous clinical trials aimed at helping patients whose cancers weren’t cured by initial therapies.

“Dr. Miklos came and looked at my chart and it was like, ‘Oh, my gosh!’” says Shaw, who credits the encounter to divine intervention. “It was a God thing.”

Whether it was ordained by a higher power, or just fortunate timing, Shaw was the perfect fit for Miklos’ trial of a new immunotherapy called chimeric antigen receptor therapy or CAR-T. This particular trial tested a medication that was programed to target a cell surface protein, called CD19, that is expressed by most B cell lymphomas. Shaw immediately enrolled in the trial.

Miklos’ trial aimed to address a problem that has long confounded oncologists. Most blood cancers are treated with a combination of chemotherapy. Those methods can be effective but often bring debilitating side effects like those that wracked Shaw, because chemotherapies don’t distinguish between malignancies and healthy cells.

To solve the problem, Miklos’ team is expanding on research first done at the National Institutes of Health to develop therapies that train healthy cells to isolate and overwhelm cancerous ones.

Prior to CAR-T therapy, patients with chemo-refractory large B cell lymphoma had a median survival of 5 months and less than 15% survived a year. Among the same-patient population receiving CAR-T therapy, one-year overall survival rates are between 85% and 90%. (Image: Stanford Center for Cancer Cell Therapy in Palo Alto, Calif.)

“It’s about understanding the power of the immune system,” says Miklos. Prior to CAR-T therapy, patients with chemo-refractory large B cell lymphoma had a median survival of 5 months and less than 15% survived a year. Among the same-patient population receiving CAR-T therapy, one-year overall survival rates are between 85% and 90%.

“They went and attacked that cancer and it's gone,” Shaw says. “It’s been four years.” Miklos’ trial was a huge success. The drug was FDA approved in 2017 and is available across the nation.

The therapy that Shaw calls her “miracle” became a pivotal FDA-approved cancer treatment developed at Stanford Medicine that also shows promise for similar patients with blood cancers that fail to respond to initial therapies.

Miklos’ research highlights the unique environment at Stanford Medicine that applies cutting edge technologies to developing and studying new immunologic cancer therapies.

Stanford Medicine has invested millions of dollars into a new Center for Cancer Cell Therapy which is led by Dr. Crystal Mackall and Dr. David Miklos. The Center has specialized research facilities and a unique cell-processing lab where some of the brightest minds in Silicon Valley biotech collaborate to engineer novel cell therapies. Patients with diagnoses that meet the research criteria may participate at no cost. And researchers like Miklos enjoy the unique opportunity to collaborate in a region where technological advancement is constant.

“Not every cancer center has these opportunities to bring a nexus of science, technology, clinical care infrastructures, and money to bear, and that really does take institutional leadership,” says Miklos. “There’s an opportunity right now to change the world, to advance cancer therapy from chemotherapy—which we used to call ‘poison’—to a living cellular therapy, which does things that cancer therapy has never done.”

For patients like Shaw, it’s life itself that changed.

“If not for this, I wouldn't be here. My daughter wouldn't have a mom right now,” she says. Instead, her recovery allowed her to reclaim time with her daughter, who was a second grader at the time of Shaw’s diagnosis and will enter high school this fall. The two have picnics, take trips to the beach, bake and go to the mall together.

She has one more thing on her to-do list.

“I haven’t sold my bike yet,” she says. “Who knows what the future holds but I hope it holds me getting to ride the Harley in my garage again.”