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Ken's Story: Genetic Analysis Guides Prostate Cancer Treatment

Marsha and Ken Tucker Genetic analysis of Ken Tucker's prostate cancer revealed that he was eligible to participate in a new, targeted treatment available through a Phase I clinical trial. Here, Tucker is pictured with his wife, Marsha. "This is a case where genetics entirely guided the treatment," said medical oncologist Russell Szmulewitz, MD. "Knowing his mutation allowed us to place him on a clinical trial that makes specific use of his genetic mutation and, fortunately, he had a great response."

In 1993, when commercial real estate developer Ken Tucker was in his early 60s, he excused himself during business meetings to use the bathroom. The father of five from Wilmette, Ill., was having difficulty urinating because of what turned out to be a benign tumor on his prostate. Surgery corrected the problem, but more than a decade later his symptoms returned and worsened. This time, he was diagnosed with prostate cancer and was treated with radiation therapy.

Then, in 2008, he was treated with hormonal therapy when his prostate-specific antigen (PSA) levels started to rise. Despite the therapy, which decreased the PSA to an undetectable value, his recurrent prostate cancer continued to progress. The tumor had grown significantly and was causing bleeding in his bladder and urethra.

Gary Steinberg, MD Gary Steinberg, MD

Doctors told him that surgery was not an option. Friends told him to make an appointment with Gary Steinberg, MD, the Bruce and Beth White Family Professor of Surgery at the University of Chicago Medicine Comprehensive Cancer Center. To Tucker's relief, Steinberg was confident that a man as fit and active as him could not only tolerate the surgery, but that it was his only hope.

In June 2011, Tucker had the surgery, during which the remainder of his prostate and his bladder were removed. When the tumor was analyzed by pathology, it no longer had typical prostate cancer features; it had mutated into a more primitive, more aggressive tumor. After his surgery, there was no evidence of disease. Sometime later, however, the cancer returned--this time spreading to other parts of his body, but not to his bones, the normal site for prostate cancer metastasis.

Because of the unusual nature of his prostate cancer, it was difficult to predict which, if any, treatment would work. Tucker and his wife, Marsha, prepared themselves for the worst.

Russel Szmulewitz, MD Russell Szmulewitz, MD

But cancer experts at the University of Chicago Medicine Comprehensive Cancer Center are constantly looking for ways to improve treatment based on an individual patient’s genetic, social and environmental factors. Samples of Tucker's tumor were sent for genotype mutational analysis, which identified several mutations that could be causing the cancer’s growth. One of those mutations was within the BRCA2 gene. Russell Szmulewitz, MD, assistant professor of medicine, who treated Tucker, said this new knowledge made him eligible for a Phase I clinical trial of veliparib, a novel targeted treatment.

"In that six-month period of time, the cancer completely disappeared," said Tucker. The doctors were thrilled with the results.

Veliparib belongs to a class of drugs known as poly-ADP ribose polymerase (PARP) inhibitors, which are used for multiple indications but may prove important to the treatment of cancer. Tucker was the only patient with prostate cancer enrolled on the study--the others were patients with gynecological malignancies that tested positive for the BRCA1 or BRCA2 mutations. He began his treatment in November 2012, undergoing six cycles of chemotherapy combined with the study drug.

"When he realized there was something specific we could do that was related to his biology, he jumped at the chance," said Szmulewitz. "He’s been given a lot of hope that he didn’t have at first, and so his outlook has changed quite a bit."

The personalized treatment was so successful that it eradicated the cancer that had spread to his liver, lungs and bowel wall. Several of those tumors, which were inches in size, were no longer visible.

"In that six-month period of time, the cancer completely disappeared," said Tucker. The doctors were thrilled with the results.

Ken Tucker plays golf Tucker enjoys golfing and swimming.

"This is a case where genetics entirely guided the treatment," said Szmulewitz. "Knowing his mutation allowed us to place him on a clinical trial that makes specific use of his genetic mutation and, fortunately, he had a great response."

At 81 and partially retired, Tucker spends time at home with his wife and frequently enjoys the view of Lake Michigan from their home. He still takes the veliparib, which causes him some fatigue but, on good days, he plays golf or tennis and swims in the pool. He was born and raised in Chicago, and calls himself lucky for having the University of Chicago Medicine Comprehensive Cancer Center available to him.

"Although the cancer could come back, my story has a good ending," Tucker said. "My doctors kept my wife from becoming a widow and, to me, that’s the most important thing."