Fighting Lung Cancer, One Step at a Time
Kathryn VonAldenbruck wouldn’t call herself a hardcore runner. She picked up running in her early 40s and considers it a sporadic pastime.
Elsa Flores, PhD, doesn’t consider herself a runner either. She actually prefers working in the lab on new therapies for cancer patients.
But on this warmer than usual Saturday morning in November 2023, both women found themselves at the starting line of the same 5K, surrounded by thousands of running enthusiasts, energetic joggers and spirited walkers. The event was an important one for both women, not for setting personal records or finishing first, but for the work it fuels and the triumph it represents.
For VonAldenbruck, a patient at Moffitt Cancer Center, Miles for Moffitt gave her a chance to show what it looks like to be a survivor.
For Flores, associate center director for Basic Science at Moffitt, the event and the money it raises bring her and her fellow researchers closer to finding the lifesaving treatments that patients like VonAldenbruck are counting on.
For both, the 2023 event marked five years into two separate journeys for a cure.
Starting from the Beginning
When VonAldenbruck first took up running, she would often participate in a string of 5Ks and then not run for a couple of years while the duties of raising three children took first place.
In 2018, her kids were getting older, and she was ready to pick up the pace again. She signed up for the Treasure Coast Halloween Half Marathon in her hometown of Stuart, Florida, and started to train. But when she couldn’t complete a mile or even walk up a flight of stairs, she suspected something was wrong.
“I kept blaming it on everything. Maybe it could be asthma. We had blue algae at the time, and red tide was coming in,” VonAldenbruck said.
She made a doctor’s appointment and got a chest X-ray. Her primary care physician told her everything was fine and that she should come back in six months. But she knew her body was telling her something.
VonAldenbruck followed up with a pulmonologist for a CT scan. The next day, she got a call to return to the office. The pulmonologist broke the news. Her scan showed signs of cancer that had metastasized to the lymph nodes.
She left the pulmonologist’s office in shock and immediately called her husband to tell him the news. At that moment, reality sank in. She couldn’t hold back the tears.
“I still hadn’t wrapped my head around everything, the diagnosis. I was still thinking: ‘I’m not going to see my kids graduate from middle school and high school. I am going to miss all the important things,’” she said.
VonAldenbruck was diagnosed with locally advanced stage 3 non-small cell lung cancer. She was 48 at the time, an otherwise healthy nonsmoker. A local oncologist in Stuart referred her across the state to Moffitt Cancer Center.
During her first appointment at Moffitt, VonAldenbruck learned surgery was not possible due to her tumor’s location and the extent of the spread. However, she did have treatment options. It turns out she was the perfect candidate for a Moffitt-sponsored clinical trial that paired radiation with an aggressive immunotherapy combination of ipilimumab and nivolumab. Her oncologist, Ben Creelan, MD, was a treating doctor and co-investigator on the trial, which was only available at Moffitt.
VonAldenbruck jumped at the opportunity, becoming the first patient on the trial. She started this intensive treatment the day after Christmas 2018.
Planting Seeds of Hope
For patients like VonAldenbruck, the innovative clinical trials and groundbreaking cancer research being done at Moffitt are a lifeline. Each year, new lifelines are launched by the funding that comes from Miles for Moffitt. Since its inception in 2006, the event has raised more than $12 million for cancer research, with grants providing seed funds for scientists and physicians exploring new avenues to prevent and fight the disease.
In 2018, the year VonAldenbruck was diagnosed and began her clinical trial regimen, Flores was embarking on a new potential lifeline for patients with lung cancer. The scientist had been awarded a $200,000 grant from Miles for Moffitt to bring together a team to study how lung tumors metabolize nutrients. The goal was to identify these metabolic pathways and therapeutically target the tumors.
“Common chemotherapy hits all proliferating cells, not just the cancer cells. These dividing cells are present in the intestines and hair follicles. That’s why people lose their hair and have a lot of digestive issues. Chemotherapy is very nonspecific,” Flores explained. “The goal is trying to find therapies that target specific pathways rather than killing every cell, including healthy tissues.”
The metabolic research is promising, but it could take years to complete. The Miles for Moffitt grant was just the beginning. It allowed Flores to bring together a team of top scientists and clinicians who shared an interest in tumor metabolism, immunotherapy and groundbreaking treatments that could be gentler for patients with lung cancer.
The funding enabled the team to begin setting up the infrastructure needed for research projects, including developing preclinical models to study tumors, training a machine learning tool to grade the aggressiveness of tumors and building a lung cancer data repository for quick analysis. In addition, the grant provided funding to hire a program manager to facilitate collaboration among the scientists.
As the foundations for the research were laid, Flores had her sights set on securing long-term funding through a high-profile National Cancer Institute grant known as a Program Project Grant (P01). A P01 grant brings multiple investigators together to study projects that share a common theme or focus. The application process is complex and requires extensive preparation.
“You’re doing all this work before you can get the P01 funding,” Flores explained. “So the Miles for Moffitt funding was instrumental in each project getting off the ground.”
Keep It Moving
While Flores and her team hustled to launch their research, going into 2019, VonAldenbruck was feeling emotionally drained. She had begun treatment on the clinical trial, which started with 30 sessions combining radiation, immunotherapy and chemotherapy.
“She got all three at the same time — the kitchen sink basically,” Creelan said. “We know that for Kathryn’s type of cancer, the odds of long-term remission is only 30% with conventional therapy. So adding immunotherapy made sense.”
Although she was hopeful, VonAldenbruck was wrestling with the anxiety of whether her treatment would work. Her half-brother, who also was diagnosed with lung cancer in 2016, had just passed away.
“It was a confusing time for me. He had gone through treatment and did everything,” she said. “One of the things I kept telling myself was that his journey was not mine. And this is my journey, and I’m going to control it as much as I can.”
During her initial treatment, VonAldenbruck stayed in Tampa. She decided to begin an exercise routine, starting with walks to Busch Gardens.
During and after treatment, VonAldenbruck kept participating in races because it was good for her both physically and mentally.
“I started exercising right away. It was the one thing I wanted to get back into. I knew it was good for me not only physically but mentally,” she said.
After seven weeks of treatment, VonAldenbruck got the good news that the trial was working. Her scans were showing no signs of cancer. She needed to continue the immunotherapy for a year, and her care team would monitor her progress during that time.
“She did phenomenal on the treatment,” Creelan said. “She responded very well.”
Back at home on Florida’s east coast, VonAldenbruck wanted to get back into running. So she decided to join a running club.
“I had to start somewhere. I said I was going to do it, and I put my mind to it,” she said. “We started with first walking a half a mile, and we would gradually build it up each week.”
Soon, VonAldenbruck was able to alternate walking and running. She signed up for the Pineapple 5K, with a goal of finishing in under 40 minutes. She finished in 36.
“I was ecstatic that I could do it,” she said.
The accomplishment pushed her to keep going. At her next race, she met a fellow survivor who shared a similar journey in battling breast cancer. The two bonded instantly.
“We did our first 5K together. And then I said if we can do this, we can do a 10K. Next thing you know, we’re doing a half-marathon and then a full marathon,” VonAldenbruck said.
Gaining Momentum
Fueled by two additional Miles for Moffitt grants in 2019 and 2020, Flores’ team was also picking up the pace during this time. The team had already traveled to the National Cancer Institute (NCI) in Washington, D.C., to pitch this research to program officers and get guidance on submitting for the P01 grant. They had received positive feedback but were told that more research needed to be done.
The additional Miles for Moffitt grants gave the researchers the funds they needed to accelerate the data required for the resubmission. Perhaps most importantly, the funding kept the research moving forward when COVID threatened to bring everything to a standstill in 2020.
“We were working in shifts. We knew we needed to get data out,” Flores remembered. “So having that funding helped keep the team together and working on the project.”
In 2021, the team resubmitted the application and got good news. The NCI awarded the group a five-year $10.2 million P01 grant. The federal funding now supports the research as the team works together to unveil common metabolic mechanisms regulated by common genetic drivers.
The team, known as the Lung Cancer Metabolism Working Group, is focused on four overarching projects:
- Flores, who is the principal investigator for the P01, is studying the tumor suppressor gene p53, which is commonly mutated in lung, breast and skin cancers. Her research is focused on understanding that pathway and finding new therapeutics that rewire the metabolism of lung cancer cells.
- Gina DeNicola, PhD, interim chair of the Department of Metabolism and Physiology and leader of the Metabolism Program, is studying the Nrf2 gene, which is also commonly mutated in lung cancer and is known to be involved in metabolism.
- John Cleveland, PhD, chief scientific officer and center director, and Eric Haura, MD, associate center director for Clinical Science and director of the Lung Cancer Center of Excellence, are studying the myc gene and working to understand the commonalities between the two major types of lung cancer — non-small cell lung cancer and small cell lung cancer — to find common therapies.
- Paulo Rodriguez, PhD, chair of the Department of Immunology and co-leader of the Immuno-Oncology Program, is focused on boosting the immune system and profiling the metabolism of immune cells, looking for metabolic treatments that could improve immunity and treat cancer.
The group meets regularly to discuss what they are learning and to share ideas. The team ultimately hopes to use this research to identify existing drugs that could be repurposed to treat cancer or find new targets for developing drugs. These advances could benefit the full spectrum of patients with lung cancer, including never-smokers, former smokers and current smokers.
Ashley Lui works in the lab of Elsa Flores, PhD, whose research is focused on finding new therapeutics that rewire the metabolism of lung cancer cells.
More and more, Creelan and his colleagues are seeing younger never-smokers like VonAldenbruck being diagnosed with lung cancer. The Centers for Disease Control and Prevention estimates that 10% to 20% of lung cancer cases diagnosed each year in the United States are never-smokers — defined as people who have never smoked or smoked fewer than 100 cigarettes in their lifetime.
“We don’t know why this is happening, but we need solutions. These people are fit. They are motivated. They want to move on with their lives,” Creelan said. “So that’s where we need the money and the research focus. This is a rising unmet need.”
In particular, research funding to explore treatment options for these relatively smaller populations of patients is crucial, Creelan explains. Seed funding like the grants provided by Miles for Moffitt can play a big role. This money is directly translated into new trials at Moffitt.
“It’s up to us — cancer centers, foundations, donors — to move the needle. Many drug companies … ignore never-smoker lung cancer. We want to move the football downfield to the goal for these populations,” Creelan said.
Pushing Forward Together
VonAldenbruck knows firsthand the power of having a team that is always pushing you forward. She now runs with a group of four women who encourage and motivate one another. They’ve dubbed themselves “GirlGangStrong.”
For her New Year’s resolution in 2022, VonAldenbruck decided to complete a 5K each month. She stayed on track until November, when after three years of being in remission, she learned her cancer had returned and had spread to her adrenal gland. This time, she was diagnosed with stage 4 lung cancer.
She went back on the immunotherapy regimen and underwent 12 weeks of chemotherapy, but she didn’t want to slow down. She decided to keep running.
A year into her second round of treatment, on Nov. 18, 2023, VonAldenbruck and her gang of running partners gathered in downtown Tampa for Miles for Moffitt. Flores and her race team, called the Research Rangers, were there, too.
Together with thousands of other Moffitt scientists, doctors, patients and supporters, they took to the streets. They raised money for the research into new lifelines that Moffitt will continue to incubate. And they ran to send a message, said VonAldenbruck, who is once again responding well to treatment:
“We hold each other up. We are thriving. We are living.”
This story originally appeared in Moffitt's Momentum magazine.
