Bill Wixon was taking morphine last spring to combat the pain of his advanced prostate cancer and was using a wheelchair when he was too fatigued to walk. Which was a lot. He rarely left his home except to go to doctor appointments.
The 61-year-old in June became the first patient in the world to start the latest international clinical trial of a radioactive drug designed to seek and kill cancer cells up close, offered locally by the Urology Cancer Center in Omaha.
By this fall, Wixon, a former P.E. teacher, was back to working out at the gym with no pain and kayaking on Flanagan Lake not far from his northwest Omaha home.
“I’m living life,” said Wixon, who has been battling cancer since 2011. “Every day is just like a brand-new day to me.”
Dr. Luke Nordquist, who heads the Omaha cancer center, said the company launched the current trial based on good results in Germany. Sponsored by drugmaker Endocyte Inc., the trial is testing the safety and effectiveness of the experimental drug, Lutetium-177. A medical oncologist, Nordquist specializes in the treatment of prostate, bladder, kidney and testicular cancer.
The study is in the last phase typically undertaken before seeking approval from the Food and Drug Administration. The Omaha center, which has enrolled 24 patients so far, is among 19 sites participating in the trial. The list also includes the Mayo Clinic in Minnesota and New York’s Memorial Sloan Kettering Cancer Center. The cancer research network Nordquist and his team started in 2017, Precision Cancer Research, also is overseeing trial sites at four other locations.
Just how well Lutetium-177 works — and for how long — has yet to be determined.
But it’s of particular interest because it’s among the early entries in a class of drugs called radiopharmaceuticals, which deliver radioactive substances right to cancer cells.
“There’s a big future pipeline of radiopharmaceuticals that are really going to change how we treat cancers,” Nordquist said.
The drugs themselves feature in a relatively new field in cancer treatment in the United States called theranostics, which involves combining diagnostic and treatment capabilities in a single agent.
Typically, Nordquist said, doctors use radiation — such as a CT scan — to find a cancer. Then they give a drug and wait to see if it goes to the tumors. Or they use radiation to target them.
With theranostics, researchers find a molecule that specifically goes to cancer cells. In the trial, they use a molecule that attaches to prostate cancer cells. They attach an imaging agent. The package goes to the cancer cells, allowing them to pinpoint and quantify the amount of cancer. Then they substitute the treatment agent — Lutetium-177. It goes to cancer cells, where it releases radiation.
Dr. Sam Mehr, a nuclear medicine physician who treats the patients in Nordquist’s trial, said the method allows doctors to deliver higher doses of radiation to cancer cells without significant exposure to nearby healthy ones.
Mehr, who directs the CHI Health Creighton University Theranostics Center and also is affiliated with Nebraska Cancer Specialists, estimated that he’s treated about 40 patients so far with some form of theranostics. He’s also using another radiopharmaceutical called Lutathera to treat abdominal endocrine tumors. Approved by the FDA in January, that drug has more than a decadelong track record in Europe. Nebraska Cancer Specialists has a dedicated theranostics center at its location at 175th Street and West Center Road.
He expects future radiopharmaceuticals to target other types of cancer, including breast and lung. “It’s a very broad and a very exciting field,” he said.
Mehr cautioned, however, that not all patients in clinical trials get such good results. Some may not respond at all.
Nordquist said the prostate drug initially was available only in Germany and Australia. Since he began offering the trial, he’s gotten referrals from Johns Hopkins, MD Anderson Cancer Center and others. Patients are traveling from California, Arizona, Delaware and a handful of other states.
Bob Brindley of Minnesota was ready to fly to Germany to seek treatment when he found out about Nordquist’s trial site in Omaha.
He enrolled and was assigned to get the treatment. A third of men enrolled will get standard care. The goal is to sign up a total of 750 patients across all trial sites — all men who’ve tried other treatments and have cancer that has spread. The trial isn’t blinded, so patients and doctors know who’s getting which course.
Brindley returned to Omaha last weekend for his third injection. His prostate-specific antigen level, or PSA, was less than one, down from the teens. Elevated PSA levels — most healthy men have levels under 4 nanograms per milliliter — can indicate cancer. In men who’ve had it, they signal its return.
“It’s just doing wonders for people,” said Brindley, 68, a nurse practitioner who now runs a medical supply business.
In an earlier trial in Australia involving 30 men, 57 percent saw their PSA levels decline by 50 percent or more. As levels decrease, indicating the cancer is shrinking, patients’ pain decreases and their appetites and energy increase.
Brindley said Nordquist has explained that the drug isn’t necessarily a cure. But he’s hopeful it will buy time for one to come along. And he feels better than he has with some other treatments.
“The whole idea,” Brindley said, “is to keep feeling good and knock it back and keep it at bay.”
Nordquist said prostate cancer, like most other cancers, currently isn’t curable once it’s spread. But it is controllable. That’s why it’s important that doctors have multiple tools to keep it in check.
Wixon, who’s had surgery and is participating in his fourth clinical trial, said the treatment has given him new hope. His PSA, too, was in the teens when he started. Now it’s down to zero. He has one shot left of the six prescribed under the trial. He’ll get that in January.
Being active again is important to him. He and his wife, Tamara, have been able to go out again as a couple. In November, Wixon watched the Huskers beat Michigan State at Memorial Stadium. Attending a Husker game was a feat he hadn’t thought he’d be able to manage again because of all the walking required.
“It’s given us our life back,” he said.
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