From cutting-edge science to deeply personal matters of faith, this latest seasonal issue of 

provides a wide-ranging look at many facets of a cancer journey.

We recognize that cancer can raise profound spiritual and existential questions. This issue explores the relationship between cancer and faith as we hear from individuals who have found solace in their beliefs during challenging times and speak with experts about the impact that cancer can have on a person’s spiritual views.

“There was a study a few years ago, and I think they surveyed over 2,000 people, the majority of whom, 70%, said that their faith had gotten stronger as a result of their cancer diagnosis,” said Dr. John Peteet, a psychiatrist at Brigham and Women’s Hospital and Dana- Faber Cancer Institute in Boston. “Only about 17% said that they experienced a negative effect on their faith.”

We also look at the Food and Drug Administration’s approval of Alecensa (alectinib) for patients with ALK-positive non-small cell lung cancer, which followed the notable results of the phase 3 ALINA trial.

“The ALINA study, in my mind, is a landmark study ... because it shows that using the ALK inhibitor [Alecensa] for early-stage lung cancer after surgery increases the survival rate of patients as compared [with] chemotherapy,” said Upal Basu Roy, executive director of research for the LUNGevity Foundation.

Elsewhere in this issue, we delve into the latest research on cancer vaccines, and discuss the potential impact of these vaccines and how they might revolutionize cancer care in the years to come.

This issue spotlights the winners of the 2024 

poetry contest, which invited patients and survivors of cancer, as well as their caregivers, family and friends, to submit poems related to the disease. More than 100 entries were received, and the four winning poems are presented here.

Additionally, this issue celebrates the honorees of CURE Media Group’s 2024 Extraordinary Healer Award, which honors nurses in the cancer community.

Throughout these pages, you’ll find personal stories and expert insights. As always, we hope you find them inspirational and informative. Thank you for reading.

For more news on cancer updates, research and education, don’t forget to 

Articles

In the 2024 CURE Summer issue, we focused on a facet of cancer: the question of faith. 

Cancer and the Question of Faith 

Vaccines are making waves in the oncology world, with one experimental messenger RNA (mRNA) vaccine, mRNA-4157 (also known as V940), that when combined with the immuno­therapy Keytruda (pembrolizumab), was shown in the KEYNOTE- 942 trial to reduce the risk of melanoma recurrence or death by 44% compared with treatment with Keytruda alone.

Ninety mRNA-based therapeutic cancer vaccines tested in clinical trials since 2000 were listed in findings published in January in 

— with 33 trials having started since 2020 and researchers noting that “the field of mRNA-based drugs is undergoing a rapid transformation, significantly altering the standard of care for numerous diseases.”

mRNA vaccines instruct the body to produce a specific protein that triggers an immune response in a patient’s body, according to the Centers for Disease Control and Prevention. While better known as vaccines to protect from viral infections, mRNA-based vaccines can also have applications in cancer, because mRNA sequences can be made to encode tumor-related protein pieces that can stimulate the immune system against a cancer of interest.

When will such cancer vaccines be approved by the Food and Drug Administration (FDA) and made available to the general public? That remains to be seen.

“It’s going to take years. It’s not going to be available in 2024 or probably even 2025,” says Dr. Jay Berzofsky, chief of the Vaccine Branch of the Center for Cancer Research at the National Cancer Institute. “But, on the other hand, I think if something is really successful, the FDA has ways of fast-tracking approval. So, if there’s a real home run, then it might happen faster than we think, and that would be wonderful.”

Teacher Gary Keblish, 62, of New York City, has lived without recurrence of melanoma for four years since receiving six post-surgical doses of the vaccine-Keytruda combination as part of the KEYNOTE-942 clinical trial at the NYU Langone Health Perlmutter Cancer Center.

The study, findings of which were published in The Lancet, showed that the combination resulted in a recurrence or death rate of 22% at 23 months follow-up, versus 40% at 24 months follow-up among those patients treated with standalone Keytruda.

Keblish’s path to KEYNOTE-942 began in 2019, after a mole on his back burst and began bleeding. His dermatologist sent him to NYU Langone, where, as he says, doctors confirmed that his “cancer was fairly far advanced and had made its way into some lymph nodes beyond the immediate area, and that, too, had to be removed.”

Following surgery for high-risk stage 3C melanoma, he was referred to the trial.

“I think it’s a marvel,” Keblish says of the treatment. “And I would encourage anyone who has the opportunity [to participate in a clinical trial] to do it. As a layperson, in terms of making the decision to do it, my choices were to do nothing further about the cancer that was removed from my body, or to enter a regular treatment plan, a known, established treatment plan, or put my name in the hat, and hope that I can be include in a clinical trial. And it was wonderful to have that choice.”

Researchers reported that the majority of treatment-related side effects were grades 1 or 2 (mild or moderate), with grade 3 (severe) or higher treatment-related side effects occurring in 25% of patients in the combination cohort and 18% of the monotherapy cohort, with no mRNA 4157-related grade 4 or 5 (life-threatening or deadly) side effects.

“The actual injection — because the mRNA vaccine was injected in one arm or the other — left me feeling on some days like I might have felt after getting a regular flu shot, a little swollen and a little sore,” says Keblish. “But [like] on other days or other years when I got the flu vaccine, it was nothing, and there were days or times when I thought, ‘What arm did I get that injection in?’”

While mRNA vaccines achieved public prominence for their use during the COVID-19 pandemic, the platform was already in the works for cancer vaccines, as Berzofsky says.

“In the case of cancer vaccines, there’s been a lot of emphasis in the last couple of years on [working] to target unique antigenic sites that are created by mutations that occur in the DNA just of the tumor cells and not the normal cells, so those [neoantigens, genetically altered proteins present in the tumor] uniquely mark the cancer cells,” Berzofsky says. “… In contrast to chemotherapy, which are mostly sort of poisons that are more toxic to cancer cells than normal cells, but also affect normal cells and that’s why people get so sick from many types of chemotherapy, the immune system can very precisely target just the cancer cells in principle. And one way to do that are these unique mutations that occur only in the tumor cells.”

The difficulty of targeting those mutations, Berzofsky says, is that they’re different in every patient — and so once a mutation is identified, a personalized vaccine has to be made for each patient.

“It basically generates an immune cell response specifically against things that are only in the tumor and not in the normal tissue,” explained Dr. Jeffrey S. Weber, the deputy director of Perlmutter Cancer Center and the senior investigator of the study Keblish participated in. “So, the toxicity should be modest. And in the phase 2 study it was. … It gives the body a chance to mount a specific immune response against those very specific neoantigens. And the [Keytruda] amplifies the response.”

The FDA granted breakthrough therapy designation to the combination for the post-surgical treatment of patients with high-risk melanoma in 2023 based on the results of KEYNOTE-942. Moderna and Merck, the manufacturers of the vaccine and Keytruda, respectively, have initiated V940-001, a phase 3 study evaluating the combination as postsurgical treatment for high-risk stage 2B to 4 melanoma.

While there have been many cancer vaccine trials in the past, Weber says, they were typically attempts to vaccinate against tumor-associated antigens — substances present in normal tissue but over-expressed in tumors. “Virtually all of those trials failed to show benefit,” Weber says.

Things began to shift in 2017 when a team of researchers led by Dr. Catherine J. Wu of the Dana-Farber Cancer Institute in Boston found that a personalized vaccine targeting patient tumor-specific neoantigens on tumor cells resulted in an anti-tumor response among patients with melanoma.

Further notable progress was made, Weber notes, with 2023 study results from Memorial Sloan Kettering Cancer Center in New York showing that a BioNTech RNA vaccine stimulated T cells in patients with pancreatic cancer.

“In that particular trial, which made a little bit of a splash from [Memorial Sloan Kettering], there were 16 patients treated who had resected [surgically removed] pancreatic cancer, which is, of course, a bad-acting cancer. Half the patients had good immune responses, [and] half didn’t. The half that had good immune responses seem to do better than those who didn’t,” he says.

The accumulated data from a number of small studies, Weber says, led to the study for which he was the lead investigator of 157 patients, including Keblish, with completely resected stage 3B to 4 melanoma, with mRNA-4157 administered for up to nine doses and Keytruda for up to 18 doses in three-week cycles.

Moderna and Merck initially announced in late 2022 that the postsurgical combination reduced the risk of recurrence or death by 44% compared with treatment with Keytruda alone, results reiterated in findings published in 

The results of KEYNOTE-942 are compelling because, as Dr. Patrick Ott explains, “it’s the first time that these personalized vaccines were tested in a randomized study. … Patients who got the combination vaccine plus the [Keytruda] had a lower recurrence rate. The study was first reported when there was about a year and a half of follow-up [data] for the majority of patients, and now we have an additional year of follow-up and those results have held up, meaning that improved recurrence-free survival has still maintained over time.

“And the main reason why this is exciting is the fact that this is the clearest sign that these vaccines can be likely active, and they can actually prevent a melanoma recurrence from happening in patients,” notes Ott, co-first author on the 2017 personalized vaccine study and director of the Center for Personal Cancer Vaccines, clinical director of the Melanoma Disease Center and director of clinical sciences of the Center for Immuno-Oncology at the Dana-Farber Cancer Institute.

According to the National Cancer Institute, mRNA-4157 is currently being studied in six clinical trials in disease types including renal cell carcinoma and squamous cell carcinoma, as well as melanoma and non-small cell lung cancer.

“There is certainly a lot of excitement about this type of vaccine as preventative or adjuvant treatment,” says Ott, “where patients have a cancer that the surgeon has removed, but they have a sometimes pretty substantial risk for having another recurrence. Let’s say a patient with lung cancer, they had a lung lesion and the surgeon removed it, or the surgeon removed a lymph node from a [patient with] melanoma and then basically, there’s nothing there that the clinician could find on an exam or a radiographic scan.

“Nevertheless, because of the stage of the cancer, we know that a certain proportion of patients will have a recurrence, and so that is where a therapy that could lower that risk for recurrence can help. Adjuvant therapy with the goal of preventing recurrence is a common treatment setting for [patients with] many cancer types. Based on the results from the Moderna study in melanoma patients, many experts currently think that adjuvant [therapy], as opposed to treatment of advanced cancers that cannot be removed by surgery, is the main place of these vaccines.”

In addition to personalized treatments, another class of cancer vaccines — known as off-the-shelf vaccines — are beginning to offer impressive trial results.

“We make the distinction between a customized and an off-the-shelf vaccine,” says Ott. “And it is certainly a lot more cost-, labor- or resource-intensive if one has to generate a new vaccine for every patient, there’s no question about it. It starts with the challenge to obtain an appropriate tumor sample for each patient that actually has enough tumor in it to even provide the basis for starting to make the vaccine, which is not a trivial issue in many patients.”

“Initial studies routinely took several months to make these personalized vaccines,” Ott says. “Now that time has been shortened to about six to eight weeks. … But nevertheless, it’s still very different if the oncologist who discussed treatment with a patient basically can say, ‘We’ll treat you next Monday, the vaccine is already in pharmacy, let’s go,’ versus ‘OK, well, hopefully we’ll be able to make a vaccine and you’ll start in six weeks.”

One such off-the-shelf vaccine is ELI-002 2P, intended for the postsurgical treatment of KRAS-mutated pancreatic and colorectal cancers. It was shown in phase 1 clinical trial results published this year in 

to elicit mutant KRAS-specific T cell responses and tumor biomarker responses in 84% of patients, with a median relapse-free survival (how long a patient lives without signs or symptoms of disease) of 16.33 months, with no dose-limiting toxicities observed.

ELI-002 2P, as explained in a news release issued by The University of Texas MD Anderson Cancer Center in Houston, is a lymph node-targeted vaccine intended to decrease the chance of postsurgical relapse by enabling a patient’s T cells, part of the immune system, to identify and destroy cells with KRAS G12D and G12R mutations.

Samera Rahman, 76, is among the patients who has been treated with ELI-002 2P.

Following more than a month of severe diarrhea in late 2022, an MRI revealed that Rahman had pancreatic cancer. Doctors wanted to administer chemotherapy and then perform surgery, but Rahman insisted on things happening the other way around.

“I said no, that’s not going to happen. I want to do the surgery now,” says Rahman, a real estate broker with homes in California and Maryland. “And I’m so glad for that decision that I was stubborn about and I made because I tell you I didn’t do very well with [postsurgical] chemotherapy. I nearly died each time I got a dose of chemotherapy. I landed in the hospital for a week to 10 days.”

Following surgery, and after ending her course of 12 recommended chemotherapy treatments after four infusions, she enrolled in the AMPLIFY-201 trial at UCLA in Los Angeles, where she starting receiving treatment in August 2023. She now has no signs of disease.

“I had no side effects from the vaccine at all, whatsoever,” she says. “I would get the vaccine in both thighs and both arms once a week initially. And what would happen is it would kind of get like a knot, like a little golf ball [at the injection site], but then it would go away within 24 to 48 hours, it would be gone. I had no other [side] effects. I didn’t have nausea or diarrhea, or any of the other horrible things that I got with the chemo.”

A phase 2 trial is currently underway with a new formulation, ELI-002 7P, designed to target more KRAS mutations.

Rahman has advice and encouragement for anyone considering enrollment in a cancer vaccine clinical trial.

“I felt very fortunate that I got into the vaccine [trial],” she says. “So, what I would say to these people is if you’re able to get into a trial with a vaccine, and they accept you, cooperate with them, do it and consider yourself lucky that you got in.”

Feature

Are cancer vaccines the new frontier in oncology? Experts and patients weigh in from the front lines. 

Cancer Vaccines Are a 'Marvel'

After rising prostate-specific antigen (PSA) levels led to a positive biopsy in July 2014, Jock Dyer, who lives in New Hampshire, received a diagnosis of prostate cancer at age 72. After laboring over treatment options with his wife, they decided on a prostatectomy (a procedure to surgically remove some or all the prostate), which he underwent that September.

However, Dyer’s PSA levels were not zero, where they should have been after the procedure. In January 2015, he received a diagnosis of metastatic prostate cancer.

Since then, Dyer, now 81, has been receiving hormone therapy at Dana-Farber Cancer Institute in Boston. 

Although he does not experience pain or discomfort, he says he loses a couple pounds of muscle per month. So, he advocates for himself and tells his doctors when he needs a break from treatment to regain some of the lost muscle.

Despite the nuisance of losing muscle because of treatment, he doesn’t let his diagnosis control his life.

“I don’t refer to it as my cancer. I refer to it as my diagnosis, but cancer is what it is,” Dyer tells 

. “I’m still me, cancer doesn’t change me. That’s been my mantra.”

Instead, he leans on his Christian faith, which has guided him for more than 45 years, he says.

“When I received the diagnosis, it was like a punch in the gut,” he says. “I was a fish out of water for a few months. One day I was at the YMCA trying to stay in shape, but I couldn’t keep up with the routine. I ended up just giving up trying to do push-ups and putting my nose on the floor, and I started to cry.”

Yet, Dyer stopped himself and realized that thinking about the possibility of death after the diagnosis was distracting him from precious life presently.

“I would pray to God, not so much make this go away or wake me up, but rather, asking [him] to help me accept the reality right in front of me by exploring helpful areas that I could control, such as nutrition, exercise, stress reduction, close friendships and prayer,” Dyer explains.

“I credit God for showing me that mortality is not so much connected to time, since I’m already standing off to the side, observing from a position of eternity,” he says. “It became clear to me that birth, life on earth and death are just three parts of one much larger life, I could let the past go, live in the present and plan for the future without worry, because God created me for eternal life.”

So, Dyer emphasizes that “the dreaded diagnosis I received in 2014 turned out to be an enormous improvement in my being.”

Faith can relate to both spirituality and religion, explains Dr. John Peteet, a psychiatrist at Brigham and Women’s Hospital and Dana-Faber Cancer Institute in Boston. He notes that spirituality can connect the self and a larger entity that may offer meaning in individuals’ lives. Religion, however, is typically seen as an institutionalized and organized form of spirituality that a community may share.

Patients with cancer who were spiritually faithful before cancer tended to have a stronger connection to their faith after receiving their diagnoses, Peteet notes.

“There was a study a few years ago, and I think they surveyed over 2,000 people, the majority of whom, 70%, said that their faith had gotten stronger as a result of their cancer diagnosis,” he says. “Only about 17% said that they experienced a negative effect on their faith. So, I think it can go in either direction.”

Having a combination of reactions is also “very common” for patients with cancer shortly after receiving a diagnosis, agrees Julie Exline, a psychology professor at Case Western Reserve University in Cleveland.

Exline says people may “turn to their faith for help coping with [their diagnosis]. Saying, ‘I’m trusting God will bring good from this,’ or ‘I’m leaning on God for help,’ or ‘My religious community can help me.’”

On the opposite end, she explains that people may also question their faith.

“There is also often a sense of struggle, maybe fear. ‘Is God still going to take care of me? Have I done something wrong? Is God going to let something terrible happen to me?’

“A key message here is that lots of people have had these feelings, including people who would say they have a strong faith,” says Exline. “Devout believers lean on God but have also had this belief that maybe if I’m good or if I’m a faithful person, if my life is surrendered to God, then bad things won’t happen to me. So often, their faith could be shaken by this.”

Spiritual distress is seen through different themes, such as beliefs, practices and community, says Peteet. These themes together may change the experiences patients could face during cancer.

“When people feel as though they’re not sure if their original faith still holds, it can cause them to question deeply held beliefs,” he adds. “If they feel that they can no longer depend on them, that can get pretty distressing.”

However, an individual’s spiritual distress can also affect their physical health, says Jamila Kwarteng, an assistant professor of community health at the Medical College of Wisconsin in Milwaukee.

“If a person has more distress, then that can lead to worsened outcomes,” she explains, referring to outcomes as the aspects of quality of life. “They could question the meaning of life, and the [additional] distress they have can lower their quality of life.”

Different dimensions of quality of life include physical, social, emotional, functional and spiritual aspects for some, Kwarteng notes. But when one element of quality of life is worsened, then it can impact patient outcomes, she says.

“If a person has improved quality of life, then that will lead to improved patient outcomes, as well,” Kwarteng explains. “Something we will want to try to achieve is to help someone to have an improved quality of life, whether it’s through providing spiritual support or some other type of support. Many studies have found that quality of life is so important in terms of patient outcomes. Those with a higher quality of life can have better survival after a cancer diagnosis as well.”

A review co-authored by Peteet and published in 

emphasizes that lack of spiritual support and negative religious coping — such as anger toward God — is associated with lower quality of life.

To mitigate this, Peteet says that receiving assistance with spiritual concerns may help.

“When people have worse quality of life, their spiritual distress can be heightened,” he says. “When someone is in pain, they may be questioning their faith. If they get help with their spiritual concerns, there’s research that shows this can improve their quality of life.

“A diagnosis itself still raises the issue of dying for most people, even though cancer is more treatable now,” Peteet says. “It raises these existential concerns about one’s mortality, what the larger meaning of life is and what happens after death.”

Cancer wasn’t what made Roberta Codemo wonder what the meaning of life is. Rather, cancer helped her understand her life’s purpose.

In 2008, Codemo went to the emergency room, thinking she had a case of appendicitis. She was initially told that she had a mass on an ovary and a twisted fallopian tube.

A follow-up appointment with her doctor revealed that she had complex endometrial hyperplasia without atypia (when the uterus lining becomes too thick but has normal-looking cells) at 44 years old. At the time, her doctor didn’t want to proceed with a hysterectomy (a surgical procedure to remove the uterus and cervix), because she hadn’t had children, and gave her progesterone instead, a medication to prevent changes in the uterus.

After, Codemo’s doctor told her she would eventually develop endometrial cancer, leaving her with, in her words, a “ticking time bomb.”

Starting around 2012, Codemo started experiencing abnormal vaginal bleeding and passed blood clots the size of her fist. She received a diagnosis of stage 1C endometrial cancer and ovarian cancer in 2014.

As a Buddhist for nearly 30 years, Codemo did not perceive her diagnosis as good or bad. Instead, she viewed cancer as “burning off” her negative karma.

“My parents had both been diagnosed with cancer and now I had my own battle to fight, but it was also seeing it as a way of burning off karma,” Codemo, of Camp Point, Illinois, explains. “Getting cancer was the best thing that happened to me.”

Her diagnosis allowed her to open herself up and “understand what suffering really is.”

“My Buddhism has deepened because I’ve gotten to know other women who have been diagnosed with gynecologic cancer,” Codemo says. “No woman should have to go through this, and that is why I advocate and continue to advocate.

“Buddhism sees illness and sickness as a means of eliminating negative karma. It gives you guidance to reach Buddhahood, if you meditate, study and follow the Eightfold Path.”

According to Britannica, the Eightfold Path in Buddhism is described as the path to enlightenment via eight elements that include having “correct” actions and choices in life, including “correct effort,” “correct speech” and “correct mindfulness.”

However, she admits her faith wasn’t always this strong. It wasn’t until she had met fellow patients with gynecologic cancers that shifted her entire view on compassion and companionship.

“I called myself Buddhist, but I didn’t practice. After my diagnosis, I met Melanie Chasen during my first day in the [chemotherapy] room, and I have her to thank for the person I’ve become.”

Her friend, who was also Codemo’s cancer mentor, always told Codemo that the reason her cancer was caught at such an early stage was so that she could “be a voice for other women who were so sick, they didn’t have a voice.”

“Getting cancer made me human,” Codemo says. “It taught me the meaning of the word compassion, which is the touchstone of Buddhism. I’m no longer cold-hearted and now advocate, speak out and do interviews like this.

“After I was declared NED [no evidence of disease], I had too much invested and had met so many wonderful women. I couldn’t turn my back and walk away.”

Now 60 years old, Codemo has been cancer-free for 10 years and continues to advocate for women with gynecologic cancers, and would like to become a patient navigator.

“I still am not fully practicing, but I understand more of what Buddhism is,” she says. “I still continue to feel that connection because I will probably continue advocating until the day I die.”

Although stories like Dyer’s and Codemo’s are common, so are other experiences with faith regarding spiritual distress.

Leaning into faith support networks can be important for patients, Kwarteng notes. She explains that patients may open up about their diagnoses with trusted leaders or others within their network.

“They might not want to share with everyone, but if they can find a few trusted people, then they may be able to get more support that can help them through their cancer journey,” she says.

Peteet agrees that patients having a spiritual community or spiritual authority in their lives may be helpful.

“It’s interesting that in the research that’s been done on providing spiritual care to people with spiritual concerns, the care that was provided through the medical team seemed to lead to less aggressive care at the end of life, as compared with the kind of support that people got from outside,” he explains. “Most cancer hospitals have cancer-experienced chaplains who can be pretty helpful.”

Still, for patients who may feel that it’s morally wrong to be angry at God or temporarily lose faith, Exline emphasizes that experiencing feelings like these is common.

“A very big take-home message is that feelings of anger and disappointment related to God or worrying that God is going to punish you [and] doubting whether you can trust God is extraordinarily common,” she says. “The counterintuitive thing about it is that once [patients] are willing to go there and acknowledge it, that is often a really huge step toward healing one’s relationship with God. If patients can address it, [then] at least they can get somewhere.”

Leaning on spiritual belief may strengthen patients' life purposes, but for many, it's common to temporarily loosen their grip on faith after a cancer diagnosis.

CURE Summer 2024

Cancer and the Question of Faith

Cancer Vaccines Are a 'Marvel'

Matters of Faith After a Cancer Diagnosis

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