THERE'S NO STOPPING HER STEPHANIE GRIMES AND OTHERS ARE LIVING - AND THRIVING - THANKS TO 'SMART DRUGS'.

Byline: Nancy Dillon

Staff Writer

A "shark bite" is how Stephanie Grimes describes the chest wound she had when she walked into USC University Hospital's emergency room in February 2006.

"It was massive, several inches in diameter," Grimes, a 46-year old fitness instructor from West L.A., recalled. "At first I thought it was a mosquito bite that got infected. But it just kept growing."

Grimes, a single mom with a 16-year-old son, was soon diagnosed with a cancer so aggressive it broke out through the flesh of her left breast as it metastasized to her lungs.

"They said on a scale of 1 to 10, my cancer was an 11," Grimes said recently after teaching a step aerobics class at Spectrum Club in Pacific Palisades. "They gave me a couple of months to live. A counselor asked if I had someone to take care of me, or if I needed hospice."

But Grimes wasn't ready to give up. She checked out of the hospital on a Wednesday and attended her son's basketball game the following Saturday. There she hooked up with a fellow mom who helped her snag a coveted meeting with Dr. Dennis Slamon at UCLA's Jonsson Comprehensive Cancer Center.

Slamon is a rock star in the world of cancer treatment, working on the cutting edge of research into the class of targeted "smart drugs" that stop aggressive tumors in their tracks without the carpet-bombing, body-ravaging approach of traditional chemotherapies.

Thanks to these new options, thousands of cancer patients are now surviving diagnoses that were considered fatal just a decade ago, writes Harvard Medical School professor Dr. David G. Nathan in his new book "The Cancer Treatment Revolution: How Smart Drugs and Other New Therapies Are Renewing Our Hope."

Indeed, drug advancements are making it possible for many patients with metastatic disease to continue their active lifestyles with the hope they can manage -- if not eradicate -- their cancers for years beyond previous forecasts.

Such new hope was evident in the announcement by Elizabeth and John Edwards that they will continue their quest for the White House despite the incurable cancer that has spread from her breast to her rib.

"Cancer takes things from you, like the innocent belief you'll have a healthy, long life. So it can become very important to hold on to the dreams and goals you had before diagnosis," said Dr. Anne Coscarelli, director of the Ted Mann Family Resource Center at UCLA.

"Even though you could look at it as a terminal disease, you don't know how things are going to play out or what's going to happen scientifically in the interim."

Grimes said she owes her hope to Slamon. It was his long-held belief that an intelligent, targeted drug could block tumor production that led to the development and approval of the first smart drug for breast cancer in 1998. Called Herceptin, the drug works against an overactive, tumor-producing gene found in about one-fourth of breast cancers. About 50,000 women in the U.S. are diagnosed with this type each year.

Luckily for Grimes, she was a match for Herceptin. She started weekly intravenous treatment in association with another new smart drug called Avastin (already approved to treat colon cancer and advanced lung cancer) in mid-March 2006. She was back at work teaching her step and spinning classes with virtually no downtime.

At her follow-up meeting with Slamon in July 2006, Grimes was happy to learn her tumor span had shrunk dramatically -- and her wound had healed so well, she didn't need a skin graft.

On the downside, she lost about 18 pounds in muscle weight and struggled with some joint pain, exhaustion and diarrhea. But the symptoms were mild and generally passed, she said.

"They were a small price to pay," said the 5-foot-3 dynamo who teaches 16 one-hour fitness classes spread across three gyms every week. "I didn't lose my hair. I didn't have to take time off. I didn't have to deal with a lot of the added emotional issues that people on chemo and radiation have to bear."

Now 13 months into her treatment, Grimes says her cancer is 90 percent under control.

"I don't have time to be sick. I'm the breadwinner in the family. I have things to do. I plan to be around for my son's graduation. His college graduation," she said.

Though the long-term efficacy of smart drugs is still under investigation, Northridge attorney Amy Applebaum, 63, has been taking Herceptin for a decade.

Diagnosed with Stage 2 breast cancer in November 1994, she underwent a mastectomy on her right breast and started a six-month chemotherapy cocktail of Cytoxan and Methotrexate in February 1995.

"It was pretty devastating -- and particularly disturbing because my younger sister died from breast cancer a week and a half after my diagnosis," Applebaum recalled.

After a March 1997 scan revealed that her cancer had metastasized to her liver, Applebaum started on Herceptin. The three tumors in her liver appeared to vanish.

"For me, it was a miracle," Applebaum said. "I had a small recurrence in 2003, and needed more chemotherapy, but I continued working full time.

"Everyone makes a decision based on how they feel and their circumstances. I just found that I felt much better if I could go to work and be productive and not focus on the fact I was ill," she said, adding that her colleagues at Sidley Austin in downtown L.A. were very supportive.

"Sometimes I only worked at a two-thirds pace or 50 percent pace, but it's what I had to do for myself."

She said her biweekly Herceptin treatments at UCLA require some finagling of her schedule, but she recently took a month-long vacation to Italy and is preparing for the birth of her first grandchild.

"In the early stages, I didn't know if I'd see my children get married, see the millennium, meet my grandchildren.

I feel very, very lucky."

"We very often now can turn breast cancer into a chronic disease," said Linnea Chap, Applebaum's doctor at Premiere Oncology in Santa Monica. "Although many women are never cured, they can live with breast cancer for many, many years with very little change in their quality of life."

Smart drugs are expensive, costing thousands of dollars a month, but interested patients also can apply to smart drug trials now under way at UCLA. For more information, call [phone].

Nancy Dillon, [phone]

[e-mail]

LIVING WITH CANCER

What: Colon cancer survivor and NPR commentator Leroy Sievers talks to his good friend Ted Koppel about the unexpected highs and gut-wrenching lows of his ongoing battle with the disease.

Where: The Discovery Channel.

When: 8 p.m. May 6.

In a nutshell: Sievers was diagnosed with colon cancer six years ago, and in late 2005 the cancer returned in the form of a brain tumor, which was successfully removed with surgery.

The program will include conversations with Sievers' doctors, other patients who are treated with him and sections from his "My Cancer" blog at www.NPR.org/mycancer.

CAPTION(S):

4 photos, box

Photo:

(1 -- cover -- color) LIVING WITH CANCER

New therapies offer hope for the long run

(2) In February 2006, Stephanie Grimes learned she had breast cancer and was given two months to live. Now she teaches 16 fitness classes per week.

(3) NPR's Leroy Sievers, left, discusses his battle with colon cancer with friend and fellow journalist Ted Koppel on Discovery Channel's upcoming program "Living With Cancer."

(4) Diagnosed with breast cancer in 1994, Amy Applebaum has been on Herceptin for a decade. "For me, it was a miracle," she says.

Tina Burch/Staff Photographer

Box:

LIVING WITH CANCER (see text)