Husband-wife thankful for precision genomic testing of two cancers

They’ve been married more than four decades, sharing the joys of parenting and now grand parenting. This Muncie, Ind. couple is determined to look two different cancers in the face and say: “Not Today.”

By IU Health Senior Journalist, T.J. Banes, tfender1@iuhealth.org

There’s no other way to say it: “It’s cute.” Jon Peckinpaugh had his picture taken wearing a t-shirt that reads: “Science is cool but my favorite subject is genomics.” He was hesitant about sharing the photo because he isn’t a fan of pictures taken alone. He’s accustomed to having his wife of 43 years by his side.

So it’s no surprise, that in this season, Jon and Robin Peckinpaugh are walking the road of cancer – diagnosis and treatment – together. Robin, 64, was first diagnosed with breast cancer 11 years ago. In March 2019, it returned. Two months later, Jon, 63, was diagnosed with pancreatic cancer.

As part of their treatment plan, both have subscribed to genetic testing through IU Health’s Simon Cancer Center. Through precision genomics, IU Health specialists look at the genetic structure of the tumor to determine if the mutations can be targeted with therapy. Not only is the therapy targeted, but the testing also determines if there is history that may be passed from one generation to the next.

While the area of the affected part of the body defines most cancers, precision genomics focuses on the disease of the DNA. Testing of genomic levels can reveal specific imperfections in the DNA. For instance, researchers have discovered that some forms of breast cancer look like ovarian cancer, more than breast cancer, and some patients with prostate cancer can have a genetic mutation that is associated with breast cancer. Doctors are then able to focus on treating what drives the cancer, rather than the body part where the cancer is discovered.

The findings are analyzed by more than 20 multi-disciplinary IU Health and Indiana University School of Medicine faculty and staff, including oncologists, genomic scientists, pathologists, pharmacy specialists, nurses, and clinical specialists. After the team’s review, patients are given various treatment options, while reducing the potential adverse side effects.

After meeting with Dr. Jonathan Berkowitz, at IU Health Ball Memorial’s Cancer Center, Robin was referred to Dr. Bryan Schneider. Founder and director of the IU Health Precision Genomics Program, Dr. Schneider is a medical oncologist with IU Health Simon Cancer Center’s Women’s Clinic.

Robin discovered the return of her cancer when she felt pain in her sternum. Further testing showed the cancer had moved to her bone and liver. Genetic testing revealed no mutations and a year ago she began immunotherapy.

Jon’s diagnosis came after he visited his family doctor for pain in his lower back and upper abdomen. An MRI showed a mass on his pancreas and he was referred to IU Health’s Dr. Paul Helft who specializes in oncology.

The diagnosis was familiar to Jon.

“My father’s side had extensive cancer issues,” he said. His dad died at the age of 63 with complications from pancreatic cancer. All six of his father’s siblings also had cancer.

Jon and Robin are parents to three adult sons and a daughter. They also have four grandchildren. “We were concerned about the hereditary aspect so we went through genetic counseling,” said Jon. His testing showed a BRCA2 gene mutation that can be passed from one generation to the next. Some recent studies have identified inherited BRCA2 in approximately one to four percent of pancreatic cancer cases.

By having their children tested, the Peckinpaugh’s can have a peace of mind that their offspring will be monitored for risk factors. Research has shown that early detection provides the most effective treatment. Cancer cells with BRCA mutations may respond best to specific types of therapies.

“A month before consulting with Jon about his results, a Phase III trial reported that an oral drug called Olaparib, can be effective in BRCA-mutated pancreatic cancer. It is the first trial in pancreatic cancer to show a survival benefit in a long time,” said Dr. Milan Radovich, co-director of the IU Health Precision Genomics Program.

Jon began taking the medication that was then FDA approved early last year. The drug is also prescribed in the treatment of BRCA-mutated advanced ovarian cancer.

“Jon started taking the drug in September 2019, and his cancer is responding still to this date. To compare, the median overall survival for metastatic pancreatic cancer is seven to nine months, with most tumors not responding to standard chemotherapy or rapidly progressing,” said Dr. Radovich.

“In May of 2019, we had our socks knocked off,” said Robin, who is retired as an administrator with Muncie schools. Jon credits her with researching their cancers and their care options. Their children jumped in and created t-shirts that read: “Not Today,” as a way of offering encouragement to their parents.

Jon said he is grateful to his employer, Capital Machinery Systems, owned by Russ Phillips, and his co-workers for additional support during treatments.

With the help of their doctors, and family members both Jon and Robin have focused on making every day count. “We are still able to do the things we want to do – working in the yard, golfing and spending time with our grandkids. We just maybe don’t do it as long as we normally would because we get tired,” said Jon.

“IU Health has been a lifesaver,” said Robin. “We have tremendous oncologists who have done an amazing job explaining everything to us and offering us options.” Jon added: “After I worked with precision genomics and got results, I had a reason to believe. They knew the makeup of my tumor and how to respond to it. I knew it would be taken care of. If my diagnosis had occurred five years ago and precision genomics didn’t exist, I may be still living, but my quality of life wouldn’t be what it is. We are truly blessed.”