Hitting a home run with melanoma treatment
Chuck Howard’s symptoms began around Christmas in 2009. They weren’t alarming – just some “minor discomforts” near what he assumed was his gallbladder. When the pain persisted into spring, his doctor ordered some tests.
As the technician performed an ultrasound, Chuck, then a 60-year-old dentist from Salem, Ore., watched for her reaction. “She tried not to tell me too much,” he says, “but it was obvious that she was concerned.” Indeed, this and other tests revealed the culprit: His body was riddled with dozens of tumors, including one above his right kidney with a mass the size of a baseball.
Chuck had advanced melanoma, a skin cancer that had gone undetected while it spread throughout his system. It was a devastating diagnosis. Metastatic melanoma kills 95 out of 100 patients within five years. Chuck’s niece succumbed to the disease at age 27. Still, his reaction was low-key. “I was taken aback, and I don’t really know what was going through my mind other than this could be the end and we’d better start preparing,” he says.
People participate in studies so the next person down the line can have more options and doctors can eliminate things that don’t work."
Chuck’s doctor in Salem referred him to oncologist Brendan Curti, M.D., medical director of Providence Immunotherapy Program in Portland, Ore. Dr. Curti specializes in immunotherapy to treat metastatic kidney cancer and melanoma. It just so happened he and Steven Seung, M.D., Ph.D., a Providence radiation oncologist and immunologist, were studying a new treatment that pairs high-dose radiation with interleukin-2, a powerful immunotherapy.
IL-2, as it’s called, boosts the body’s immune system to seek out and kill cancer cells. It has produced remarkable results, delaying the disease’s progression and in some cases even curing the cancer. But it works for only 15 to 20 percent of patients. On his first visit with Dr. Curti, Chuck had no idea if he would be one of them. He recalls Dr. Curti’s metaphor: “He said the treatment would be either a strikeout or a home run.”
Despite Chuck’s optimism, his health was declining rapidly. Experience has taught Dr. Curti that the sicker the patient, the less chance of recovery.
Chuck and his wife, Jo, who worked in his dental office, hoped for the best, but began to prepare for the worst. He visited a financial consultant, began to draft his will and advertised for an associate to take over the practice while he was in treatment. “I was thinking that even if I recover, I’m probably going to have a shortened life expectancy,” he says.
Game-changing radiation technology
Researchers have known for years that radiation affects the immune system, and in the 1980s they conducted a study combining radiation and IL-2, a treatment they hoped would deliver the one-two punch needed to kill the cancer. The results, however, were disappointing.
“Radiation techniques were not as sophisticated as they are now,” Dr. Seung says of the early research, “and the dose intensity was less than was necessary to kill the melanoma cells.”
In early 2009, Providence acquired a state-of-the-art radiation machine that solved the problem. It could focus a radiation beam precisely on a tumor with doses 10 times stronger than traditional radiation without significantly harming surrounding healthy tissue. This technique is called stereotactic body radiotherapy, or SBRT.
Drs. Seung, Curti and Marka Crittenden, M.D., Ph.D., a Providence scientist and radiation oncologist also involved in the research, designed a study to see if SBRT might give IL-2 the boost it needed to succeed with more patients.
Dr. Curti enrolled Chuck in the new study combining radiation and IL-2. Because the trial was a pilot study, Chuck was one of only 12 patients given the combination therapy.
Chuck’s treatment began with radiation sessions, followed by a series of IL-2 treatments. The therapy provokes a powerful immune response, with side effects ranging from drops in blood pressure to joint pain and nausea. Because of this, week-long hospitalization is required during each round.
For six months in 2010, Chuck and Jo traveled back and forth between Salem and Portland, making the best of it. Jo referred to Providence Cancer Center as “the resort,” where happy hour began at 3 p.m. with a cocktail of IL-2. Chuck celebrated his 61st birthday on the seventh floor. The staff sang “Happy Birthday,” and Chuck watched the Ohio State Buckeyes trounce Miami.
Meanwhile, his immune system was finally recognizing the cancer cells and started waging a fierce battle. As side effects – which at one point included hallucinations – worsened, doctors found more evidence that the therapy was working.
Sure enough, the tests that followed each cycle were encouraging. The first scan showed that the number of tumors and size of the cancer decreased by half. Chuck’s tumors were shrinking, then disappearing. The treatment was a home run.
The same was happening with others enrolled in the trial. Not just one patient, which would have been typical for IL-2 alone, but half the study group was seeing astonishing results.
“Factoring in that it was a small study, this finding is very, very surprising,” Dr. Curti says. “It really has not been observed in the history of interleukin-2 therapy.”
Six months after treatment, there was no evidence of cancer in Chuck’s body. And given what researchers know about IL-2 success, there’s a good chance it won’t come back. Nowadays, Chuck sees Dr. Curti only once a year for his annual scan, and every time has resulted in a clean bill of health.
Chuck returned to work full time until spring of 2016, when he hung up his hat at the dental practice. During retirement, he plans to spend time with two of his hobbies, photography and woodworking. He and Jo also are planning some trips, including one to New Zealand to attend their daughter’s wedding.