Biochemotherapy for Treating Metastatic Melanoma
Erick Davis' Story
In the spring of 2004, Erick Davis discovered a lump just above his elbow. "It felt like a marble had been placed under my skin," stated Erick. At the time, Erick was training for the "Escape from AlcatrazSM Swim" a 1.5-mile swim from Alcatraz Island in San Francisco Bay. He thought the lump was just a muscle knot or some other athletic injury, fortunately his wife convinced him to consult with his local primary care doctor.
Erick grew up in Connecticut, spending long summer days in the sun. As an adult, during his years in the Air Force, he was stationed in Guam where the sun’s ultraviolet (UV) radiation levels are very high. . 12 years ago Erick had had a stage I melanoma removed, stage I indicated the cancer is localized in one specific area, and was considered cancer free. His physician had the lump in his arm biopsied, and when the lump biopsy lab results came back positive for cancer, Erick’s physicians sent him for further testing in San Francisco.
Diagnosing Metastic Melanoma
A CT scan found lumps in his liver and his lung, fearing the cancer had spread to his brain the physicians ordered a brain MRI, which gratefully came back negative for tumor infiltration. Further screening, using a Positron Emission Tomography (PET scan), found a tumor had developed in his vertebrae. It was at this point Erick was diagnosed with stage IV metastatic melanoma, stage IV indicates that the tumor has spread to other organs or lymph nodes far away from the original tumor site, such as the brain, kidney or liver. His physicians suggested he try biochemotherapy with Dr. David Minor. Biochemotherapy is an intensive drug treatment regime that combines three chemotherapy drugs with two active biological agents, interleukin 2 (IL-2) and interferon.
"I went on the Internet to do some research on my diagnosis, that was really scary. Everything I read told me I had a 5% chance of survival," stated Erick. "When Dr. Minor told me that with biochemocherapy my chances of survival increased to 20%, I couldn’t believe it. I had two kids at home and I wanted to see them graduate from high school."
Erick entered the hospital for his first biochemotherapy treatment that summer and spent the next six months running his own personal marathon, one week in the hospital, one week at home in bed, then one week feeling pretty normal. He worked when he could, maintaining contact at his office through e-mail and stopping by the office on his good week.
Biochemotherapy
During biochemotherapy sessions, patients are admitted to the hospital and over four days receive intensive treatment with five different drugs. This cycle is repeated six times at three-week intervals, after which patients are admitted for two-day treatments once a month for the next one to two years. "The treatments can be unpleasant and physically incapacitating, side effects range from extreme nausea and vomiting to kidney failure and systemic inflammatory response, inflaming the patient’s entire body including joints and vital organs," states Dr. Minor. Erick describes his first biochemotherapy treatment, "the first cycle hammered me. I came home and it felt like red ants were crawling all over my body. This stuff was poison, like round-up for your body." After the third treatment cycle all of Erick’s tests came back clear of cancer, making the uncomfortable side effects seem insignificant. "I tell everybody, you get through it. It’s like running a marathon. At mile 13 you say to yourself, you’ll never make it, then you just dig down and do it – then before you know it you’re finished," Erick explains.
California Pacific Medical Center
Patients at California Pacific are admitted to a new unit called the TICU-3 staffed by nurses who are highly trained to help care for oncology patients receiving IL-2 treatment. Patients in the T-3 also receive care from Christine Kim, R.N., N.P. Christine is an advance practice nurse working exclusively with IL-2 patients. She manages the care of each patient from the moment they are admitted throughout their hospitalization and their discharge. On average, Christine may see anywhere from two to four patients daily. "You really get to know these patients and it’s so rewarding to see a regression in tumor growth because you know the treatment is working," states Christine. Working closely with Dr. Minor, Christine keeps him informed on each patient’s day-to-day condition, and makes sure all medical needs are met.
Christine and Dr. Minor are currently working on a "patient-to-patient" peer-support system for patients undergoing IL-2 treatment. The system will pair a patient with someone who has gone through the treatment and understands the day-to-day issues from a personal level.
Biochemotherapy is used on select patients with metastatic cancer. According to Dr. Minor, "the short-term improvement rate for patients with metastatic melanoma receiving chemotherapy alone is only about 15%, and long-term survival is almost zero. When patients are treated with biochemotherapy close to 50% for patients show short-term improvement and 15% are long-term survivors." Dr. Minor recently published a paper titled "Retrospective Study of Biochemotherapy for Metastatic Melanoma: The Importance of Dose Intensity," and clinical research trials are still being conducted on IL-2 therapy at research centers including the California Pacific Medical Center Research Institute.
How You Can Protect Your Skin
The American Cancer Society (ACS) statistics show that melanoma accounts for about 4% of all cancer cases in the United States. ACS estimates that in 2005 there will be 59,580 new cases of melanoma in the United States and approximately 7,770 of these people will die. Nearly one in five Americans will get skin cancer in the course of their lifetime and 25% of these people are under forty years of age. Talk to your doctor about any suspicious moles or skin growths and follow these simple skin protection rules.
Protecting the skin from the sun’s damaging rays is the only preventive measure currently available to fight this devastating disease.
Erick finished his last IL-2 treatment in November 2005 and after a year and a half he is training again for the July 2006 Escape from Alcatraz Swim.