New treatments allow Hoffman Estates man to survive Stage 4 cancer
Could advances in personalized medicine and immunotherapy be the key to developing more effective treatments for diseases such as cancer?
Ed Wojdyla of Hoffman Estates will be celebrating an extra happy New Year this week.
It has been nearly three years since two well-established, but rapidly advancing medical tools -- precision medicine and immunotherapy drugs -- conquered Wojdyla's aggressive, late stage melanoma and granted him this chance to celebrate with his wife, four children and six grandchildren.
"If it hasn't come back by now, it's 90 percent likely that he's cured," says Dr. Bruce Brockstein, Wojdyla's oncologist and medical director of NorthShore University HealthSystem's Kellogg Cancer Center.
"I'm a walking, talking miracle," says Wojdyla, 78, the retired director of building and grounds for Prospect Heights District 23. "I benefited from good doctors, good science and a lot of prayers."
Personalized medicine, which dates back to the 1970s, is a genetics-based tool that uses DNA analysis and a patient's health history to help predict, prevent and diagnose certain diseases and to tailor treatments to fight them.
Immunotherapy drugs, also launched in the 1970s, reactivate the immune system so it can wage war with disease. Cancer cells trick our T-cells into thinking the cancer isn't a threat, but immunotherapy drugs block that signal so the T-cells will suit up for battle.
As both tools grow more sophisticated, they are generating a lot of excitement in the medical community and its grateful patients.
Wojdyla's ordeal began in 2008 when he was diagnosed with Stage 3C melanoma after a tumor on his right knee and two lymph nodes tested positive for the cancer. Brockstein prescribed nine months of grueling interferon treatments.
"It knocks the daylights out of you completely," says Wojdyla. "It's like having the flu constantly, 24 hours a day, seven days a week. I had fatigue. I slept a lot and I would get so chilled my wife was piling almost every blanket on top of me and I was still shaking like a leaf."
But it worked.
For four years he was cancer-free, until January 2013 when the melanoma returned with a vengeance, spreading to his liver, lungs, spleen and lymph system. "I was devastated," Wojdyla says. "You hear Stage 4 and that's like the end of the world. They came into my room with a packet of DNR (do not resuscitate) documents, and that knocks the wind out of you, too."
Brockstein had to move quickly and smartly.
"His liver was in such bad shape, I didn't expect him to survive," says Brockstein. It was twice normal size, and overrun with too many tumors to count. "He didn't have a month or two to spare."
Brockstein ordered genetic testing of the tumor, which is the heart of personalized medicine, hoping that it would detect a gene mutation known as BRAF, which was known to respond very quickly to an inhibitor drug called Vemurafenib.
The test was negative, so he reluctantly turned to an immunotherapy drug that was fairly new at that time called Ipilimumab, or "Ipi." It was known to work in roughly 40 percent of patients, but much more slowly than Vemurafenib, and the clock was ticking down.
"He was very lucky," says Brockstein. "The treatment worked the fastest I've seen in the five years since the drug has been available."
A longtime swimmer who had been logging 5,000 yards a week until his illness, Wojdyla was back in the pool following his second Ipi treatment and after the third treatment could swim his former distance.
After the fourth treatment Wojdyla's scans came back with startling results: they were completely clear.
"Dr. Brockstein is a very reserved, quiet man, but he came running into the office, virtually bouncing off the walls, saying, 'You're not going to believe this. I don't believe this. There is no cancer.'"
In January, if his test results are still clear, as expected, Wojdyla will celebrate three years in remission.
Brockstein credits NorthShore's on-site precision medicine testing with getting him results quickly and steering him to the best treatment for Wojdyla. But, he says, immunotherapy such as Ipi is far more exciting in oncology now and may produce more immediate results in the field.
However, the limelight in medicine has been shining brightly on genetic testing and personalized medicine. Earlier this year President Obama announced the $250 million Precision Medicine Initiative to study genetics-based medical treatments, citing critical advances in this field.
Dr. Matt Siegel, a medical oncologist/hematologist at Edward Cancer Center in Naperville, which employs precision medicine, its targeted drugs and immunotherapies, shares the president's enthusiasm.
"We're going through a revolution," he said. "We always thought that each ovarian or lung cancer was the same, but now we're moving toward what's driving each cancer."
Brockstein concurs that genetics-based testing is a valuable approach, though it is not yet providing widespread solutions partly because diagnostic ability has outstripped the development of drugs to treat specific mutations. While it is possible to sequence hundreds of genes on a tumor to find abnormalities, medications have not been developed yet to target all of them, and that could take decades, if not centuries, said Brockstein.
Cancer is very crafty, too. Tumor cells can mutate to work around specific drug treatments by selecting for other mutations, but immunotherapy drugs "have the potential to cure people" by freeing the immune system to do its job, Brockstein said.
Beyond that, record keeping for personalized medicine is a sizable challenge.
"You have hundreds of patients with reports on hundreds of genes, and as drugs become available we need to be able to pull that information up and match patients with drugs," says Brockstein. Numerous companies are working on that, but the software isn't readily available yet.
In the midst of all this development is Wojdyla, a major success story.
Yes, there have been side effects, which are expected with any cancer treatment.
He is on medication to control his thyroid and blood pressure; his hair became an unusual, multi-toned hybrid of bald spots alternating with patches of brown, black and white, and then fell out completely; and he suffers from dry eyes and dry mouth. But he has no regrets.
"They treat my symptoms," says Wojdyla. "And it's better than being dead."