Bill went to his primary care doctor and a local hospital in 2011 because he had swollen glands in his armpit. At the time, he made no connection between the discomfort he was feeling and the stage I melanoma lesion that his dermatologist had diagnosed and excised ten years prior. Upon the reoccurring diagnosis in 2011, this time stage III melanoma, Bill once again turned to his trusted dermatologist for advice. His advice was ‘I want you to get a second opinion from someone who is an expert in the field of melanoma cancer.’ He recommended Harriet Kluger, MD, Associate Professor of Medicine (Medical Oncology) at Yale Cancer Center. That day his dermatologist proceeded to arrange the appointment for Bill. Bill attributes the quality of his decade long patient-doctor relationship with his dermatologist to his continued peace of mind, and to saving his life in 2001 and again in 2011.Bill met with Dr. Kluger and his case was discussed at a weekly Melanoma Tumor Board at Smilow Cancer Hospital. Afterwards, he felt that there was a plan for him and was hopeful that he could fight his diagnosis, being “in the best of care that anyone can possibly wish for.” He was initially treated on a clinical trial comparing a new drug, ipilimumab, to another drug used for stage III melanoma, interferon; he was randomized to receive treatment with interferon. Approximately a year later, the melanoma spread to his liver and additional lymph nodes. At that point Dr. Kluger helped Bill participate in a new clinical trial with ipilimumab in combination with an anti-PD1 drug, nivolumab. Both of these are immunotherapy drugs that work by activating the patient’s own immune system. Ipilimumab blocks one brake on the immune system, CTLA-4, while nivolumab blocks another brake, PD-1. The hypothesis was that the combination would be a more potent activator of the immune system than either drug alone, potentially allowing it to work against the tumor cells.
When Bill shared the news with his oldest son who was about to graduate with a master’s degree in bioscience, his son Ian said, “Dad, I did some research on your clinical trial, and you are about to participate in a truly groundbreaking research trial that will be remembered years from now.” Bill further explained, “I was fortunate enough to qualify for the clinical trial I am currently on. It is based on groundbreaking immunotherapy research and the level of care I am receiving is unmatched.”
For years researchers have wondered why the immune system does not attack the cancer cells when they begin to invade the body. Yale, in collaboration with colleagues at other institutions, found that the interactions of certain proteins and receptors allow tumor cells to disable T cells, the immune system’s main fighters. Using PD-L1 as a binding partner for PD-1, a receptor on the surface of T cells, cancers inactivate T-Cells. By using an antibody to block either PD-1 or its binding partner, PD-L1, the immune system can be provoked to attack cancer cells. PD-1 and PD-L1 inhibitors are well tolerated and this approach has had excellent results. The June 2013 issue of the New England Journal of Medicine noted that this immunotherapy approach to attacking melanoma may be an option for other types of cancers as well. “When we combined inhibitors of PD-1 or PD-L1 with inhibitors of CTLA-4, we saw unprecedented responses in patients with a variety of tumor types. The results of this trial in melanoma have been dramatic and have led to a national trial comparing the two drugs to either drug alone,” Dr. Kluger said. For Bill, the spot on his liver has shrunk significantly, and the lesions on his spleen are gone. Bill takes great pride in being part of the clinical trial and was recently re-enrolled for 2 more years. He is handling the regimen well and responding without any major side effects. Bill is a firm believer in keeping your mind, body, and spirit strong and remains active and very upbeat. Recently the Smilow nursing team dubbed Bill “the 8th floor mayor” because he seeks out fellow cancer patients to listen to and shares experiences, fears, hopes, and of course a few laughs.
Last year Bill rode 62.5 miles in the Closer to Free bike ride, proudly wearing a homemade banner to honor and thank his melanoma care team on the 8th floor of Smilow. He described the entire team as his second family and wanted to ride for them as a way to express his gratitude for their gifts of talent and devoted care they have given him. “I wanted to ride for the team, to honor them for all that they do, not just for me, but for all patients. Their devotion, talents, expertise, and attitude give one hope and peace that you feel truly cared for by the best. They are a gift to us all.” Bill has already signed up to ride in this year’s event on September 6th and is recruiting fellow melanoma “thriver survivors,” as he calls himself, to join him. One thing is certain, that Bill will once again ‘banner’ his passionate gratitude for the Smilow 8th floor team. “There is so much expertise and noble passion at Yale, which is critical when you find yourself confused and fighting for your life. They will do everything in their power to help you get better while finding a cure, and I am well on my way there. Blessings Smilow 8.”