Best Advice

What was the best advice you received and from whom?

Jeffrey Menashe, MD, Compass Oncology East
Jeffrey Menashe, MD, Compass Oncology East

Luis Volls, MD, my primary care provider, ordered the initial scans that confirmed that I had cancer in my chest and lungs. He called me into his office immediately and I was grateful that Eddy wanted to go along to receive the results of my tests. Along with the news that I might have untreatable cancer, he referred me to Jeffry, Menashe, MD, at Compass Oncology East. With this referral, Luis said, “I talked to Jeff about your case and he thinks there may be treatments that will help you.”

Chad Crouch joined us for the earliest available appointment with Dr. Menashe. While being friendly and reassuring, he recommended getting a biopsy to pin down the exact cancer in my chest. We tried a bronchoscopy and then a mediastinoscopy, when the bronchoscopy was inconclusive. With tumor tissue, the lab was able to clearly diagnose the characteristic pyramid shaped cellular structure of metastatic melanoma.

I had a melanoma skin lesion removed thirty-five years before and possibly this was the original source of the disease in my chest. Doctors say they can’t be sure, especially since metastatic disease usually develops in a few years after a primary lesion is removed, or not at all.

Dr. Menashe remained positive and hopeful when we met to review lab results and plan treatment. Rather than talk about the disease staging or survival statistics, he carefully presented his recommendation: start immediate treatment with Interleukin-2 (IL-2). He provided a printed sheet which substantiated IL-2 as the standard first-line treatment for metastatic melanoma. He said it this way: “IL-2 is your best chance for a durable remission tantamount to a cure. And if it doesn’t work for you, there are other treatments that you can fall back on.”

I was especially impressed with the phrase “tantamount to a cure” which is not often associated with treatment of many cancers, especially advanced melanoma.

Dr. Menashe tried to prepare me for the rigors of IL-2 treatment, including unpleasant side effects, and potential hazards. He emphasized that I would have to establish eligibility by passing tests that prove my health was strong enough to withstand the treatment. By presenting it in this way, I started to see the treatment as a challenge to be surmounted.

Because Dr. Menashe specializes in lymphoma, leukemia, and myeloma, not melanoma, he referred me to Brendan Curti, MD, who specializes in treatments for kidney cancer and melanoma. Dr. Curti was in full accord with Dr. Menashe’s recommendation, and I was admitted for IL-2 treatment. Fortunately, as treatment progressed, scans revealed that my immune system was responding to stimulation by shrinking the melanoma. Treatment continued for six week-long hospital stays over an 8-month duration. Two years later, I remain in stable condition.

Since my treatment, I’ve learned that IL-2 is often not recommended nor offered to patients with advanced metastatic melanoma. Many medical centers do not offer this treatment, and tend to talk their patients out of transferring to a medical center that does. They argue IL-2 treatment requires hospitalization, has unpleasant side effects, and frequently does not work.

Dr. Curti agrees with the rationale, but reaches a more nuanced conclusion. The record of all cases of metastatic melanoma and renal cell carcinoma treated with IL-2 at Providence Cancer Center demonstrates complete or partial response for 28% of the patients. IL-2 offers a fighting chance for a durable response, which hasn’t yet been proven for the newer treatments. IL-2 is a rigorous treatment that requires a high-level of expertise from the doctors and nurses who administer it. Doctors and medical centers that are not fully prepared, should not attempt it. For patients fortunate to have access and the strength to qualify for IL-2, it’s still the best first-line treatment.

As a result of the care and medical advice from the doctors, nurses, and staff at Providence, I’ve walked back from the mortality cliff. While I’m awarding the best advice prize to Dr. Menashe, he shares it with Dr. Curti and the staff at Providence Cancer Center who supported his advice and enacted the extensive treatment.