Medical Treatment

Treatment selection algorithm for metastatic melanoma
Treatment selection algorithm for metastatic melanoma circa 2014. This is no longer current.

After performing tests and scans for several weeks, my first oncologist (Dr. M) provided a credible diagnosis of metastatic melanoma with active tumors in the lymph nodes located near my heart, in the upper lobe of my right lung, and in my adrenal gland.

Dr. M said that he prefers not to dwell on staging and probable outcomes.  (I imagined that this would be a grim conversation.) We talked about available treatment options and how to work out which to select.

My primary physician (Dr. V) had stated that surgery was not an option — too many tumor sites, too close to my heart and major blood vessels. Dr. M agreed.

Dr. M provided the above treatment selection algorithm to inform the discussion. As shown by the highlighted decision path, primary viable treatments were:

Both options would rev up my immune system by increasing tumor-attacking T-Cells in body tissues. In action, the fundamental difference is that IL-2 works by stimulating the production of T-cells (put foot on the accelerator), whereas IPI binds to the suppressor T-lymphocyte antigen-4 (CTLA-4), decreasing the dampening action on T-Cell production (take foot off the brake).

Dr. M recommended IL-2 treatment under the care of an oncologist who specializes in this care. He explained that IL-2 doesn’t work in all cases, but when it does work, IL-2 is capable of providing a durable remission (many year remission) from metastatic melanoma.  Ipi, when it works, is also capable of providing a remission, but Ipi may provide a shorter remission.  Side effects of IL-2 are reversible and less dangerous than Ipi. Treatment with IL-2 does not rule out nor negate future treatment with Ipi, should the IL-2 fail to subdue the tumors.

I appreciated this recommendation together with the clear reasoning and decided to proceed.

We met with Dr. C shortly thereafter. He concurred with the advice of Dr. M and recommended that we begin IL-2 treatment as soon as practicable. He warned that IL-2 treatment is rugged, meaning that it requires up to six weeks in the hospital, has several unpleasant side effects, and provides no guarantee of success. He also stated that additional tests would be required to determine if I was qualified to take IL-2 treatment.

Additional physiological tests were performed to ensure that I was qualified for IL-2. These included:

  1. Pulmonary function (breath test)
  2. Cardio-pulmonary function (treadmill test)
  3. Brain MRI (scan for brain tumors)

Fortunately, I passed all these tests and began receiving hig-dose Interleukin-2 infusion (IL-2) treatment in February 2014.

Treatment with IL-2 is just the first in a series of medical interventions for advanced metastatic melanoma. Please see my blog posts for the latest story from my experience.