Andrew Messinger: Melanoma
In 2005, I was diagnosed with melanoma. It happened after my doctor found a protruding lesion on my chest and reluctantly had it biopsied. After it proved to be melanoma, he referred me for surgery and my first consultation at Memorial Sloan-Kettering Cancer Center. At this point, my scans did not show signs of any metastases in my body.
A month later the lesion was surgically removed, and I spoke with multiple doctors to get opinions on which therapy to pursue. The data were confusing, but I made my decision: interferon. The first night after the initial drug infusion was the most painful and difficult I would experience over the next six years. However, the hospital staff learned how to reduce the side effects, and after a month as an outpatient, I continued with a year of interferon self-injection and scans.
By 2007, however, scans showed lesions on my lung, and I consulted chest surgeons. Surgery revealed additional disease cancer in nearby lymph nodes as well. Still grasping for any way to try to slow the disease, I went on a medication that stimulates the production of blood cells that would hopefully fight off the melanoma, even though it is not FDA approved by the U.S. Food and Drug Administration (FDA) for the treatment of melanoma. I did well for several months on the therapy, known as granulocyte-macrophage colony-stimulating factor, or GMCSF, until additional lesions on my lungs were detected.
In early 2008, things started to look up. I began four rounds of interleukin-2, or IL-2, and the lesions shrank measurably. I was generally encouraged. The constant therapy was very demanding, but at the time few other treatment options were available. Meanwhile, talk of a new drug, ipilimumab (“ipi”), was spreading. Fortunately for me, the melanoma was not.
But by 2009, scans showed new tumors in my lungs, and for the first time, a brain lesion. At my doctor’s suggestion, I immediately joined a small clinical trial to study the effectiveness of ipi on brain lesions. I experienced side effects and actually missed a round of treatment as a consequence, but scans quickly showed that my lung metastases had stabilized, even though ipi was ineffective on my brain lesion.
I underwent radio-surgery for the brain lesion and the ipi has kept the metastases in my lungs stable with manageable side effects. Going into the last few ipi infusions on my two-year trial I remain tremendously encouraged. Because of my experience and the experience of other patients like me, ipilimumab (Yervoy) was FDA-approved in April. Ipilimumab is an antibody that re-activates your immune system so that it can help clear your melanoma.
I could easily dismiss my three prior treatments as unsuccessful because my disease kept progressing. However, they helped me get to ipi. One major take-away from my experience is that patients should absolutely accept the argument that even in the face of a tough prognosis, the situation can change very quickly. And treatments that offer what is seemingly only incremental survival might actually be the ticket to longer-term success, because they may get you to the treatment that ultimately works.
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