Dr. Al Stroberg: Surviving Long after a Melanoma Diagnosis Thanks to Ipilimumab
By early 2011, melanoma had spread widely through my body despite surgery, radiotherapy, and several other treatments. I was so sick that my sons came home and we began preparing my wake. Then, on Father’s Day 2011, not long after my second infusion with a new treatment called ipilimumab (Yervoy), I began noticing an improvement in my condition. After that, I had just one more infusion with ipilimumab, my tumors shrank and, ultimately, they disappeared. That was more than nine years ago, and I’m now enjoying life with no sign of cancer.
My journey with cancer began back in 2005, when I noticed a lump on my neck. It turned out to be non-Hodgkin lymphoma. I was lucky; chemotherapy and an immunotherapy called rituximab (Rituxan) cleared it up and I was able to return to my work as an orthopedic surgeon at UCLA.
A few years later, I noticed another lump under my chin. I immediately thought it must be a recurrence of the non-Hodgkin lymphoma and returned to my oncologist at UCLA. To my surprise, and the surprise of my oncologist, a biopsy of the lump showed that it was melanoma, not non-Hodgkin lymphoma.
After numerous tests and scans, it was determined that the melanoma had originated in a freckle on my right cheek and spread to some of the lymph nodes in my neck. I had an eight-hour operation during which the surgeon removed the original tumor on my cheek and 27 lymph nodes in my neck. Analysis of the lymph nodes showed that 25 of them were positive for melanoma; the surgeon told me that he had never seen a melanoma so widespread before.
Given the extent of the disease, I had two months of radiotherapy aimed at my head and neck during spring 2010. Unfortunately, this did not stop the melanoma from spreading, and so I started a course of interferon, which boosts the immune system. The goal of the treatment was to boost the immune system enough that it would attack the melanoma, but it did not work for me and I experienced the intense flu-like symptoms that are side effects of interferon treatment.
We then tried a chemotherapy called Abraxane. Again, this did nothing to slow the spread and growth of the melanoma. I did lose my hair and have peripheral neuropathy in my hands and feet, which made it hard to tie my shoes and button my shirts.
At this point, I was very sick. I had lost 40 pounds. I couldn’t climb the stairs. I spent 18 or 19 hours of the day in bed because I could barely move. Fluid began to accumulate around my lungs, a condition called pleural effusion, which made it hard for me to breathe. At first, I had to go to the hospital regularly to have the fluid drawn from around the lungs. Later, a surgeon placed a tube in my chest so that my wife and I could drain the fluid at home.
My oncologist knew of a new type of treatment, an immunotherapy called ipilimumab, that was being reviewed by the U.S. Food and Drug Administration (FDA) and that he believed might help me. It was approved on March 25, 2011, and I received my first infusion a few weeks after that.
My condition didn’t seem to change after the first infusion of ipilimumab, and I was sure I was going to die. My sons came home to say their goodbyes. Then, just after the second ipilimumab infusion, I noticed that the amount of fluid we were drawing off the lungs every day started to decrease and a large lump on my right shoulder began decreasing in size.
By the third ipilimumab infusion, there was no fluid to draw off my lungs. My next scan showed the cancer was disappearing. We drove the children back to the airport so that they could go back to school and get on with their lives.
Today, the scans continue to show no sign of melanoma, and I am immensely grateful for the basic research that led to the development of treatment that saved my life. Ipilimumab works by taking the brakes off immune cells called T cells. In 1974, when I was in medical school, I spent several months in a basic research laboratory that was at the forefront of T-cell research. Work like that was built upon over the years by many researchers, including Jim Allison, and led to ipilimumab.
We need the federal government to invest in research because this will drive progress against cancer in the future. There is nothing more important than that for our children and grandchildren.