Jim Garrity, 59, was typically so healthy it was rare for him to even see his primary care physician. But after he discovered a lump in his right armpit, he mentioned it to Brett Barkimer, MD, internal medicine physician, during his annual exam at North Hills Health Center in Menomonee Falls. Jim had been treated for a cancerous lesion on his upper back three years prior, and he had a bad feeling that the lump was connected to his previous melanoma.
Dr. Barkimer referred Jim to the Skin Cancer Center at the Froedtert & MCW Clinical Cancer Center at Froedtert Hospital campus for further testing. Tests revealed that the melanoma had returned and spread to Jim’s lymph nodes, liver, abdominal wall and brain.
“What they found was a total shock to me — I was just thinking it was in my armpit,” Jim said. “Within one week, my world was turned upside down and inside out.”
Although the initial outlook for his stage IV melanoma wasn’t promising, a combination of immunotherapy and whole brain radiation therapy succeeded in eradicating the widespread cancer cells.
“We would have anticipated a life expectancy of less than a year, and now it’s been two years and there’s no sign of disease,” said Amy Harker-Murray, MD, medical oncologist. “Jim has had a phenomenal outcome for what would have otherwise been a poor prognosis,” said Joseph Bovi, MD, radiation oncologist. “Metastatic melanoma used to be almost uniformly fatal. But as medicine has advanced and new targetable mutations in these tumors have been discovered, we can consider using the word ‘cure’ for some patients.”
The Power of Immunotherapy
Jim started immunotherapy at Froedtert Hospital in January 2015 before moving with Dr. Harker-Murray to Community Memorial Hospital, closer to his Menomonee Falls home. Immunotherapy can be used in place of chemotherapy and has been shown to significantly improve outcomes for metastatic melanoma.
“Immunotherapy works by activating the patient’s own immune system to fight cancer cells,” Dr. Harker-Murray said. “It takes longer to work, but it’s far more effective in treating metastatic melanoma, and it doesn’t have the standard side effects of chemotherapy.”
Dr. Harker-Murray first tried the immunotherapy drug ipilimumab, but a CT scan a few months later showed that the cancer had progressed and spread to Jim’s heart. Dr. Harker-Murray immediately switched Jim to pembrolizumab, a newer immunotherapy drug. “That’s the one that potentially put him into remission,” she said.
Jim felt so good throughout treatment that he continued working full time and running 3 to 5 miles five days a week.
“He’s an extraordinarily healthy guy, and I think that’s helped him do as well as he has,” Dr. Barkimer said.
Treating Cancer in the Brain
Another key element of Jim’s treatment plan was whole brain radiation therapy with Dr. Bovi and Jennifer Connelly, MD, neuro-oncologist. Whole brain radiation therapy has been considered less frequently as radiation oncologists have turned to more targeted radiation therapy. But Jim’s scan showed several brain lesions, and Dr. Bovi suspected there were more that couldn’t be seen.
“I still think there’s a role for whole brain radiation therapy in certain diseases, and metastatic melanoma is one of them,” Dr. Bovi said. “In melanoma, there is often a more extensive microscopic disease process than is detectable by MRI.”
Although cognitive decline can be a side effect, Jim didn’t experience any cognitive problems.
“We know that cognitive effects from radiation therapy happen in some patients, and our current research efforts in brain metastases are exploring a more sophisticated way of delivering radiation therapy to all areas of the brain except areas associated with cognition,” Dr. Bovi said. He is leading a national study of a modified version of whole brain radiation therapy that avoids the hippocampus, the part of the brain associated with learning and memory.
The Froedtert & MCW Cancer Network also continues to lead research on potential improvements to immunotherapy. “Clinical trials are key to helping us advance care so we can help even more patients,” Dr. Harker-Murray said.
Today, Jim is cancer-free and no longer on maintenance therapy, though he has an MRI of his brain and a CT scan from the neck down every three to four months to make sure the cancer hasn’t returned. “The medical team was very professional and comforting,” Jim said. “They did everything possible. I can’t say enough about the people who helped me.”
And he’s as active as ever. “You have to keep looking forward and not look back,” he said.
Dr. Barkimer said that although Jim’s case turned out well, it shows just how serious skin cancer can be.
“Unfortunately, melanoma is one of those cancers that creep up on you,” he said. “That’s why it’s important to check your skin in a mirror once a month for any changes. If you see anything worrisome, don’t wait — go see your doctor.”