Years of war-gaming worst case scenarios at the Pentagon as a naval officer couldn’t prepare J. Paul Royston for one of the deadliest threats he’d actually have to face: recurrent metastatic melanoma. Despite multiple rounds of surgery and radiation, Paul’s aggressive cancer kept coming back. Fearing the worst, he enrolled in an investigational cancer vaccine study. To Paul’s surprise, the vaccine halted the cancer’s progress and gave him back years he’d thought he’d lost. Now he’s hoping that a second cancer vaccine will be even more successful than the first.
“I’ve always been in good physical shape and have had almost no health problems,” Paul told CRI. “So I was shocked when a lump I found under my right arm in April 2001 turned out to be stage III metastatic melanoma.” Two weeks later, he had his first surgery, followed by 12 months of interferon alpha therapy to stimulate non-specific immune activity. Paul’s doctors hoped his ramped up immune system would detect any remaining cancer cells and kill them.
Unfortunately, the treatment didn’t work. Paul grew weak, lost 35 pounds, and the cancer came back ten months later. A second, and then a third surgery over the next two years failed to stop his very aggressive cancer. “It was getting worse, so they decided to irradiate me.”
Paul says he’d begun to grow pessimistic about his chances. “I was starting to think that I wasn’t going to beat this. My wife Dolores really kept my spirits up, though. We decided to take a trip to Ireland with some friends before that third surgery. I welcomed the chance to get away from the doctors and hospitals for a while.”
Turns out while in Ireland Paul would find a doctor that would change everything.
“A friend traveling with us introduced me to Dr. Munroe Neville from the Ludwig Institute in London. Dr. Neville impressed me immediately.” He told Paul about a clinical trial in Germany that was testing a new cancer vaccine and suggested that Paul send over tissue samples to see if he’d be eligible to enroll in the trial.
“After how sick I got on the interferon, I wasn’t very keen on another immune booster. But Dr. Neville assured me this was very different and more sophisticated and that I wouldn’t get sick this time.” Paul decided to take Dr. Neville’s advice. A laboratory confirmed he was a match for the vaccine.
“I figured I didn’t have anything to lose, so I phoned up the Ludwig Institute and they made all the arrangements for me. They were all wonderful, in fact.”
In March 2003, Paul flew to Frankfurt, Germany, where he received four rounds of the cancer vaccine under the supervision of Dr. Elke Jäger, now head of the oncology unit at Northwest Hospital in Frankfurt.
“My wife and I would stay in Germany for the week, I’d get my vaccine, and then return home. We did that for four months. No bad side effects, either. All in all, visiting Germany was a rather pleasant experience, actually.”
The real pleasure, though, came for the Roystons when subsequent tests showed that Paul’s cancer had not returned. “Again and again, the test results came back good. We were elated.”
For the first time in three years, Paul felt like he had a fighting chance. He remained cancer-free for the next two-and-a-half-years, longer than any of the other treatments had done. “This vaccine seemed to be doing the trick,” he told his doctors. But they advised him to remain cautious.
“I didn’t expect to be cured. I was just grateful for the extra time the vaccine gave me.”
In September 2005, Paul got some bad news. A new lump had formed, again in Paul’s upper right chest. Another surgery and an additional round of radiation therapy followed, but Paul’s doctors told him it was unlikely they could operate in the same area again. “After four surgeries and two radiation treatments, my doctors had done all they could.”
With no other options available to him, Paul decided he’d try another cancer vaccine. “The first one was so successful, I thought maybe I’d have good luck a second time.” He enrolled earlier this year in a cancer vaccine study at NYU Medical Center. This trial is supported by a Cancer Research Institute/Ludwig Institute for Cancer Research Cancer Vaccine Collaborative (CVC) grant.
“This vaccine targets the NY-ESO-1 cancer antigen, which Mr. Royston’s cancer expresses,” said Dr. Nina Bhardwaj, head of the NYU Cancer Vaccine Program. “We combine it with immune-stimulating adjuvants like CpG and Montanide, and hope that this combination will trigger an immune response specific to Paul’s melanoma.”
Paul’s treating physician, Dr. Anna Pavlick, is one of Manhattan’s leading melanoma clinicians, seeing up to 4,000 patients a year. “It’s such an unpredictable disease,” she said. “Some people go years without recurrence, and then, wham, it comes back.” Dr. Pavlick hopes this vaccine is at least as successful as the previous one.
“We can’t really ‘cure’ anyone of their cancer,” Dr. Pavlick said. ‘Long-term remission’ is a term I prefer. That’s a more likely outcome from cancer vaccines. I try to explain to my patients that we’re trying to control their cancer so that they can keep living a healthy life. In a way, it’s like living symbiotically with their cancer.”
In talking with him, one quickly gets the idea that Paul Royston has no intention of losing his battle with cancer.
“I’m guardedly optimistic,” Paul told CRI. “Considering everything I’ve gone through with this cancer, you can understand why I don’t want to get my hopes up too high. Still, if it weren’t for these cancer vaccines, I’d have no optimism at all. Heck, I’d probably not even be here right now.”
Paul talks of plans for the future and admits that retirement may be a little too slow-paced for him. “I might go back part-time to my consulting work, helping developing countries build their economic infrastructure.” In the meantime, Paul and his wife continue to travel the world. “We visited our son in Paris recently, and also got to spend some time touring Jordan with my daughter. There’s still a lot out there for us to see.”