Immune to Cancer: The CRI Blog



Thèrése B’s Immunotherapy Story


I’m amazed I’m still alive because I know how terrible a disease it is.

Thèrése’s Story

As a doctor and a pathologist, Thèrése Bocklage knew her prognosis was grim. The melanoma she’d had removed 20 years earlier had returned, spreading to her lungs and abdomen. But she also knew that new treatments for her type of cancer were becoming available every day, and she had expert colleagues to ask for advice.

That advice led her to Antoni Ribas, MD, PhD, an oncologist at UCLA’s Jonsson Comprehensive Cancer Center, who is pioneering new therapies for the treatment of melanoma. The particular treatment that Thèrése received is a novel drug called pembrolizumab, made by Merck. The drug is an antibody that targets a molecule on T cells called PD-1. PD-1 is a checkpoint molecule that shuts down immune responses. By covering up this molecule, pembrolizumab “takes the brakes off” the immune response, allowing a stronger anti-cancer response.

Dr. Bocklage began treatment in January 2012. A little over 2 years later, TheAnswertoCancer (TheA2C) spoke to the 54-year-old physician-scientist, who is in complete remission.

Questions and Answers

How and when did you first learn you had cancer?

Well, we have to go way back to 1991. I was with some friends who were fellow medical residents and we were hiking up in the Sandia Mountains. One of my friends was walking behind me, and he noticed I had an unusual looking mole on the back of my leg. That was when I was 31. It turned out that it was a minimally invasive, very small melanoma that had arisen out of a mole I’d had all my life. I had that removed in late 1991. It was shallow and there was no evidence of spread, and 98% of people are cured with that level of invasion. 

Then in late 2011, Christmas time, I was bringing a Christmas tree in from the garage to put up in our house. I banged my leg and noticed a bump after that, and thought the bump was from maybe the Christmas tree. But it didn’t go away and it didn’t have any bruise. So that’s when I approached one of my friends in our department, who’s a fellow pathologist, and said “Do you think I should get this checked out?” And she said, “Yes.” So right away she did a fine needle aspiration biopsy of that and it turned out that it was metastatic melanoma. That’s one of the very strange things about melanoma—it can show up many years later, and it did. 

How did you learn about immunotherapy and why did you decide to do it?

If you look up clinical trials on the NCI website, there are dozens you can potentially try to sign up for. And so I asked my friend who is a melanoma expert what she thought and she was highly complimentary of Toni Ribas. And Toni Ribas happens to be at UCLA, which is three miles away from where my sister and her husband live. So I was able to stay with them when I went out for therapy. 

It was the PD-1 antibody. So PD-1 is the protein on T cells that acts as a “brake” on the immune response. Malignant tumor cells activate this brake on T cells, which prevents them from coming in and attacking the tumor. So the antibody kind of globs on to that protein and kind of de-represses the T cells so they can come in and attack the melanoma. 

I started in January 2012 and finished up in December 2013. I didn’t quite do 2 years. I was feeling really good and Dr. Ribas thought I was doing very well. I had a complete remission 6 months into the therapy so I didn’t have to continue the full 2 years. 

What was treatment like? Did you have any side effects?

The only side effect I had was a little bit of fatigue and, other than that, nothing. Every other week, I went into UCLA, had some blood work done. The infusion itself was very straightforward—it lasted only 30 minutes. 

During the infusion, I was in the big room with all the other cancer patients. Many of them were breast cancer patients, prostate cancer patients, and they were on multiple drugs for 6 or 8 hours and feeling nauseated. I felt very sorry for them because I was a half-an-hour in and out. 

And the nurses were just remarkable, very kind—a really good oncology nursing staff. So it was pretty much a painless process

Are there things that surprise you about the cancer experience?

I just would encourage patients with advanced melanoma not to give up and to recognize that we’re riding the wavefront of new, remarkable therapies. And they shouldn’t give up. They should work with people, talk to other patients, get onto the websites where people list who they’ve worked with, talk to their doctors. But don’t give up because new therapies are opening up that actually are proving to be very effective. 

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