Poster Child for Immunotherapy
For Marguerite Sullivan, 63, it was important to her that she be able to continue working while receiving cancer treatment. As director of federal funds for the third largest public school system in New Jersey, Marguerite has a lot of responsibility, including overseeing No Child Left Behind. She credits immunotherapy with allowing her to carry on with her normal life while also receiving the best care for her cancer—metastatic melanoma.
I truly feel I'm here because of immunotherapy.
In November 2013, Marguerite enrolled in a clinical trial of an immunotherapy called nivolumab (trade name Opdivo®, from Bristol-Myers Squibb) at Memorial Sloan Kettering Cancer Center. Nivolumab belongs to a class of drugs called checkpoint inhibitors, which “release the brakes” on the immune system, allowing a stronger attack against cancer. She had an amazing response to the treatment. Her doctor, Michael A. Postow, M.D., calls her a “poster child” for immunotherapy, since she is now cancer free.
We talked to Marguerite about her experience with immunotherapy and how it changed her expectations of cancer treatment.
Tell us how you first found out you had cancer.
Marguerite: I was in my office and bumped my leg hard on my desk. This was in 2012. Then a few days later it seemed like the area was inflamed. I went to my doctor because it was not getting better. She put me on an antibiotic. That did not work. Then they thought it was a blood clot, so they set me up with a surgeon. I had surgery immediately, and he did a beautiful job. But when I went back for the follow up, he said “Where’s your husband?” Why would my husband come for a follow up visit? Well, that’s when he informed me that I had stage 2 malignant metastatic melanoma. Hearing those three M’s…it was a tremendous shock. From there, I saw an oncologist. I was back in for surgery immediately. The good news is my lymph nodes were clear, but they did quite extensive surgery on my thigh. Then the oncologist set me up with interferon.
What was the interferon like?
Marguerite: Lord. It was horrendous. If you had the opportunity to meet me, you’d know I’m a very optimistic person, I have a great outlook on things. But while on interferon, I actually felt what it meant to be depressed.
When did you know you needed to try something else?
Marguerite: Six months later I had another scan and the news came back that it was in my thigh and my lungs. So in June 2013, I sent my documents to Sloan Kettering and they called me immediately. I was assigned to the chief of melanoma—at that time it was Dr. Gary Schwartz. He gave me the real background of what’s going on inside of me and what is or is not available. That was a really tough meeting. He said to me, “With your diagnosis now, we’re talking six to nine months with conventional therapy.”
How did you learn about immunotherapy?
Marguerite: Dr. Schwartz explained to me all about PD-1, nivolumab, and how it works to “release the brakes” on the immune system. And he said, “We’ve got to get you into this trial.” But the day before I was supposed to start the trial, the cancer ended up in my brain. And that meant I couldn’t enter the trial.
That must have been devastating.
Marguerite: It was. But Dr. Schwartz said, “Don’t you worry, we can take care of your brain.” So they gave me radiation for that and also started me on ipilimumab. I ended up having a tremendously quick response to the radiation treatment, so I was able to enroll in the PD-1 trial after all.
By this point, the cancer was on my leg, it was in my lungs, and it was growing quickly. Every test showed it getting bigger. I started nivolumab on November 13, 2013, and in eight days, my tumor decreased in size. The tumor on my leg got so small that I was having trouble finding it. Can you imagine?
Marguerite: I truly feel that I’m here because of immunotherapy. I’m truly blessed. On July 3, 2014, I received a call from Dr. Michael Postow, who took over my case when Dr. Schwartz left, and this is what he said to me, “Hi poster child. You have had a 100 percent response.”
What is the experience of receiving the immunotherapy like?
Marguerite: I have to tell you, I don’t miss a day of work. The only time I miss work is every other Tuesday at 2:15 p.m. I swipe out, I get in the car with my husband, and we’re off to the city for our “date night”—which is what my husband calls the time we spend together going to my treatments. PD-1 immunotherapy does not interrupt my life.
Do you end up doing anything else in the city after you go to the hospital?
Marguerite: Most times, yes, we’ll look for a favorite spot for dinner. And when the weather is nice, I always make the trip to St. Patrick's Cathedral, to check in to pray and say thank you.
Do your doctors think your previous treatment with ipilimumab and radiation complemented the PD-1 therapy?
Marguerite: Yes, I think so. We’ve had discussions about how there is a good chance that one supported the other. You probably know that some people are having combined therapy with ipilimumab and nivolumab. Of course, I didn’t have that because that wasn’t the trial. But in a way, I sort of did.
Are you still on treatment?
Marguerite: They always ask me, “Do you want to stop?” And I say, “Absolutely not.” I really look forward to my treatment days because I feel it sustains me, and it’s not a hardship on my life. Actually, when I go there now, it’s almost become a social event. We don’t have much to say about melanoma because I don’t have any.
Do you think about the future?
Marguerite: There was a moment last summer when I was looking at an online shoe sale and saw a pair of sandals I liked and thought, “Next summer? I don’t know if I'm going to need those sandals.” I was having one of those days. Then I turned around and said to myself, “I’m ordering four pairs.” This summer, my precious fifteen month-old granddaughter and I have put those sandals to good use.