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By the time Joseph Rick considered going on a clinical trial, he had already bought a grave. Thirty-two weeks of chemotherapy and nine general anesthesia surgeries to remove parts of his colon, stomach, liver, lung, and pancreas had all failed to stop the encroaching melanoma. The 40-year-old psychologist-in-training weighed just 90 pounds, down from 210, and was ready for hospice.
At the recommendation of a visiting nurse, he decided to contact Antoni Ribas, M.D., Ph.D., at the UCLA Jonsson Comprehensive Cancer Center, who was conducting a clinical trial of a new immunotherapy drug called tremelimumab. Tremelimumab, developed by Pfizer/MedImmune, falls into a class of drugs known as checkpoint inhibitors. These drugs bind to and block molecules on T cells that serve as “brakes”—in this case, a molecule called CTLA-4. By “taking the brakes off” T cells, tremelimumab enables a more powerful immune response against cancer.
TheAnswertoCancer (TheA2C) spoke to Joseph about his experience with immunotherapy and the stranger who changed his fate.
I had a home health care nurse who was coming in and keeping me hydrated and giving me medications. I was just about ready for a morphine drip. The nurse mentioned that she had another patient who was on a drug trial at UCLA with Dr. Ribas. She actually gave me his name and telephone number, and she said, “You should try and go there.” By that point, I was pretty much done with doctors and everything. I’d already bought a grave.
I remember going to see Dr. Ribas the day before Christmas Eve. The nurses did some tests and took my blood. Then they told me to come back the day after Christmas, and they would start me on an experimental drug trial. The first drug that they put me on didn’t work. I had an adverse reaction. So they tried another one right after the New Year, in 2004. By that time, CT scans and PET scans showed that the cancer had metastasized into stage 4. It was all throughout my entire body from the neck down.
By this time I had started to get external skin lesions—big brown and purple spots. I had one on my clavicle, one on my right arm, and several on my right leg. I showed them to Dr. Ribas, and he said, “Yeah, that’s not good.” So he decided to start me on the anti–CTLA-4 (tremelimumab) trial right away.
It wasn’t what I had initially expected. I thought it would be a series of injections, but instead it was an infusion. I would lie in the Clinical Research Center at UCLA, and they would infuse me over a period of five hours. When the infusion was complete, the nurses would come and check my vital signs every 15 minutes for the next five hours. It was like a 10-hour day. That was the first week of January of 2004.
When I went back after two weeks, I was in Dr. Ribas’s office, and I had on one of those examination gowns. Dr. Ribas started to examine me and he said, “My God.” And I said, “What?” And he said, “Those lesions… they’re gone.” I looked at my arm and shoulder and I hadn’t even noticed they weren’t there anymore. “Oh my God, this is gonna work!” he said. “This is gonna work!” “Yeah, yeah, whatever,” I replied—because at this point I was still very sick, very weak, and feeling skeptical.
Over the next two or three months, I started feeling better. I started eating again. I started putting on a little bit of weight. I think I gained 30 pounds in three months. That was a lot considering I only weighed 92 pounds by that point. I was basically a 6’4” skeleton of skin and bones.
Well, it’s like I got a second chance at life. Before I got sick, I had just completed my post-Master’s hours in clinical psychology and was working towards becoming a licensed marriage and family therapist. I worked really hard to get all these hours, and I was doing it on top of working full-time as an accountant and a teacher. And then I got very sick, and basically I lost all the hours that I invested. But then I got the immunotherapy and I got better, and I had to decide in my late 40s, okay, what am I going to do with my life?
In 2010, I registered for school and started a doctoral program in psychology. I’ll be starting my last year in the program this fall. I am within reach of obtaining a lifelong goal of earning a doctoral degree and eventually becoming a licensed clinical psychologist. That’s something I never could have imagined 12 years ago when I was so sick and fighting for my life.
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*Immunotherapy results may vary from patient to patient.
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