ImmunoAdvocates Brendan C Melanoma Brendan ‘s Story Jumping out of a plane. Ice climbing. Hiking the Grand Canyon. These are a few of the things Brendan Connors did upon turning age 30, in 2013. A former competitive swimmer, Brendan is used to rigorous physical activity. Having adventures to look forward to, Brendan says, was crucial in helping him cope with the emotional and physical taxes of cancer treatment for stage 4 metastatic melanoma. Brendan’s treatment consisted of multiple surgeries followed by two separate immunotherapy clinical trials. The first trial, which took place at the National Institutes of Health (NIH), involved adoptive cell therapy using billions of copies of his own T cells grown in a lab. The second trial, which took place at Memorial Sloan Kettering Cancer Center (MSKCC), was a combination of two immunotherapy drugs, ipilimumab (Yervoy®) and nivolumab (Opdivo ®). These two drugs belong to a class of immunotherapies called checkpoint inhibitors; by “taking the brakes off” the immune system, they enable a stronger attack against cancer. Among Brendan’s doctors at MSKCC were Jedd Wolchok, MD, PhD, director of CRI’s clinical program; Margaret Callahan, MD, PhD, a former CRI Lloyd J. Old postdoctoral fellow; and Michael Postow, MD, who shared his expertise alongside Brendan in a CRI Cancer Immunotherapy and You webinar. Questions and Answers How and when did you first learn you had cancer? I scratched a mole on my back, that I didn’t know was there, and it started to bleed. In May 2010, I went to the doctor and had a biopsy, which showed the mole to be pre-cancerous. What was treatment like? Did you have any side effects? I ended up having surgery the month after my diagnosis to remove the mole, as well as two minor lymph node dissections. I went into surgery thinking that they were just going to remove a mole and I would be good to go. I was naïve. I didn’t fully understand what would come next. The healing process was long, as the hole took months to heal due to letting my body regenerate the skin from the surgery. Later that summer, I had a PET scan that revealed my lymph nodes were all clear under both arms. Then, around November, I had another PET scan which showed metastatic melanoma. There was a tumor in my left shoulder area and armpit, as well as in my right femur. I went to Yale University Hospital and reviewed treatment options with Dr. Mario Sznol. He recommended a clinical trial at the NIH involving IL-2 and my own immune cells. I was deemed a perfect candidate during the interview process: young, non-smoker, no past cancer or family history of melanoma. I was slotted to start treatment right after Christmas 2010. IL-2 basically uses your body as an incubator to multiply the cells and continue to fight off the cancer. I had a reaction around Labor Day in 2011. I broke out in hives all over my neck and upper back. I went to the emergency room and needing a steroid to counteract the reaction. At my next appointment, my doctors and I decided I didn’t need to continue the trial since there was no more visible cancer, my last treatment was September 2012. Then, between January and July 2012, I went back to the NIH four times for three check-ups. Each trip showed improvements. However, in July, a scan showed a slight enlargement in my left shoulder area. Once that happened, the NIH directed me back to Dr. Sznol at Yale. He recommended a clinical trial with Dr. Jedd Wolchok at MSKCC pairing ipilimumab with nivolumab. I started this trial at MSK in September 2011. I went to MSK every six weeks for treatment. I showed great reaction to the medicine combination and the cancer around my left shoulder was getting progressively smaller. It was shrinking, but only in very small percentages. In June 2012, I went in for another surgery to remove the remaining cancer. I continued the clinical trial, even though at that time I didn’t have any detectable cancer. I remained on the trial until May 2014. I went back for scans on my chest, abdomen, and pelvis, but wasn’t receiving any treatment. As of May 2014, I was officially off the protocol. I now go back to MSKCC just once a year for scans. Are there things that surprise you about the cancer experience? I was grateful to God, the scientists, researchers, all the doctors and nurses, as well as my big Irish family and friends for their support. I tried to keep a level head during the whole process because the one thing that you realize when you’re diagnosed with cancer is you don’t really have a choice. It’s not like you walk into a car dealership and they ask, “Do you want the Toyota Corolla or the Lamborghini?” I kept as positive an attitude as I possibly could. To be honest, I didn’t really dwell on it too much. I kind of just said, “Okay, what’s next?” Having cancer has changed my outlook on life. I don’t sweat the small things, at all. If you can’t really control it, then there is no point in worrying about it. What would you want another patient to know about immunotherapy or about participating in a clinical trial? Participating in two immunotherapy clinical trials saved my life. The key is you need to be open to it. You need to trust the process. I know that sounds scary because you’re giving complete control over to the doctors. If you’re in a cancer immunotherapy clinical trial and you’re at a comprehensive cancer center, they know what they’re doing and will have your best interest in mind. They eat, breathe, and sleep immunotherapy. I wasn’t a number or statistic to them; I was Brendan Connors. Stay positive and ask the questions that you are afraid to hear the answers to, it’s your life.