Sunday, June 24, 2018
Health

Drug combo tested at Moffitt extends survival in advanced melanoma cases

TAMPA — James "Mango" Buckwald was near the end of a two-day appointment at Moffitt Cancer Center last week, waiting for his oncologist's verdict on a lung scan.

"The news is good," said Dr. Jeffrey Weber, director of Moffitt's Melanoma Research Center of Excellence. "Everything looks good."

They were the words Buckwald, 46, longed to hear — and news that could mean a great deal to other patients with advanced melanoma, the deadliest kind of skin cancer because it is so likely to spread to major organs such as the lungs.

Since 2011, Buckwald has traveled from his home in Fort Lauderdale to Tampa where he has been part of a clinical trial testing a pair of drugs that gave modest results when taken separately but, doctors hoped, might do more in combination.

For Buckwald and others in the trial, the answer was good. The therapy regimen, found to extend average survival by almost two years beyond conventional treatment, received FDA approval in January. It is considered a major breakthrough for advanced melanoma patients.

"This used to be a depressing medical specialty," said Weber, who has treated melanoma patients for 27 years. Ten years ago, he had only chemotherapy to offer patients with disease that had spread, and the promise of about eight months of survival. Even five years ago, he said, the prognosis was still "pretty poor. We had no drugs approved that prolonged survival."

The drugs, Mekinist and Tafinlar, block signals between cells that promote cancer growth. When taken alone, the body eventually builds up an immunity and the drugs stop working. But taken together, usually one pill in the morning and one in the evening, that doesn't happen.

The estimated cost: $192,000 per year for both drugs, Weber said, explaining that patients continue to take it as long as it is effective and well tolerated. As a participant in a clinical trial, Buckwald has not had to pay for the therapy, but he said he has learned that his insurance would cover the drugs if the trial ends.

It only works in about half of patients with metastatic disease, those with gene mutations known as BRAF V600E and V600K. But Weber said he expects more treatments to be available soon.

During clinical trials, the combination of drugs had a 76 percent success rate. Weber called it a major advancement in melanoma treatment, one of the biggest in the past 30 years. Buckwald, whose cancer has been in remission for three years, went further. "It's a miracle," he said.

After delivering the good news at Buckwald's appointment last week, Weber pulled up the images on a screen so his patient could see the one blip reported by the radiologist: a white, oval-shaped speck with fuzzy edges, smaller than a grain of rice. Something to monitor, but not fear. "I'm not concerned," Weber said.

Back at home, Buckwald, who returns to Moffitt every three months for these two-day appointments, said he is extremely relieved.

Though melanoma can strike patients who have not had enormous amounts of sun exposure, going unprotected does dramatically increase risk.

Buckwald admits spending much of his life "just burned to a crisp." He remembers bad, blistering sunburns as a child growing up on the Jersey shore. As an adult, he spent more than 15 years as a boat captain, taking executive clients on tournament sport fishing trips from Key West to Cancun. Gone for months at a time, he spent every day in the sun, never thinking about sunscreen or skin cancer.

Then one day in 2009 his wife noticed a spot on his back and even produced an older photograph of Buckwald without a shirt to prove the growth was new. A biopsy soon confirmed melanoma. His South Florida doctor prescribed several weeks of interferon therapy, then declared Buckwald cured.

A year later, Buckwald found a lump near his collarbone. In general, he just didn't feel like himself.

"I had tumors in my lung, under my collarbone, on the other side of my chest, there was one in my stomach. It was getting real bad, real quick," said Buckwald. He was referred to Weber at Moffitt and was accepted into the combination therapy clinical trial. "I was on the drug three months and everything, all the tumors, just started shrinking, fading away," remembers Buckwald.

With his cancer in remission, Buckwald now works for a marine taxidermy company and still spends time in the sun on boats and on the golf course. His skin is still bronzed, but he says he covers up with clothing when out in the sun and wears sunscreen every day. He also shares his story with the young boat captains and crew members he meets on the job, especially his new feelings about sunscreen. "I highly recommend it," he said.

Despite his positive checkups, however, he always keeps his emotions in check at Moffitt.

''No celebrating in the hall," Buckwald said. "There are people there who are in worse shape than me and it just wouldn't be right."

Irene Maher can be reached at [email protected]

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