It’s difficult to watch a loved one be diagnosed with cancer. Don and Carol Gerard know what that is like. Each of them has endured cancer during the past few years, and they are grateful to have benefited from treatment advances that were not available a decade ago. Fortunately, both Mr. and Mrs. Gerard, who live in Westford, responded well to treatment.
In December 2016, Mr. Gerard was diagnosed with stage 4 melanoma that metastasized to his lungs, adrenal gland and prostate. His case was serious. He needed to have a strong response to advanced treatment.
Fifteen years earlier, a small lump on Mr. Gerard’s leg was found to be melanoma and was surgically removed. “When I got the diagnosis in 2016, at least I knew who to contact,” he says. “Carol was already seeing Dr. DuBois, because he was managing her non-Hodgkin lymphoma.”
Mr. Gerard soon had an appointment with Jon DuBois, MD, medical director of the Mass General Cancer Center at Emerson Hospital-Bethke, and Donald Lawrence, MD, a medical oncologist at Massachusetts General Hospital who specializes in treating melanoma. “I wanted Don to see Dr. Lawrence about receiving cutting-edge treatment and, if necessary, participating in a research trial,” Dr. DuBois explains. “His case is an example of how the collaboration with Mass General specialists works so well.”
The immediate goal was for Mr. Gerard to begin therapy that would have an impact within weeks. “We determined that Don had the BRAF mutation, which is expressed by 30-50 percent of individuals with melanoma,” Dr. DuBois notes. “We prescribed a combination of two oral medications, trametinib and dabrafenib, that target that mutation.”
The two medications went to work and, as Mr. Gerard found out, the side effects were bearable and well worth it. “I had chills and night sweats, but in a few weeks, a CT scan showed that the tumors had all decreased,” says Mr. Gerard, who retired from the Air Force after 21 years of service. “Dr. DuBois told me the pills I was on would become less effective the longer I was on them, so he would transition me to another therapy.”
Immunotherapy produces a dramatic response
That was when the real response occurred. Mr. Gerard began receiving pembrolizumab, known by the tradename Keytruda, which was approved by the FDA in 2014 for treatment of melanoma. It is one of the best known immunotherapy agents, and it is exactly what Mr. Gerard needed.
Immunotherapy drugs achieve something research scientists have worked on for decades: they manipulate the body’s immune system — specifically white blood cells — to recognize cancer cells as “foreign” and destroy them. “We got Don onto Keytruda, and the response was dramatic,” says Dr. DuBois. “His lung nodules, adrenal tumors and prostate tumor all steadily reduced in size.
“Ten years ago, Don would likely have a prognosis of six months to live,” says Dr. DuBois. “Today, we consider patients like Don to potentially be in long-term remission. The only question is: when can we stop treatment? It may be that he will receive maintenance treatment.” The medication is so new that oncologists are waiting for the results of research studies to guide them.
Mr. Gerard currently receives an infusion of Keytruda, which takes about 30 minutes, every three weeks at Emerson. He feels well, and he has a good amount of energy. “Don goes out walking now, which he couldn’t do before,” says Mrs. Gerard. His one complaint is that the treatment makes his skin itch. He uses dermatologist-recommended creams.
“We watch for autoimmune side effects — where the immune system attacks normal tissue in patients on immunotherapy drugs,” says Dr. DuBois. “Don’s itchy skin is dermatitis, a treatable autoimmune condition.”
One treatment cures two diseases
Autoimmunity plays a role in Mrs. Gerard’s story. When Dr. DuBois began seeing her in 2013 for what he believed was chronic lymphocytic leukemia (CLL), she told him she had been diagnosed with autoimmune inner ear disease, a rare condition. “It caused me to begin losing hearing a few years earlier,” she says. “There were other symptoms, such as loud ringing, migraines and nausea. I asked Dr. DuBois if he thought there could be a link between the autoimmune ear disease and my CLL, and he said yes.”
A year later, Mrs. Gerard’s CLL had developed into non-Hodgkin lymphoma, with symptoms including anemia and swollen lymph nodes. “We prescribed a combination of chemotherapy and rituximab [Rituxan], one of the early targeted therapies,” Dr. DuBois explains. “Its main target is lymphocytes — the main cells involved in autoimmunity. Could we treat Carol’s non-Hodgkin lymphoma and autoimmune ear disease? Yes, the lymphoma responded exceptionally well, and her autoimmune disease — and with it, hearing loss — stopped.”
Mrs. Gerard is off treatment, feels well — and is relieved. “I wear two hearing aids, but I don’t worry about more hearing loss,” she says. “I see Dr. DuBois every six months.”
The two advances that benefited the Gerards — targeted therapy and immunotherapy — give oncologists the ability to treat cancer with greater precision. “We’ve learned so much about the human immune system and how cancer behaves,” says Dr. DuBois. “The result is that we have highly effective therapies, and the community we serve has access to these cutting-edge therapies.”
As medical center director, Dr. DuBois is committed to an even higher level of collaboration with Mass General. “It means more programmatic development — specifically, a focus on disease-specific programs in the more common breast, lung, urologic and gastrointestinal cancer,” he says. “We aim to provide more Boston-level care in Concord.”
The larger, more comfortable Naka Infusion Center, which opened in 2017, is another sign of progress. There is more to come, says Dr. DuBois. “Our cancer center is known for providing compassionate care, so we are looking at ways to expand our supportive services. We hope to increase the number of dietitians on our staff, better integrate our social workers and work with the hospital’s Steinberg Wellness Center for Mind and Body to plan new offerings for individuals with cancer.”
The Gerards are grateful for the personalized care they both receive from Dr. DuBois. “I know how busy he is, but I always feel like we’re his only patients,” says Mrs. Gerard. “Dr. DuBois gives you confidence, and more importantly, he gives you hope. He’s one of the good guys in the white hats.”