Metastatic Colon Cancer
Normally, it takes Richard Tracy just around 45 minutes to mow the lawn at his home in Dansville – no big deal. However, one day in May 2016, he got halfway across the yard and his body wouldn’t let him go any farther. He knew something was wrong, so he saw his primary care doctor.
That led to a diagnosis of colorectal cancer, which had spread to Richard’s bones. It was too advanced for surgery, so he began coming to Wilmot Cancer Institute in Rochester every two weeks for chemotherapy. The treatments weren’t working, and Richard felt like he was going backwards, experiencing a number of side effects and quickly losing 50 pounds.
“My body just couldn’t work. I had to fight, everything I did,” he says.
His oncologist, Marcus Noel, M.D., had further analysis performed on Richard’s tumor and learned it was deficient in specific DNA repair proteins. This meant an immunotherapy drug called pembrolizumab (Keytruda) could be effective, although it had not yet been approved by the U.S. Food & Drug Administration (FDA) for treating colorectal cancer. Noel and his team obtained permission for compassionate use of the drug, which allows a seriously ill patient to use an unapproved drug when no other options are left.
Richard received his first infusion of pembrolizumab on a Friday morning in February 2017 and felt a big difference just a few days later.
“Four months ago, before I started this thing, my wife had to button my shirts. I just could not button a shirt,” he says. “Nobody helps me with anything now.”
Just a few months after Richard started on pembrolizumab, the drug was approved for use in tumors with a specific genetic feature, regardless of where in the body that cancer originated. Historically, the FDA has approved drugs for treating cancer based on the organ of origin, such as the lung, skin or kidney. In May 2017, the FDA granted accelerated approval to use pembrolizumab in metastatic patients who have a biomarker known as microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR).
Only a subset of patients have this particular genetic biomarker, but oncologists are excited about what this could mean for the future.
“The FDA’s recent approval of Keytruda for mismatch repair deficient tumors is a potential game changer,” says Noel. “Over the last two to three years, it has been quite evident that the FDA is focused on bringing oncology drugs to market quickly in order to maximize the potential benefit to our patients. Furthermore, Keytruda’s approval based on individual tumor genetics exemplifies the true meaning of personalized medicine.”
It has helped Richard get back to eating a more normal diet now, and he has gained back much of the weight he lost. His cancer remains at bay. He’s returned to work doing what he loves and is even able to get back in the yard.
“I’m mowing my lawn. I couldn’t do that for a year this spring, and now I’m back doing that again,” he says. “I’m 81 years old and I feel like a kid.”