John Bell is no stranger to skin cancer, having dealt with various forms of it for more than 30 years. A decade ago, the 70-year-old Manalapan resident noticed a red circle that was enlarging on his scalp. It proved to be melanoma that had spread to his lymph nodes—but after surgical removal appeared to be successful, he didn’t think much more about it.
Then, a few years ago, the back pain began. When an MRI showed suspicious findings, Alexander Goldberg, MD, John’s board-certified family medicine physician on staff at CentraState, referred him to board-certified hematologist and oncologist Bhavesh Balar, MD. Dr. Balar suspected a melanoma recurrence and ordered a full-body PET scan.
“I was shocked by the results,” John says. “I had a spine fracture, a herniated disc, two bulging discs, and cancer in my spine, stomach, right lung, liver, and adrenal gland. It was overwhelming.”
Determining the Course of Treatment
The next step was to determine whether the cancer was indeed melanoma, and a lung biopsy confirmed this suspicion. To learn whether John might benefit from targeted cancer treatment designed around his genetic makeup, Dr. Balar also ordered next-generation gene sequencing on the biopsy. This test showed no mutations that would impact treatment. However, John was a good candidate for immunotherapy—another type of precision cancer treatment that wasn’t available when he was first diagnosed with melanoma.
“Immunotherapy works by charging up the body’s immune system while turning off the tumor’s ability to protect itself,” Dr. Balar explains. “The immune system can then recognize and attack cancer as it would any infection. Based on more recent findings, we can now combine immunotherapy medications to enhance the immune response and dramatically improve results in certain patients with advanced melanoma.”
John received an initial four-treatment course of nivolumab and ipilimumab, immunotherapy medications that have slightly different mechanisms of action. He also underwent radiation therapy under the care of Edward Soffen, MD, a board-certified radiation oncologist at CentraState, to help with pain relief in his spine. John experienced several bouts of colitis, a common side effect of aggressive immunotherapy, but Dr. Balar helped him manage this issue so he could continue with treatment.
An Amazing Response
Even mid-way through immunotherapy treatment, a follow-up scan showed remarkable results.
“The cancer was disappearing before our eyes,” Dr. Balar says. “It was an amazing, impressive response. After four treatments, John’s scans were essentially normal and showing complete remission.”
According to Dr. Balar, immunotherapy is used for many cancer types, but it is particularly effective for melanoma. Newer types of immunotherapy are continually being studied in an effort to better harness the immune response mechanism for other types of cancer.
John is currently receiving a bi-weekly maintenance course of immunotherapy, and his prognosis is excellent. He also visits his dermatologist every three months for skin checks. He’s looking forward to taking a 10-day Caribbean cruise with his girlfriend this spring—a great opportunity to celebrate their life ahead.
“Looking back, I was probably fortunate that I had the back pain,” John says. “My doctors, the CentraState team, and Dr. Balar’s staff really took care of me and helped me stay positive.”
“Now, I tell people not to wait and take a chance if something isn’t right,” he adds. “If you see something, do something—and of course, keep up with those checkups.”