by Matthew Hadfield
Prior to attending medical school, I worked as a research coordinator on clinical trials for new oncology drugs. Through this position I was fortunate enough to meet many patients suffering through their cancer diagnosis. It was in this position I met Jack, a man in his mid-fifties who had stage four, metastatic mesothelioma. Jack was a very proud man from East Boston, and had worked his entire life as an auto-mechanic. It was only a year before I had met Jack when he had found out he had mesothelioma. He had been at the car garage he was employed at when a dry hacking cough started producing blood. He was referred to an oncologist the very next day.
Within a week Jack transitioned from his life of fixing cars to support his family to deciding which treatment options he would choose. I don’t believe anyone can understand the emotions and feelings that a person experiences when they find out they have cancer, unless they’ve lived through it. The disease starts with one mutated cell smaller than can be seen with the human eye. Yet it creates shockwaves through a person’s life, rocking the world of everyone they care about. Cancer can decimate the health of a person, strain relationships and threaten financial security. It does all of this without discriminating.
By the time Jack was referred to the experimental oncology group his mesothelioma had metastasized from the pleural lining around his lungs where it had begun. The chemotherapeutic agents he had been started on failed to hinder the cancer’s growth. We placed Jack on a highly experimental drug combination that had some evidence that it may work in his cancer type. He no longer qualified for surgery. There were no other conventional chemotherapeutic options for him. Our trial would be his last hope at beating his disease.
Jack’s wife was teary eyed as our oncologist explained his likely prognosis. There was an extremely unlikely chance this treatment would help. It was explained that phase 1 trials are designed to determine the safety of medications and not to study their efficacy. The reality was that Jack would be helping future cancer patients with his participation far more than he was helping himself. Jack kept his proud demeanor through the entire conversation and consented to the trial.
“I hope I help someone by doing this” he told the oncologist as he signed his name.
Phase 1 trials were often discouraging to work on. With the purpose of the study being to determine safety, the dosages used are very small. The doses are so small they don’t typically illicit clinical responses in the patients. When Jack began the trial, he had a CT scan done of his lungs. The scans showed very large lesions where the cancer had spread. He would return to the center weekly for check-ups and would be rescanned in six weeks.
The combination of experimental drugs was difficult for Jack to tolerate. At his weekly appointments, he complained of extreme nausea and vomiting. He felt extremely fatigued. He was discouraged. Each week he needed reassurance from the nurses to continue the trial. At each week’s visit, it appeared the treatments were getting less and less tolerable. Finally, week six came. Jack would be rescanned and the physicians would review his images. When the final report was available I impatiently waited for it to load on my computer. I had to read through it three times to fully comprehend the report.
“All lesions have regressed by over 90%” the report read.
I was in disbelief. The experimental drugs were melting the mesothelioma away. I had felt more hopeful than I had in months. I thought these drugs would cure Jack’s mesothelioma. The team’s oncologist was even more excited and could not wait to share the news with Jack later that day.
Jack didn’t share the enthusiasm. He was pale and weak. When he learned of the improvement of his cancer he hardly reacted. The cancer was being treated, but our drugs were literally killing his body. He pleaded with the team to reduce the dosages of the medications.
The team hesitated.
He was responding to the treatment so well and to dose reduce him could jeopardize that. Jack left them no option, either go down on the dose or he would remove his consent from the trial.
We reduced the dosages of both medications he was taking. His demeanor started improving at each of his weekly visits. His nausea and vomiting started to get better and he was no longer fatigued. He was visibly better each week we saw him. Soon another six weeks had passed and the team held their breath when he got his CT scan. It felt like it took a lifetime for the report to load on my computer. After opening it, my heart sank. The lesion’s in Jack’s lungs had grown back and new lesions had formed. Several lymph nodes had expanded in size.
The cancer had exploded.
Jack’s mesothelioma had progressed so rapidly that we had to take him off the trial. Within three weeks he was placed on hospice care. Within one month he had passed away, with his wife and children by his side.
I didn’t have much knowledge of mesothelioma until I was fortunate enough to meet Jack. I learned an enormous amount about the science and the pathological features of the cancer. Even more importantly I learned that Jack likely developed mesothelioma from his years of working on car brakes. The asbestos he was exposed to every single day lead to this horrible disease. He was exposed to a toxin that caused cancer at the place he worked so hard to make a living.
I think of Jack often. He is the reason I came to medical school to become an oncologist. He was a courageous man who willingly entered a clinical trial so that others could learn from his sacrifices. He was a man who worked hard every single. I feel very passionate about the field of oncology. Cancer is truly a disease we have not fully come to understand. People like Jack are the reason I work hard every single day to become a physician. I hope to someday contribute to the knowledge of cancer, and help to find a cure for this devastating disease.