Two South Florida males, identified a number of years in the past with pancreatic most cancers — one of many deadliest types of the illness — are main regular, lively lives at this time.
Their recoveries are as a result of remedies utilizing new therapies at Sylvester Comprehensive Cancer Center on the University of Miami Miller School of Medicine and the Miami Cancer Institute at Baptist Health South Florida.
Luis Rios, a retired licensed public accountant who lives in Miami Beach, was identified with probably the most superior type of pancreatic most cancers — Stage 4 — in 2017 when he was 59.
Rios, who by no means suffered any digestive issues as much as that time, visited his major care physician due to persistent abdomen acidity. When the issue received worse, Rios underwent blood assessments, a CT scan and ultrasound.
“They found a definitive mass on my pancreas that had spread to the liver,” Rios, 64, informed the Miami Herald in a phone interview from Churchill Downs, the place he was attending the Kentucky Derby.
The analysis was a shock.
“It was Stage 4 pancreatic cancer,” he mentioned. “I’m a non-smoker and come from a very large family … no one had pancreatic cancer. I went to Versailles and had a box of croquetas and a glass of Johnny Walker Blue,” mentioned Rios, who got here to Miami from Cuba in 1961 when he was 3.
Rios’ spouse, Mari Tere, instantly lined up a sequence of appointments with native specialists. The docs informed him the most cancers was not operable, however one doctor referred him to Dr. Peter Hosein, an skilled in pancreatic most cancers and co-leader of the Gastrointestinal Cancers Site Disease Group at Sylvester.
Hosein initially put him on a chemotherapy protocol.
“It worked great for about the first eight months — much better than expected,” Rios mentioned. “I felt good and was asked to volunteer for a clinical trial at the [MD] Anderson Cancer Center in Houston,” mentioned Rios, who needed to cease working due to the illness. Rios had offered his CPA follow in 2007 however continued working with just a few shoppers till the most cancers analysis. “I was planning to retire, and then I got cancer.”
On his common visits to Anderson, Rios obtained an experimental drug (Olaparib) and continued to see Hosein. But a couple of 12 months after the scientific trial, Rios felt “a gnawing sensation” in his stomach in 2019. Hosein informed him the most cancers had returned, and put him on chemotherapy once more. “I was in great pain … even painkillers and marijuana didn’t help.”
By the summer time of 2019, Rios’ most cancers had change into proof against all remedies, together with three various kinds of intensive chemotherapies, Hosein mentioned.
But Rios is one in every of a uncommon set of pancreatic most cancers sufferers whose tumor had an inherited genetic mutation — RAD51C. “This subgroup — with mutations like BRCA and RAD51C — accounts for about 5 percent of pancreatic cancer patients,” Hosein mentioned, “and their cancers respond to immunotherapy, while others do not.”
‘A real breakthough’
Hosein and his group — about 25 professionals — administered two completely different immunotherapies, ipilimumab and nivolumab, to Rios and a number of other different sufferers for 2 years. The mutation makes pancreatic tumors extra possible to answer immunotherapy medicines, which permit the physique’s immune system to determine and assault the most cancers cells. Without immunotherapy, the physique’s immune system wouldn’t acknowledge or assault the malignant cells.
The immunotherapy medicines weren’t coated by medical insurance. “I had to pay for the first treatment — about $34,000 to $35,000 — but Bristol Myers Squibb gave me the rest of the treatments,” Rios mentioned.
The success charges have been wonderful for the sufferers with superior, treatment-resistant pancreatic most cancers handled at Sylvester.
“After the first infusion, I started to feel wonderful,” Rios mentioned. “And since then, I’ve been leading a pretty normal life … I have a great level of energy, I’m active and I eat like a 15-year-old.”
After two years of remedy, he had no detectable illness. “This is a real breakthrough,” Hosein mentioned.
“Dr. Hosein saved my life,” Rios mentioned. “God put him in my path. He’s like a doctor from the old days. He took my call and saved my life.”
Earlier this 12 months, UHealth, the University of Miami Health System established the Sylvester Pancreatic Cancer Research Institute to advance analysis and coaching geared toward stopping, diagnosing, treating and curing pancreatic most cancers.
“The SPCRI will revolutionize pancreatic cancer care for patients in South Florida and beyond,” Dr. Steven Nimer, Sylvester’s director and the Oscar de la Renta Endowed Chair in Cancer Research, mentioned in a press assertion.
Laparoscopic surgical procedure on former Carnival CEO
In February 2019, Bob Dickinson, the retired president and CEO of Carnival Cruise Lines, went to see his major care doctor, Dr. Felipe Del Valle, at Baptist Health South Florida for a case of bronchitis.
But the physician mentioned his affected person didn’t look properly, and after an examination ran some blood assessments.
“That evening, the doctor called to tell me I had either a lesion on the pancreas or was going to pass a gallstone,” mentioned Dickinson, who lives in Coral Gables. Del Valle ordered extra testing and Dickinson — then 76 — was identified with Stage 1 pancreatic most cancers.
Understanding the gravity of the analysis, Dickinson was able to seek for the most effective remedy wherever within the nation, however Del Valle suggested him that one of many main specialists in pancreatic most cancers remedy — Dr. Horacio Asbun — had not too long ago moved to the Miami Cancer Institute from the Mayo Clinic in Jacksonville.
Dickinson instantly met with Asbun, chief of hepatobiliary and pancreatic most cancers surgical procedure at MCI. “He spent an hour with me,” Dickinson mentioned. “He interviewed me like a psychologist, an employee, a priest, a rabbi. It was very comprehensive. He explained everything and said I might die on the table. Was I willing to accept this? It’s God’s call, I said.”
Asbun used laparoscopy to carry out a Whipple process on Dickinson. The Whipple is main surgical procedure, whereas laparoscopy inserts a fiber-optic instrument by means of small incisions within the belly wall to look at organs and perform surgical procedure.
To remove any malignant tissue, the Whipple often entails eradicating a part of the pancreas and small gut (duodenum), the gallbladder, a part of the bile duct and lymph nodes. In some procedures, a part of the abdomen can also be eliminated.
“Mr. Dickinson’s case illustrates the advantages afforded by the minimally invasive approach (laparoscopic/robotic), and the improved surgical techniques that have allowed for decreased complications, and enhanced significantly better patient experience,” Asbun mentioned in an e mail to the Miami Herald.
Dickinson mentioned the surgical procedure lasted six hours and 45 minutes, adopted by eight hours in restoration. The operation eliminated 40 p.c of his pancreas, the gall bladder and concerned ‘reengineering’ different close by organs, Dickinson mentioned.
After spending a number of nights within the hospital, Dickinson began chemotherapy, first on the hospital after which at house utilizing a pump that delivered common doses of anti-cancer treatment. He returned to the Miami Cancer Institute for normal blood assessments and changes to the chemotherapy.
Pain was minimal
“I never had pain,” Dickinson mentioned. “Felt some discomfort. No stress — I was cheery and upbeat.”
He and his spouse Andria traveled all through the U.S. whereas he was receiving chemotherapy and flew abroad after the classes ended on Oct. 30, 2021.
Only one minor grievance: The sound of the chemo pump activating woke him up.
Aside from journey, Dickinson stays lively in charitable actions, particularly Camillus House, and does some consulting in hospitality.
“I have to give credit to Andria,” he mentioned. “If I were alone, it might have been different.”
Dickinson, now 79 and cancer-free, mentioned Del Valle and Asbun saved his life. Del Valle recognized the most cancers and Asbun and his group efficiently handled it. Faith, nice medical care and assist from his spouse have been important to his success, he mentioned.
“Everyone at Baptist was hospitable and courteous. They create a nurturing culture for patients. I was in the right place at the right time,” mentioned Dickinson.
What is pancreatic most cancers?
Of all of the sorts of most cancers, pancreatic most cancers ranks as one of many deadliest.
In 2020, it ranked third (46,774) by way of U.S. deaths, following lung (136,084) and colorectal most cancers (51,869).
Pancreatic most cancers represents about 3 p.c of all cancers within the nation, and seven p.c of all most cancers deaths.
Although estimates differ, the five-year affected person survival fee for this illness is 11.5 p.c for all phases, starting from localized tumors to tumors which have unfold (metastasized) to lymph nodes and different organs, in line with the National Cancer Institute’s statistical division.
For probably the most superior tumors, or those who have metastasized, the survival fee is 3.1 p.c. The greatest survival fee — 43.9 p.c — is for localized tumors which were found and handled at an early stage.
This organ sits behind the abdomen and in entrance of the backbone. Surrounded by the gallbladder, liver and spleen, it makes enzymes that assist to digest meals, and produces hormones — together with insulin — that management ranges of sugar within the bloodstream.
Pancreatic most cancers is tough to diagnose throughout its early phases. Generally, individuals don’t expertise any signs till the most cancers has unfold to different components of the physique. And whereas a doctor performing a routine examination can really feel a tumor on a affected person’s liver, he/she will’t palpate the pancreas as a result of it lies so deeply within the physique.
Signs of pancreatic most cancers
Symptoms embody higher belly ache that will unfold to the again, jaundice and yellowing of the pores and skin, lack of urge for food and surprising weight reduction, darkish urine, light-colored stools, itchy pores and skin, blood clots, nausea and vomiting and fatigue.
Pancreatic most cancers is identified by means of endoscopic ultrasound (a slim tube with a digicam is inserted within the mouth and pushed into the abdomen the place it could actually seize a picture by means of the abdomen wall), a biopsy (tissue pattern) and blood assessments looking for a selected substance (a carbohydrate antigen) that may be a marker for pancreatic most cancers cells.
Tumors are categorized in 5 common classes. They might vary from Stage 0 (irregular cells within the lining of the pancreas) to Stage 1 (a tumor exists within the gland) to Stage 4 (the most cancers has unfold to completely different components of the physique, such because the liver or lungs), with two different phases in between.
There are quite a lot of therapies, relying on the place the tumor is situated, what stage it’s in and the affected person’s state of well being. Sometimes completely different therapies are mixed.
Surgery could also be carried out to take away the cancerous part of the pancreas and localized lymph nodes. In extra superior circumstances, the surgeon might use the Whipple process, eradicating a part of the pancreas, the duodenum (the primary part of the small gut), the gallbladder, a part of the bile duct and close by lymph nodes.
Radiation remedy shoots doses of high-energy at tumors, whereas chemotherapy makes use of all kinds of medication to kill most cancers cells.
Immunotherapy prompts the physique’s immune system to combat most cancers cells and focused remedy makes use of small-molecule medicine and monoclonal antibodies (proteins made in labs) that assault malignant cells.
Even although sufferers with pancreatic most cancers typically have poor survival charges, it could actually typically be cured if detected and handled on the earliest phases.
Doctors say they don’t know what causes pancreatic most cancers, however oncologists have recognized various threat components. They are: smoking, diabetes, extreme use of alcohol, weight problems, age (most individuals identified are over 65), continual irritation of the pancreas (pancreatitis) and household historical past of pancreatic most cancers or a genetic syndrome that will increase the danger of most cancers, akin to a BRCA2 gene mutation, a familial atypical mole-malignant melanoma syndrome (FAMMM) and Lynch syndrome.
Sources: American Cancer Society, National Cancer Institute (NCI), Florida Cancer Data System (FCDS), Cleveland Clinic, Miami Cancer Institute at Baptist Health South Florida, the CDC, the University of Miami Health System’s Sylvester Comprehensive Cancer Center and the Mayo Clinic.
This story was initially revealed May 13, 2022 6:30 AM.