Halloween comes early

I was both patient and photographer
in Dr. Vetto's clinic at OHSU. That's
my arm he's cutting on.

I missed the news last month that Portland real estate developer John Gray is donating $5 million to the OHSU Knight Cancer Institute for melanoma research, so that gave Dr. Vetto and I something to chat about during my surgery yesterday. Dr. V wouldn’t confirm that he'd also treated Gray, but it’s a good bet he did. Gifts from grateful patients (or their survivors) who also happen to be extremely rich are a reliable source of funding for all types of hospital-based medical research.

Gray’s donation is generous, but pales in comparison to the $100 million pledged to OHSU in 2008 by Phil Knight. For that gift, Knight got the whole cancer center named after him.  I guess that’s what selling 100 million pairs of sneakers a year will do for you. All Gray ever did was build resort developments like Salishan and Sunriver, where you’ll see lots of people wearing the swoosh to play golf and tennis or to just run around in.

I asked Dr. V if OHSU would consider launching an immunotherapy treatment program, like the one that my medical oncologist directs across town at Providence Cancer Center. He doubts it. Dr. Brian Druker, who directs the Knight Cancer Institute and is a celebrated researcher in his own right, has placed his bet on the development of molecularly targeted therapies for all types of cancer. This “personalized” approach to treatment is the hottest trend in cancer research. For patients with advanced melanoma, the new FDA-approved drug Zelboraf falls into this category, as does Gleevec (which Druker developed) for patients with chronic myeloid leukemia. It’s unfair to compare these two products as Gleevec has been hailed as a miracle drug, while Zelboraf is but a first, feeble volley in targeted therapies for melanoma. More of them are in the pipeline.

The small mass that Dr. V removed from my left arm yesterday has been sent to pathology to confirm what we both know to be melanoma, and will then go to the cancer registry at Providence where it will join a growing collection of mets I’ve had resected over the last 18 months. By retaining access to the genetic information present in these cancers, it’s conceivable that I could in the future be matched with drugs or clinical trials that are appropriate for my particular type of cancer. Metastatic melanoma adds and subtracts genetic mutations over time, so there is some apparent value in following their progression. It’s a little Halloweenish to imagine this lineup of pea-shaped black masses embedded in a block of wax sitting in some lab with my name attached to it. Sort of like my own private melanoma morgue.

My surgery was about as routine as these things get. Moving quickly and decisively, as usual, Dr. V took a fairly generous margin of tissue, which means I’ll be rewarded with another prominent scar. The inarguable logic in this approach is that stray cancer cells can sometimes be missed during surgical excision, so better to take too much than too little tissue. That’s fine by me. The only time I was seriously concerned about the aesthetics of my surgeries was with my first met, which appeared on my face. I was bothered enough at the time that we postponed a wide local excision and subsequent plastic surgery. Fortunately, the met never reformed and my face remains unscarred.

I can expect to find more subcutaneous mets in the future, but neither I nor my doctors are in a rush to do anything more than remove them surgically for now.  Dr. V believes IL-2 therapy is plausible even with only sub-q’s—providing there are a sufficient number of them and/or they appear at a quickening pace. If I can hold out long enough, treatment options for melanoma will gradually widen and outcomes improve. It’s possible that with the cash infusion from John Gray and Phil Knight, something promising for metastatic melanoma might even emerge from the research labs at OHSU.