Immunotherapy is ‘Game-Changing’ for Metastatic Melanoma Patient

By the time Barry O’Brien learned he had stage IV melanoma, in April 2020, the skin cancer that had been halted once before had advanced far from its original spot on his shoulder. He was in need of immediate neurosurgery to remove a pair of tumors in his brain, and with the COVID-19 pandemic surging in Massachusetts, the 68-year-old was at heightened risk for contracting the virus.

It was a scary moment, O’Brien recalls, but one he now believes held a significant silver lining. O’Brien’s 2020 diagnosis came on the heels of breakthroughs in immunotherapy treatment for melanoma underway at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC). And during nine months of active treatment at DF/BWCC, O’Brien was comforted by a multidisciplinary team of caregivers that retained its warmth while adhering to strict COVID-19 protocols.

“I always felt safe, and all through treatment never had to stop working,” says O’Brien. “Today, coming up on the one-year anniversary of my diagnosis, I’ve had three straight cancer-free full-body scans and am feeling great. If I had been diagnosed 10 years before, it would have been a different story.”

Striking response

Immunotherapy, which uses the body’s own immune system to recognize and fight tumors, has proven an especially effective treatment against certain cancers — including melanoma. Dana-Farber researchers have been leaders in developing drugs capable of finding and unleashing immune system attacks on cancer cells; among the most effective are checkpoint inhibitors, which can outsmart even those tumors that cover themselves with normal-looking proteins to evade detection.

After successful clinical trials at Dana-Farber and elsewhere, a two-drug immunotherapy regimen was approved by the U.S. Food and Drug Administration (FDA) in 2015 for treatment of brain metastases resulting from melanoma. The trial raised four-year survival rates significantly for late-stage disease, and in many cases these rates have remained stable.

For O’Brien, whose own two-drug immunotherapy regimen was FDA-approved after a related trial, the timing was everything.

“There is no question that Barry has had tremendous benefit from this treatment, which has been game-changing for melanoma patients with brain metastases,” says Patrick Ott, MD, PhD, clinical director of the Center for Melanoma Oncology at Dana-Farber. “The responses are absolutely striking, and really unheard of previously in melanoma.”

Treatment during COVID-19

O’Brien’s first melanoma diagnosis came in July 2018, when he had a patch of skin cancer resected from his left shoulder. He had a sentinel biopsy — the standard treatment — and then check-ups each six months. Told that there was a “very slim” chance the cancer would arise somewhere else, he resumed his active life of work, sailing, and enjoying time with his wife, Suzanne, and their family.

When the cancer did metastasize into his brain, Dana-Farber was well-positioned to treat it — and to ensure a safe environment for O’Brien and all on-campus patients and staff during the COVID-19 pandemic. Strict physical distancing guidelines, continuous disinfections and deep cleanings, and mask requirements for all visitors were put (and remain) in place, along with daily COVID-19 screenings for all staff and visitors.

“COVID-19 has made everything we do harder, but we have adapted well and are able to provide the necessary treatment for essentially all our patients,” says Ott. “A positive attitude, which Barry definitely has, is always helpful.”

So is the multidisciplinary care that O’Brien has received from his DF/BWCC clinical team. In addition to Ott, it is led by neurosurgeon Timothy Smith, MD, and radiation oncologist Ayal Aizer, MD, MHS.

“There is no question that the close working relationship of Oncology, Radiation Oncology, Pathology, Radiology and Neurosurgery results in objective increases in overall patient survival, as well as subjective improvements in quality of life,” says Smith. “And while COVID-19 has certainly challenged our team-based approach, ultimately it has resulted in even better virtual and telecare options.”

Suzanne O’Brien knows this first-hand. After dropping off Barry for his DF/BWCC appointments — per COVID guidelines, loved ones can only accompany adult patients on their initial visits — she was able to patch into three-way calls with her husband and the clinicians he was seeing.

“The communication we had with the team was incredible,” she says. “One night, Barry spiked a fever and his temperature went up to 103. Although it was past midnight, Dr. Aizer stayed on the phone with me for 90 minutes while I fed Barry ice chips.”

These days, such incidents are rare. Barry’s cancer has remained under control, and he and Suzanne recently celebrated their 50^th wedding anniversary. Parents of a son and daughter, they are anticipating the arrival of their second grandchild in April.

“Given an opportunity like this, you have to take advantage of it,” says O’Brien. “I feel that I am a small contributor in a massive improvement in advancing successes in cancer care. It is a joyous relief and an honor to be both a beneficiary and participant in the revolution happening at DF/BWCC.”