When Michael Voisine went to the doctor in 2017, he had just one symptom: a burning sensation on his skin, right around the corner of his stomach. After a CAT scan, he was rushed into the operating room for an emergency appendectomy.
But doctors found more than just an inflamed appendix: They also discovered an “orange-sized tumor outside of the colon,” recalls Voisine, who works in construction. Later, his cancer would recur in his abdominal wall.
Voisine was diagnosed with metastatic colon cancer. He was only 36 years old.
A growing cancer in younger adults
Colorectal cancer is on the rise in younger adults. In 2020, 11% of colon cancers and 15% of rectal cancers occurred in patients under 50 years old, compared to 5% and 9% respectively in 2010.
For this reason, the American Cancer Society lowered the recommended age a which to be screened from 50 years old to 45 in 2018. To treat younger adults like Voisine, and better understand why colorectal cancer is affecting younger adults, Dana-Farber launched the Young-Onset Colorectal Cancer Center. It’s one of the first and only centers in the country that focuses on younger patients with colorectal cancer and exclusively treats patients under 50 years old and the many unique challenges this age group faces.
“We asked ourselves if there are different ways we should be treating these younger patients. They may be parents with young children, or want to preserve their ability to have children, or just have a different set of social concerns and needs,” says Douglas Rubinson, MD, PhD, an oncologist in the Gastrointestinal Cancer Treatment Center at Dana-Farber/Brigham and Women’s Cancer Center. “This program brings all of that together, and also allows us to do research on why this phenomenon is occurring.”
A rare cancer, requiring extraordinary care
After initially going through a year of chemotherapy at his local Connecticut hospital, Voisine started going back to the gym to make himself feel better again. After the gym one day, he thought he had pulled his rotator cuff — but that’s not what tests revealed.
“Sure enough I had a large tumor on my deltoid muscle, and when they put me back through a PET scan, I had tumors from head to toe,” Voisine says.
“I had tumors on my thighs, my feet, my back. I had tumors everywhere,” he recalls.
Voisine’s oncologist sent Dana-Farber a tumor sample to see if they could help. Experts performed genetic sequencing on that sample an Oncopanel, which can detect not only genetic mutations, but also other critical types of cancer-related DNA alterations. The results were astonishing.
“His tumor is one of the less than 1% of metastatic colon cancers that, instead of having a range of five to 10 mutations per million base pairs of DNA, had more like 175,” said Rubinson. “His tumor had more mutations than we’re used to seeing in any cancer and certainly in colon cancer.”
Previous studies had shown that pembrolizumab, an immunotherapy drug that turbocharges the immune system to attack tumor cells, is more likely to work in cancers with a high number of mutations.
“Because cancers like his have so many mutations, that just gives more targets for the immune system to recognize. We called his oncologist and told them he needed to get here ASAP,” said Rubinson.
Because pembrolizumab was not approved to treat highly mutated cancers at the time, Voisine and Dana-Farber worked with the manufacturer of pembrolizumab to provide him with free treatment. After 14 weeks of treatment, Voisine was cancer-free, and has stayed that way for nearly five years.
“I was told I had a 50% chance of making it five years. I’m coming up on five years soon,” he said. “Before coming here, I had no more faith but said ‘let’s go to Boston’ and do what we have to do. They really went above and beyond for me here.”