Stage IV Colorectal Cancer Patient Given New Lease on Life
Greg Mancini's response to immunotherapy made his doctor believe something she previously didn't think was possible: that perhaps one day, there will be a cure for metastatic disease.
As an avid soccer fan, Greg Mancini knows sometimes it only takes a single play to turn the tide of a match. Mancini's game-changing moment came when he received immunotherapy at Dana-Farber.
In 2015, Mancini, who was just 39 at the time, was diagnosed with stage IV colorectal cancer after experiencing severe abdominal pain. Given his age and active, healthy lifestyle, doctors initially thought he might have appendicitis.
He was prescribed an antibiotic for the pain and told to come back the following week. When the antibiotic failed to help, Mancini underwent a CT scan, which showed that he had a tumor in his colon. The scan also revealed that the cancer had metastasized to other parts of Mancini’s body.
“I couldn’t comprehend what was happening. I felt like I was moving through a fog,” Mancini recalls. “It took me a long time to process the information and realize this wasn’t a bad dream.”
Mancini immediately underwent surgery at his local cancer center to remove the tumor in his cecum, which is in the right colon at the beginning of the large intestine. He was then placed on a chemotherapy regimen to treat the metastases in his liver, and a second surgery to remove the liver tumors was scheduled.
However, when the cancer continued to spread despite the chemotherapy, Mancini’s surgery was canceled, and he started thinking about getting a second opinion. After doing hours of research, Mancini’s wife suggested he meet with Kimmie Ng, MD, MPH. Ng now serves as the director of the Young-Onset Colorectal Cancer Center at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), a center that formed after Mancini received his treatment.
“When I met Greg, he had disease everywhere and was in a lot of pain,” Ng recalls. “Usually, chemotherapy will shrink the tumors in nearly half of all patients. Not only did Greg not responding to the treatment, he progressed, which is fairly unusual.”
Part of the reason Mancini’s cancer was spreading quickly was because he had an MSI-High (MSI-H) tumor. These tumors contain multiple gene mutations, which arise as a result of the body’s inability to repair mistakes in the DNA. If not caught early and monitored or treated accordingly, gene mutations can result in aggressive cancers. However, they’re also more likely to be recognized and targeted by the immune system. Ng planned to use that to her advantage.
Mancini was enrolled in a clinical trial for MSI-H colon cancer patients that tested the effectiveness of two immunotherapy drugs called nivolumab and ipilimumab, both of which work as checkpoint inhibitors. The drugs are designed to release the “brake” on the immune system, allowing it to better recognize and attack the tumors.
For Mancini, the results were remarkable. Within weeks, the tumors started shrinking, and since finishing treatment in 2016, Mancini has stayed in full remission. His tumors are still decreasing despite not being on active treatment.
“I had bulging tumors in my neck that melted like ice cubes. It was unbelievable,” says Mancini.
“It was extremely gratifying to be able to give him his life back,” adds Ng. “His response was the best that I have seen to immunotherapy, and it has made me believe that perhaps one day, we can cure widely metastatic disease. This is something that I previously did not think was possible.”
Since completing the trial, Mancini’s treatment has become the standard of care for MSI-H colon cancer patients. However, there is still a lot of work to be done: While many patients respond positively to the combination, few are able to maintain complete remission.
Today, Mancini is once again playing soccer, camping, and mountain biking with his two sons. In 2017, he knocked off a bucket list item when he flew to Sweden to watch his favorite soccer team, Manchester United, win the UEFA Europa League Final.
“My life changed forever when they told me I had cancer,” Mancini explains. “But I am so lucky and blessed we found something that worked.”
This is my Niece’s Husband. We cannot express how happy and blessed we are to have Greg in our lives. We love him and were so worried that we were going to lose him. Right now my husband is facing Stage IV Renal Cell Kidney Cancer and going through Immunotheraphy. We are praying for successful results too!! Thank you for all you have done for Greg. Yours, Mary and Art Reeves
I, too, am one of the very blessed Stage IV Metastatic patients who also had a remarkable response to Immunotherapy treatment thanks to an amazing Oncologist (Dr. Rajitha Sunkara) who is now part of Dana Farber’s South Shore Cancer Center. I was under her care when she was at Lahey, and I also went to DF for second opinions, when I was diagnosed in early 2015 with Stage IV NSCLC that had spread to my brain. A total shock with no lung symptoms or warning until it hit the brain. I love both centers and was thrilled that I was able to have my care close to home. I was treated with Nivolumab as a second line treatment, shortly after it received FDA approval back in 2015. I am also now in Remission and my last Nivo infusion was back in August of 2016. I do think for some of us, the Immunotherapy drugs are life savers and I hope every day more and more people will share our same wonderful results. I felt exactly like Greg, when I learned I had Stage IV Cancer and never imagined back then, I’d be here today writing about it. I had a very grim prognosis and was very ill, totally out of the blue, only two days of what we first thought was “vertigo”…? But, I was determined to fight and wanted to be here to see my youngest get married and hoped to some day have a grand child. It really does feel like a miracle and I’ve since been blessed with two precious grand-daughters who are now my greatest inspiration.
Wow Lisa! That is SO amazing to hear about your response to immunotherapy as well💛
I too have/had renal cell clear cell carcinoma and also, at the same time, had a GIST. I did the chemotherapy and eventually immunotherapy with Nivolumab. At this very moment my cancer is “inactive” and was not noticeable on my last scan. I have not had a treatment in almost 2 years! Dr. Lauren Harshman and many team members saved my life!
I’m so happy to read this and know the progress being made in cancer treatments and cures. My father passed away in 2008 after fighting colon cancer and other Lynch syndrome cancers. I too have the lynch syndrome gene MSH2 and want more people to understand their genetic risks and causes of cancers. If you get tested for genetic cancers and know you have a gene you can get annual screenings for cancer that are life saving.
I also was diagnosed with colon cancer with mets to my lymph nodes in a few places and when they opened me up, they said it was “like sand” all over my omentum after learning I had Lynch Syndrome after I went in for some genetic testing at the age of 40. (My mom died at the age of 45 from ovarian cancer, her mom from stomach cancer in her 50s, my dad from throat cancer in his 70s, my uncle from bladder cancer in his 70s, their mother from breast cancer in her 70s – so I had the cards stacked against me in some way – just wasn’t sure how. I know that it was from my mother’s side now.) When they found my cancer, they wanted to do chemo right away, but I found out about a clinical trial at John Hopkins run by Dr Luis Diaz and he had a satellite study at the University of Chicago running, which I qualified for and started right away. Did Pembrolizumab (Keytruda) for 1 year before I came down with crazy case of pneumonitis (my immune system became so strong that it started attacking my lungs (rare side effect), took 8 months to resolve – but in the end, almost all my cancer was gone! They just had to remove one lymph node that was had some cancer tissue that was still hanging on…but even that was killing itself off. I was given the prognosis “no evidence of disease” in April 2019 and have two CTs since that look good so far so I’m living every moment to the fullest! And grateful for it all!!! the 1st in 3 generations that I know of to come through alive so far…Now to get my kids tested. But I have hope – with knowledge comes power and with the innovation our medical scientists and doctors are showing, there is reason to continue having hope.
This is amazing! I too am a survivor! Stage 4 at 37 and was in hospice before starting the trial. There are miracles!
Please connect me with your Lynch Surveillance Teams.
Lynch + Epcam previvor.
What is the difference between MSI-H colon cancer and Adenocarcinoma colon cancer and if I had come to you how would you have treated my adenocarcinoma colon cancer?
Hi Cynthia,
Thank you for reading. Unfortunately we cannot provide medical advice without a consultation.
Below are some additional helpful links:
-For more information on a particular type of cancer or the latest updates we have available, please visit our website (https://www.dana-farber.org/) or search our blog by clicking the magnifying glass at the top of our homepage: https://blog.dana-farber.org/insight/
-For information on whether you would be eligible for a certain treatment, please visit our website for more information on how to make an appointment or get an online second opinion: https://www.dana-farber.org/appointments-and-second-opinions/
-For information on clinical trials available at Dana-Farber and elsewhere, please visit the Dana-Farber database: https://www.dana-farber.org/research/clinical-trials/find-a-clinical-trial/, and/or: http://www.clinicaltrials.gov
Again, if you have a specific medical question, we recommend talking to your doctor or other care provider.
Wishing you all the best,
Dana-Farber Insight team