Thankful

 

It’s that time of year again; where we get together with family and friends to celebrate the Thanksgiving holiday. It is also a time for reflection and appreciation, which has even greater meaning for me this year.

It was the day before the Thanksgiving holiday in 2015 when I first discovered a suspicious lump protruding from the right side of my neck. The formal diagnosis of Stage IV oropharyngeal cancer would occur several weeks later, but I knew at the time that the palpable growth just below my jaw line was anything but benign.

As a senior executive working in the field of biotechnology, and in particular the area of oncology, being diagnosed with cancer was difficult – but hearing “Stage 4” was especially disheartening. While staging systems are specific for each type of cancer, in general the cancer stage refers to the size and extent of the disease and is assigned a number from 1 to 4. If my cancer was confined to the right tonsil (where it started…) and hadn’t spread elsewhere, I would have been diagnosed with Stage 1 disease. Localized spreading would have been Stage 2 and depending on the extent of involvement of nearby lymph nodes – progress to Stage 3. When cancer has metastasized, or spread to other organs or throughout the body, it can be classified as Stage 4 and may also be called advanced or metastatic cancer. Stage 4 usually carries a grim prognosis compared to earlier stages of the disease.

Accordingly, when one is diagnosed with Stage 4 cancer, the immediate concern is whether or not the individual will be able to survive the disease. For me, however, the bigger concern was surviving the treatments and their side effects. In particular, my experience licensing and launching a product to treat oral mucositis made me very familiar with this debilitating side effect from both radiation and chemotherapy.

When reviewing treatment options with Dr. David Pfister, my medical oncologist at Memorial Sloan-Kettering Cancer Center (MSKCC), I was really hoping that I would be a candidate for recent advances, such as biologic agents and immunotherapies. This was due to my familiarity with their targeted and less toxic profiles, especially when compared with chemotherapy and radiation. In fact, back in early April 2010 I published a 150-page industry report titled “Cancer Vaccine Therapies: Failures and Future Opportunities” and later that year held the inaugural “Cancer Immunotherapy: A Long-Awaited Reality” conference that took place at the New York Academy of Medicine in New York. For more information and background on immunotherapy, read “Insight: Training immune system to fight cancer comes of age” by Bill Berkrot of Reuters.

Unfortunately, approved targeted agents like Erbitux® (cetuximab) still require combination with radiation therapy and its associated side effects. Immunotherapies, such as Opdivo® (nivolumab) and Keytruda® (pembrolizumab) were only recently approved by the FDA to treat head and neck cancer, but their initial indications are limited to patients with disease progression during or after chemotherapy. I remain hopeful that use of these and other new agents will expand to newly-diagnosed patients going forward and that ultimately we no longer rely upon chemotherapy or radiation to treat this disease.

Nonetheless, it is encouraging to see two new drugs approved to treat head and neck cancer this year and know that there are options for me in the unfortunate event that my disease returns. In this regard, I was glad to help ring the Nasdaq Stock Market Opening Bell last month to celebrate cancer immunotherapy advances and the one-year listing anniversary of the Loncar Cancer Immunotherapy ETF (Ticker: CNCR). I first met Brad Loncar (@bradloncar on Twitter), Chief Executive Officer of Loncar Investments, at my inaugural cancer immunotherapy conference and he was kind enough to extend me an invitation to the Nasdaq event.

Photograph by Christopher Galluzzo / @NASDAQ

Jill O’Donnell-Tormey, Ph.D., CEO and Director of Scientific Affairs of the Cancer Research Institute, Brad Loncar, Chief Executive Officer of Loncar Investments, and Michael Becker. Photograph by Christopher Galluzzo / NASDAQ

Ultimately, I went through seven weeks of daily radiation and three cycles of chemotherapy at the start of this year, which as actor Michael Douglas was quoted “somehow seemed very accurately mapped to the seven circles of hell.” In 2010, Michael Douglas was also diagnosed with Stage 4 oropharyngeal cancer and went through the same treatment regimen at MSKCC in New York.

So, while this year started off rough (understatement), I am extremely lucky and thankful to have no evidence of cancer following treatment and to finally be free of “most” of the debilitating side effects from therapy. For example, in recent months I have noticed a dramatic improvement in both energy level and saliva output and have started to reverse a 40-pound decline in weight I experienced during and after treatment.

Aside from eternal gratitude for my wife and daughters’ love and support throughout the process, I would like to extend a special thanks to all of the healthcare providers at MSKCC for their superb care. From my “dream team” consisting of medical oncologist Dr. David Pfister, radiation oncologist Dr. Nancy Lee, and surgeon Dr. Benjamin Roman to amazing nurse practitioner Nicole Leonhart and all of the others who cared for me. I wouldn’t be here today without you!

Photo of Michael Becker and Dr. Nancy Lee

Photograph of Michael Becker with radiation oncologist Dr. Nancy Lee of Memorial Sloan-Kettering Cancer Center (MSKCC) taken November 18, 2016

For my family, friends, and colleagues – too numerous to name – thank you again to EVERYONE that helped in some way…the thoughts, emails, prayer chains, food deliveries, financial support, hospital visits, etc. were all greatly appreciated.

My next PET scan is scheduled for early February 2017 and I hope to report that all remains clear around that time.

PS – as a native of Chicago and loyal fan, I am also thankful to have witnessed the Cubs baseball team winning the World Series for the first time in 108 years in 2016! Go Cubs Go!

Looking Over Your Shoulder

CancerAs I approach the five-month mark since completing chemoradiation, I can FINALLY start to see light at the end of the tunnel. Just this month, I’ve started to notice significant improvement in both energy and ambition. A few weekends ago, I actually went out to see a movie, ran errands, did a photoshoot, and even jump-started a car. It seemed like a miracle! Prior to that, my weekend activities consisted solely of laying on the couch napping or watching television after managing to get through the exhausting work week routine.

I’m not sure if the increased energy was related to my body finally starting to heal or the fact that a few weeks ago I started taking a special type of ginseng supplement that has been shown to help with cancer treatment-related fatigue. For more information, you can read about it here. Either way, the difference is dramatic compared to a month ago.

Unfortunately, my appetite isn’t quite back to normal and my weight is now down 46 pounds from the start of therapy. Don’t get me wrong, I’m very happy to have shed those unwanted pounds – but I don’t think the chemoradiation diet fad will catch on anytime soon. Aside from not being hungry, my saliva output is still greatly diminished and that impacts on food selection and taste.

However, with the recent favorable PET scan, energy returning, and being back to what I consider my ideal weight – you’d think the word “cancer” would slowly start to fade from everyday thoughts and discussion. Not so.

Case in point: this past weekend. A series of minor gastrointestinal issues was easy to dismiss until escalating Friday evening. After vomiting for the fifth time during the evening, I briefly passed out while making my way to the bathroom and my wife had to call 911. While I couldn’t imagine any possible connection between head/neck cancer and the new gastrointestinal symptoms, it didn’t stop me from going to that “dark place” while laying face down on the bathroom floor and during the short ambulance ride to the hospital (PS – my first ambulance ride; not as exciting as it seems on television). Fortunately, this was one of the few non-cancer related trips to the emergency room and I was simply diagnosed with the norovirus, also known as the winter vomiting bug (lucky me to catch such a bug during the middle of summer…). After receiving two bags of intravenous solution to replenish my electrolytes, along with anti-nausea medication, I was released and felt much better by Monday.

What I hear from other cancer survivors is true – every little ache or anything out of the ordinary immediately causes anxiety that the disease has somehow returned. You are always looking over your shoulder.

Final Day of Chemotherapy

Today was my last chemotherapy appointment. It was bittersweet watching the final drops of cisplatin fall from the bag, stream down the winding tubes, and finally enter the intravenous line into my vein.

On the positive side, I was able to complete all of the three cycles of chemotherapy that are associated with the encouraging survival rates published by the physicians at MSKCC. Some patients don’t make it through all three cycles due to side effects, and I was nervous earlier this week when I started running a fever that they may skip the last cycle.

On the negative side, the week following chemotherapy has been difficult for me in terms of nausea and a general sense of feeling crappy. On top of that, the doctors keep reminding me that the coming few weeks will be the toughest. This is due to the cumulative effects of both radiation and chemotherapy, as the two therapies continue to exert their toxic effects even after they are discontinued.

Michael Becker and Daughter Megan in the Chemotherapy Suite at MSKCC

Michael Becker and Daughter Megan in the Chemotherapy Suite at MSKCC

Fortunately, I was joined not only by Lorie but also my youngest daughter Megan. Megan was able to come to NYC thanks to Lorie’s best friend since 3rd grade of elementary school – Debby Novack. She came into town to help out after Lorie’s sister went back to Illinois after her three week tour of duty. Not an overly exciting day for Megan sitting around the chemotherapy suite and shuffling between various appointments, but it was great having her there.

The following two days (Thursday and Friday) are also my final days of radiation therapy. It will be so nice to have at least part of my life back next week – not having to be a slave to the daily treatments and the three chemotherapy cycles. Any remaining doctor appointments will simply be routine checkups leading up to a PET scan in approximately 3-4 months to determine in part whether or not the treatment was successful or if further intervention is needed.

Most important, my lower back pain has greatly subsided and I can get up and down much better than even a few days ago. Either the muscle spasm went away on its own or the myriad of pain medicines and muscle relaxers finally started working. Regardless, I’m happy and better positioned to deal with the coming weeks with one less ailment to worry about.

Radiation Dermatitis

During Week #5, another common side effect from chemoradiation treatment emerged – radiation dermatitis. Just like oral mucositis discussed in a prior post, radiation dermatitis is graded on a scale – with Grade 1 being mild and Grade 4 being severe. In most patients, radiation dermatitis is mild to moderate (grades 1 and 2), but ∼20%–25% of patients experience severe reactions¹.

Photo of Michael Becker's neck with mild/moderate radiation dermatitis.

Photo of Michael Becker’s neck with mild/moderate radiation dermatitis.

Right now, I have mild to moderate radiation dermatitis on my neck in the area that is being targeted. This is characterized by mild erythema (red rash), which you can see in the accompanying image. The more severe forms of radiation dermatitis are associated with itchy, peeling skin and ultimately open wounds and ulceration. I’m hoping that my condition doesn’t advance to those stages.

The treatment for radiation dermatitis is basically keeping the skin moist by applying Aquaphor ointment. No creams or ointments have shown superior efficacy over another in randomized clinical trials.  This includes topical steroids and other agents.

Other than that, there is some indication that my kidney function might be impaired due to elevated serum creatinine levels. They are still running more tests, but worse case would be more frequent intravenous hydration to flush out the kidneys. Kidney function can be negatively impacted by the chemotherapy (cisplatin).

I did have intravenous hydration today and have been feeling pretty good overall. Fatigue is still my major complaint, but also par for the course.

¹ Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck. Ann Oncol (2008) 19 (1): 142-149. doi: 10.1093/annonc/mdm400. First published online: September 4, 2007

Steady As It Goes

The second round of chemotherapy and end of Week #4 was relatively uneventful – especially when compared with the first cycle when I came down with the flu. The biggest changes are increased taste alteration and fatigue.

Michael Becker Receiving IV Hydration

Michael Becker Receiving IV Hydration

My heart rate and blood pressure were elevated this week, so my physician ordered an extra 2-hour intravenous hydration session. Frankly, I was happy to do so – as I planned on coming home to Pennsylvania for the extended weekend.

I took the train home on Friday afternoon, but spent most of the day on Saturday sleeping which isn’t like me at all. I’m not normally one to take naps, but the fatigue from radiation and chemotherapy makes it hard to even keep my eyes open at times. I feel like I’m sleeping the entire weekend away!

Lorie’s sister Maureen is in town for a few weeks and has been a tremendous help around the house. She’s also a great cook and has been making some fabulous meals, although I just haven’t been up to eating them and have very little appetite. However, Lorie and the kids are enjoying them.

Sunday (today) is Lorie’s birthday in addition to being Valentine’s Day, which is another reason why I really wanted to make it home this weekend. I definitely owe her a proper celebration after we are past the cancer treatment, but in the meantime it will be nice to have a small celebration at home.

Monday starts Week #5 and it looks like March 4th will be my last radiation session. From what the doctors tell me, this is where things start to get rough with the treatment. Accordingly, I’m a bit nervous about what the coming days/weeks will bring…

Progress Report

Yesterday marked the beginning of Week #3 for my chemoradiation treatment. By now, the cummulative effects of daily radiation have started to appear.  This includes oral mucositis (where the mucosal lining of the mouth breaks down forming ulcers) and xerostomia (dry mouth). The World Health Organization (WHO) Oral Toxicity Scale measures anatomical, symptomatic, and functional components of oral mucositis¹. The scale ranges from Grade 0 (no oral mucositis) to Grade 4 (unable to eat solid food or liquids). The majority of head and neck cancer patients (83%) who are receiving radiation therapy develop oral mucositis and 29% develop severe oral mucositis².

IMG_7111

Oral mucositis ulcer on side of tongue

My current assessment would be WHO Grade 2, which means that I can still eat solid foods despite the presence of ulcers (see photo of the single ulcer on the side of my tongue). Recall that I started taking Caphosol® at the start of my chemoradiation treatment. This oral rinse has been shown to reduce the severity and duration of oral mucositis in a clinical study. The study design used a different oral mucositis scale devised by the National Institute of Dental andCraniofacial Research (NIDCR), which ranks oral mucositis on a 0-5 scale where I would presently be at Grade 2 (single ulcer <1 cm). Results from the study demonstrated a peak Grade 1.38 for patients using Caphosol compared to Grade 2.41 for the placebo group. Accordingly, it will be interesting to see whether or not I develop additional ulcers or more severe oral mucositis to help determine the benefit of using Caphosol.

I received a progress report during my appointment with Dr. Nancy Lee, my radiation oncologist at Memorial Sloan-Kettering Cancer Center (MSKCC). The results are encouraging, as the tumor has markedly decreased in size over the first two weeks of therapy – characteristic for my type of cancer. The better news was that the PET imaging study looking at levels of oxygen deficiency (hypoxia) in the tumor tissue showed dramatic improvement. In particular, the pre-treatment scan showed “mild” radiotracer uptake in the primary tumor (right tonsil) and “intense” radiotracer uptake in the neck lymph node, indicating a significant amount of hypoxic tumor cells that are generally more resistant to radiation and many anticancer drugs. However, the most recent PET scan showed “no” radiotracer uptake in the primary tumor and only “mild” persistent uptake in the neck lymph node. Unfortunately, the fact that there is still some hypoxia means that they won’t be able to reduce the amount of radiation to the neck node, which could have reduced some of the side effects.

This morning I had my follow-up hearing test, which showed no change from pre-treatment.  This is also good news, as the chemotherapy (cisplatin) can sometimes cause hearing loss. Next week will be my second round of chemotherapy on both Monday and Tuesday. I’m hoping that this cycle will be less eventful than the first and that I don’t contract the flu or have any other surprises.

¹ World Health Organization. WHO Handbook for Reporting Results of Cancer Treatment. Geneva, Switzerland: World Health Organization; 1979:15-22.

² Vera-Llonch M, Oster G, Hagiwara M, Sonis S. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer. 2006;106:329–36.

Coming Home

In contrast to the first week, the second week of treatment was relatively uneventful. I had daily radiation therapy Monday-Friday and the effects of the flu seemed to dissipate with each passing day. Still not what I would consider back to 100%, but a heck of a lot better than how I felt last Friday!

I’m writing this blog post on the New Jersey Transit evening train heading home to Bucks County, PA for the first time since I started treatment on Monday, January 18. I normally commute to NYC daily for work, so it is a very familiar ride. But the prospect of seeing my wife and kids, family pets, and sleeping in my own bed is making the trip seem a lot longer – almost like time is standing still. I’ll spend the weekend home and then return to NYC for week three of treatment. It’s a calculated risk coming home and being far from MSKCC, especially in view of what happened last weekend. However, I fear this will be one of the last times I’ll feel up to commuting back-and-forth and I really need a distraction at the moment.

By now, I’ve started to see the same familiar faces in the men’s locker room to change before getting daily radiation. The first few times, there wasn’t a lot of discussion or interaction. Slowly, you strike up conversation that is oddly reminiscent of a prison scene from the movies. “What are you in for?” “How long is your sentence?” Stuff like that.

It’s a strange cast of characters and most of them are much older. Almost everyone I’ve spoken with seems to have some cancer involvement in the lungs that required surgical removal of at least a portion of them in addition to subsequent radiation. Then there are the real strange diseases, like the older guy who had cancer in some tissue left behind from his umbilical cord when he was an infant that spread to both his bladder and lungs. Another guy who has cancer of the eye, with visible impact. They all remark that they are at peace with their fate; ready to go if this is their time but not minding a longer stay on this earth if the opportunity is provided by the treatment. Maybe because I’m the younger one in the crowd, but not me…I’m not at all at peace with the situation and ready to fight like hell.