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Target: Melanoma

Monday, March 07, 2016 9:00 AM

Simply put: Melanoma is one of the most dangerous forms of skin cancer. When not caught early, it has a high probability of metastasizing—or spreading—inside the body and potentially becoming deadly.

John Plotner

The good news is that NorthShore Kellogg Cancer Center has the expertise to tackle even the most complex melanoma cases, with diagnostic techniques and treatment options found at few other health systems. As part of NorthShore’s leading-edge Center for Personalized Medicine, advanced genetic testing and diagnostics—including on-site laboratory services—provide specialists with the resources to make quick assessments and develop highly customized treatment plans that can lead to miraculous outcomes.

Near the Brink
Personalized, targeted treatment options recently turned the tables on advanced melanoma for two patients of Bruce Brockstein, MD, Kellogg Cancer Center Medical Director. While each case was incredibly complex and challenging, both proved the power of personalized medicine in zeroing in on cancer.

Edward Wojdyla and John Plotner were both diagnosed with advanced melanoma that had invaded multiple organs and left them fighting for their lives. Wojdyla, of Hoffman Estates, had fought off a previous bout of melanoma diagnosed by NorthShore-affiliated Dermatologist Jonathan Dalton, MD. It involved a grueling year of interferon treatment, which kept him melanoma-free for three years. But then Wojdyla became weak and developed a distended abdomen.

“Follow-up tests showed the melanoma had come back and it was really bad. It was in my liver, lungs, spleen and lymph nodes,” recalled Wojdyla. “Dr. Brockstein told me, ‘This is growing really quickly and we’re in a foot race against liver failure.’”

Plotner, meanwhile, had a cancerous growth removed from his back in 2011, and physicians found the cancer had spread to his lymph nodes. Plotner, of Grayslake, had 18 nodes removed. But two years later the cancer not only returned—it had spread. He also faced unrelated heart issues and kidney failure, which required dialysis.
“There was a lot going on inside my body,” recalled Plotner, “and with the advancing melanoma, I knew I was in trouble.”

Targeted Therapies Based on Genetics
Personalized medicine techniques—including advanced laboratory and pathology tools at NorthShore—provided the pivotal difference in the care for both men. Dr. Brockstein and his team sprang into action with the latest treatment options available, including genetic testing of their tumors to determine whether either carried a mutation of the BRAF gene. Nearly half of advanced, invasive melanoma patients have a BRAF mutation. Armed with this information, doctors can provide more targeted, effective therapy for each unique cancer patient.

The tumor profiling proved to be a critical turning point for both Wojdyla and Plotner—but in different ways. Plotner’s cancer tested positive for BRAF, while Wojdyla’s did not. Still, the opposite results helped Dr. Brockstein and his care team design specific care plans for each man, which would lead to lifesaving results using the same class of drugs that, to date, have effectively treated former President Jimmy Carter’s invasive melanoma.

“Both of these cases illustrate the power of personalized medicine techniques in the precise treatment of cancer,” said Dr. Brockstein, who holds an academic appointment at the University of Chicago Pritzker School Of Medicine.

Edward Wojdyla

Second Chance at Life
Plotner’s positive BRAF test would lead to an initial regimen of immunotherapy to tackle the melanoma. But his other health complications created additional challenges—including a bleeding tumor in his intestines. Surgery would have been optimal, but due to Plotner’s heart disease and need for potent blood thinners, he was not a candidate.

Dr. Brockstein collaborated with Plotner’s NorthShore surgeon, heart and kidney specialists to devise a treatment strategy to minimize these additional complications. The care team ultimately decided to put him on a reduced dose of BRAF-inhibitor drugs designed to suppress the cancer and resulting bleeding, which put his melanoma in remission. Plotner was later switched to a different immunotherapy medication, and today there is no evidence of cancer in his body.

“My recovery continues, but I couldn’t be happier to be here for my wife, kids and grand-kids,” said Plotner, who simplifies managing his complex conditions by going online with NorthShoreConnect to chat with his care team and manage appointments and medications via the mobile app or on the Web. “Dr. Brockstein and the NorthShore team have just been fantastic.”

Complete Turnaround
The care plan for Wojdyla—who tested negative for the BRAF mutation—took a different course. He, too, was placed on an immunotherapy medication and began seeing positive results almost immediately. While the medication temporarily affected his adrenal gland, a consultation with NorthShore Endocrinologist Romy Block, MD, had him back on his feet in two days. Dr. Block also holds an academic appointment at the University of Chicago Pritzker School Of Medicine.

“I felt so good by the end of my third treatment, I was back to swimming 1,000 yards a day, five days a week.” Following his fourth treatment, an imaging scan showed no sign of cancer. “Dr. Brockstein came bursting into the exam room saying, ‘Wait ‘til you see this! I can’t believe it!’ There’s no question, I’m a walking, talking miracle!” Wojdyla added.