Retired psychologist and resident of Bowling Green, Stephan Silverman is a walking miracle—with a little help from a breakthrough medical treatment, a new version of “Immunotherapy.”
Silverman, 73, has not smoked since 1979, but was diagnosed with stage-4 lung cancer in December 2014. He had been experiencing a very bad, dry cough for a few weeks prior, with no symptoms of a cold.
“I went to my general physician who also happens to be a cancer specialist, Dr. Sacks in D.C.,” Silverman said. “He looked up my history and realized that I had been a smoker when I was a young guy, 35 years ago. Because I had been a smoker, he sent me to get an X-ray and they found a big spot.”
He was then sent for a CT scan, which found a tumor the size of a peach on his bottom right lung. There were also three large, cancerous lymph nodes blocking the airflow to his lungs.
“He had what we normally would have called ‘incurable cancer,’” said Dr. Deepa Subramaniam, M.D., M.Sc. at Medstar Georgetown University Hospital.
Silverman was not a candidate for surgery or radiation, but he was selected as the 25th candidate in a 25-person clinical trial of a new drug called MPDL320A or Atezolizumab.
Dr. Subramaniam is the director of the Brain Tumor Center and Multi-Disciplinary Thoracic Oncology Clinic at Georgetown. She also belongs to the Clinical & Experimental Therapeutics Program at the Lombardi Comprehensive Cancer Center. This program researches and tests new cancer drugs in which these trials are done.
Silverman received four cycles for 12 weeks of traditional chemotherapy combined with the test immunotherapy drug.
“When I had the first stages of chemotherapy, I went through the same thing that everyone does. I lost my hair and lost about 20 pounds,” Silverman said. “I had no strength or energy.”
Though the traditional difficulties of chemo were still there, he had this other drug on his side.
Immunotherapy has been around for 30 to 40 years. Back then, it was either ineffective or somewhat effective, but fairly toxic, with tough side effects.
Now it has been made safer and more successful. Normally, cancer is able to “hide” from the immune system—these drugs prevent the cancer from “hiding,” so it is easier to fight.
“The rate at which progress is being made is quite rapid,” said Subramaniam, who explained that these particular drugs have only been in experimentation for the past three to five years.
Ever since Silverman’s combined treatment was completed, he has been receiving IV infusions every three weeks of the immunotherapy drug alone.
After one year, his tumor had been reduced to 3.5 inches wide, and is now less than one inch. His lymph nodes are clear. A small area of cancer on his shoulder is completely gone as well.
At first, he did not know that he was going to make it. His wife and two children went through a very rough time. “We have a lot of faith and a very good spiritual connection,” Silverman said.
Now he has 80 to 90 percent of his strength back, is living a normal life and going to the gym again. As part of his recovery, he needs to eat regularly and drink lots of water. Initially, he must avoid high stress and the possibility of infection, for instance flying, because airplanes are a breeding ground for viruses and bacteria.
“There are less than 1,000 people in the world who have had this immunotherapy drug,” Silverman said. “Basically it looks like I am going to live longer.” This particular drug has only been in use for the past two years.
“This trial has many different arms for treatment. Three of them are for lung cancer patients. There are arms for breast cancer patients and colon cancer patients,” Subramaniam said. “At the oncology society meeting last summer, patients on the lung cancer treatment appear to have done very well.”
Subramaniam has one patient on the exact treatment as Silverman who has achieved complete remission. This individual started in March 2014 and is almost at the two-year mark, making him one of the longest patients on this drug. He is in great shape and still continues the immunotherapy infusions, as Silverman does.
“Plain chemotherapy for lung cancer, even if the tumors shrink, it is only seven to 10 months before the cancer starts to grow again,” Subramaniam said. “So when cancer stays in control for more than a year, that is already unusual.”
A few of these drugs have already been approved by the FDA for melanoma, lung cancer and kidney cancer.
The one that Silverman is on will likely be approved, but there are still a number of trials to go through before that happens. His regimen is called a phase-one program, because it tests brand new drugs for the first time.
“The intention of these trials is to test the safety and probability of the combination of chemotherapy with immunotherapy,” Subramaniam said.
The clinical trials of these drugs are ongoing in multiple cancers. Even after approval, more testing remains to find the best use, whether in combination with other medications or alone. Some of these drugs have better response rates than others. One may have 20 percent and another 70 percent. In Silverman’s case, his stage 4 lung cancer was pronounced “incurable,” but is now almost gone.
To learn more about these clinical trials, visit: lombardi.georgetown.edu
For immunotherapy, visit: cancer.org
-CP Reporter Bridget Douglas