For Ali Hanna, skiing down mountain slopes, dashing across tennis courts, and taking business trips to South America and his native Ireland were the norm. Then, in the fall of 2011, while recovering from routine hernia repair surgery, his stomach began to feel persistently “sour.”
“I assumed it was related to the hernia surgery,” recalls the former management consultant. As a precaution, his internist recommended that he undergo a colonoscopy and a sonogram of his upper intestine. During the test, the radiologist noticed two dark spots on Ali’s chest wall.
“I was told that the spots could be anything – inflammation, a tumor, they didn’t know,” he explains. Additional tests were ordered at Memorial Sloan-Kettering, where Ali had been treated successfully several years earlier for melanoma of the eye (ocular melanoma).
A Tricky Diagnosis
Thoracic surgeon Nabil P. Rizk performed the biopsy, passing flexible tubing through Ali’s mouth to his chest to remove tissue for analysis by a pathologist. Although the team found no cancer, Dr. Rizk wasn’t convinced that this was an all-clear sign, since Ali had been treated for cancer once before.
“At first we celebrated because we thought that not having more melanoma was a good thing. Then we looked up mesothelioma and realized that I’d gone from the frying pan into the fire.”
—Ali Hanna, Mesothelioma Survivor
Several weeks later, the test was repeated and a lymph node biopsy was taken. Still nothing was found. “But Dr. Rizk wasn’t happy,” recalls Ali. “He told me, ‘I think we missed it’ – probably because of my previous bout with cancer. He thought they had to be related in some way.” A third test was performed using a different approach, which involved entering the chest cavity through the back using a syringe.
When the results came in, Ali and his wife were in Brazil. Although melanoma had been suspected, the pathologists determined that the spots were mesothelioma, a cancer of the lining that covers and protects many of the body’s internal organs, including the lungs, abdominal organs, and heart.
“At first we celebrated because we thought that not having more melanoma was a good thing,” recalls Ali. “Then we looked up mesothelioma and realized that I’d gone from the frying pan into the fire.”
Cancer 50 Years after Asbestos Exposure
In most cases mesothelioma is caused by exposure to asbestos, building material that was commonly used for insulation and fire protection until it was banned in most developed countries during the 1980s. Ali’s career had been in management consulting, not construction, so at first he was puzzled.
“Then I remembered that in 1963, I had a summer job in a manufacturing plant where I cut sheets of asbestos,” he says. “I think that’s how this happened.”
It doesn’t take a lot of exposure to asbestos to contract this cancer, explains Ali’s doctor, thoracic oncologist Lee M. Krug, who is also the director of Memorial Sloan-Kettering’s Mesothelioma Program.
Treating Pleural Mesothelioma at Memorial Sloan-Kettering
Ali had developed pleural mesothelioma, the most common subtype of mesothelioma. This cancer develops in the membrane sacs that protect the lungs, called the pleura.
At Memorial Sloan-Kettering, doctors turn to the institution’s database of more than one thousand mesothelioma patients – the world’s largest – to help in formulating a treatment approach. The database is invaluable in choosing not only who is a good candidate for surgery, but which type of surgery will likely be the most effective for a person’s subtype of mesothelioma.
Experts in surgery, radiation, and chemotherapy discussed Ali’s case, and developed a multimodal treatment approach for him that involved surgically removing the cancerous spots, along with several other tumors, a portion of his pleura and one rib.
Ali then underwent four cycles of chemotherapy and a month of intensity-modulated radiation therapy (IMRT). This highly targeted approach enables doctors to deliver radiation directly to the pleura, with lower risk of side effects than standard radiation therapy. For people with mesothelioma, IMRT can reduce the risk of damaging the lungs.
“We have identified a gene, BAP1, which predisposes people to the development of both ocular melanoma and mesothelioma.”
—Lee Krug, Thoracic Oncologist
Ali’s team also recommended that he enroll in a clinical trial testing the Wilms’ tumor 1 (WT1) analog peptide vaccine, a drug developed at Memorial Sloan-Kettering to boost the immune response to this kind of tumor.
Ali’s treatments were completed in April 2012. “Although patients with mesothelioma are never really cured,” explains Dr. Krug, “Ali was faring well.”
Memorial Sloan-Kettering doctors also identified a gene, BAP1, which appears to predispose people to the development of ocular melanoma and mesothelioma – both of which Ali had.
So at Dr. Krug’s suggestion, Ali enrolled in a study to learn whether he is carrying a mutation in BAP1. It turns out that Ali does not have this mutation, although if he had it would have likely been very useful for close relatives such as his brother to know, as they could have chosen to undergo regular screenings for these cancers.
Golf Tournament Champion
His treatment completed, Ali flew to Ireland for an annual golf tournament with a group of friends. Although he expected to relax and ride on a golf cart, Ali surprised himself and his friends by playing ten rounds in seven days, never using the cart, and winning the entire tournament.
Now Ali continues to play tennis weekly, and he and his wife are back on the ski slopes.
He also undergoes quarterly scans to detect possible recurrences, and when his doctors found another tumor in his lung in late 2013, they devised a new course of treatment for him. The approach involves a novel immunotherapy with an investigational drug called tremelimumab, designed to stimulate the body’s immune system to attack and kill cancer cells.
“Throughout this entire process, I’ve felt like everyone is on my side,” explains Ali. “Drs. Krug and Rizk, and the nurses – everyone at Memorial Sloan-Kettering – have been fantastic, really cheering me on. I simply couldn’t have asked for a better team.”