Flu-like symptoms and a persistent burning sensation under his ribcage landed 50-year-old Robert “Guy” Davidson in the hospital. Doctors diagnosed pancreatic cancer and recommended immediate surgery. But before going under the knife, friends convinced Guy to get a second opinion at Memorial Sloan Kettering. He listened, and today he’s feeling well and likely to live a lot longer than anyone could have anticipated.
Days after his 50th birthday, bond manager Robert “Guy” Davidson lay jaundiced and listless in a midtown Manhattan hospital bed with life-threatening pancreatic cancer. Surgery to remove the mass was scheduled for the following morning.
It was a stunning turnaround for Guy, who had been in seemingly perfect health until six months before, when his internist tested him for an ulcer after he complained of a burning sensation and sour feeling under his ribcage. They found nothing, but with antacids ultimately proving useless for the escalating pain and flu-like symptoms settling in, Guy’s wife, Sally, took him to the emergency room in desperation.
On April 15 — National Tax Day — a CT scan showed a tumor in his pancreas. “I was supposed to be filing my taxes — lord knows anyone would have a stomachache,” says Guy. “Next thing I know, they say I should have surgery. At that point, you have a tumor and you want it out and you wonder if you’re going to see Labor Day.”
A Critical Call
Visitors included Guy’s priest and longtime friend, Reverend Kathleen Liles from Christ and Saint Stephen’s Episcopal Church on Manhattan’s Upper West Side. Liles took a look at the man she knew to be a fit and active father of three and convinced him to consider a second opinion at MSK. Doctors at the hospital that had diagnosed the malignancy hadn’t determined if the tumor was even operable, and the situation’s uncertainty was disquieting.
Guy contacted surgical oncologist Peter Allen. It turned out to be a critical bedside chat. Based on what he heard, Dr. Allen urged Guy to check out of the hospital and report to MSK the next day, where he could receive critical imaging and expertise not available at his current hospital.
Guy quickly agreed to the switch. At MSK, Dr. Allen implanted a stent to fix the bile duct obstruction that was slowly poisoning Guy while they carried out other key tests, including a biopsy to help define the tumor’s cell type — information which could potentially alter Guy’s prognosis and help determine the best plan of action.
Dr. Allen did find a large tumor on his pancreas, but the cancer had not spread to other parts of Guy’s body. At this juncture for people with pancreatic cancer, “the question becomes whether an operation can be designed to completely remove the tumor,” he says.
“There may be 259 shades of gray, but in the case of pancreatic tumors we typically group people into three groups: resectable [removable], unresectable (not removable), or borderline (possibly removable). When we first evaluated Guy, I felt he had a borderline resectable tumor.”
First, Shrink the Tumor
Medical oncologist Eileen O’Reilly concluded that Guy’s chances for surviving and living long enough to see his nine-year-old graduate from college would rise significantly if he underwent chemotherapy to shrink the tumor before surgeons removed it.
Dr. O’Reilly and colleagues based their strategy on relatively new findings showing that blending four medications (referred to as FOLFIRINOX: leucovorin, fluorouracil, irinotecan, oxaliplatin) was more effective than standard chemotherapy.
In fact, this drug combination, which is rigorous and toxic, had produced the longest survival improvement ever observed in a phase III clinical trial of people with pancreatic cancer whose tumor had spread widely. In 2011, FOLFIRINOX was just emerging as an option for people with metastatic pancreatic cancer.
Dr. O’Reilly explained to Guy that the therapy was not routinely used in people at his stage of pancreatic cancer. But his relative youth and overall health seemed to justify a hard-hitting approach. “The regimen hadn’t been studied in a preoperative setting, but it was clearly the most active regimen at the time and probably still is in pancreatic cancer,” explains Dr. O’Reilly. “Our goals were high from the beginning.”
The MSK team was nonetheless amazed by the effect of the drugs. After three months, a tumor the size of an oversize golf ball had withered to the size of a tiny marble.
Radical Surgery for a Marble-Sized Tumor
Dr. Allen prepared Guy for the complex and lengthy Whipple surgery, designed to eliminate the cancer altogether by removing not just the tumor but parts of the pancreas, small intestine, gallbladder, bile duct, and, in some cases, stomach.
Guy sailed through the procedure and stayed at MSK’s Memorial Hospital for five days. “The whole place is uplifting, from the people who clean the room to the doctors to the patients and everyone in between,” says Guy, who had to return at one point to clear a small collection of fluid near the surgical site but has otherwise stayed out of the hospital.
Two months later, after healing from surgery, Guy resumed the same chemotherapy regimen for four months to destroy any remaining cancer cells, followed by several months of radiation treatments aimed at a tiny, suspicious area near his surgical site.
As the months wore on, tingling and numbness developed in Guy’s feet and hands. That, along with fatigue and “chemo brain” — the term commonly used to refer to the cognitive effects of chemotherapy — made it difficult to power through responsibilities in his customary way. He worked when he could and made it to his kids’ events, but dropped everything else for a chance to rest.
Support from friends, extended family, colleagues, and fellow church members helped him retain his sense of humor. “I remember going on a walk with my wife and asking if she wanted to wear towels instead of gloves. The wrong word would pop out,” he recalls. “Those became our family jokes — so I had side effects, but nothing we couldn’t make fun of.”
Now, nearly four years after his diagnosis, Guy comes to MSK for follow-up tests every six months. It’s important to keep a close eye on things: Dr. O’Reilly estimates that only a small percentage of people with cases similar to Guy’s survive for more than five years after a diagnosis.
“I don’t think I would have lived if I’d stayed with the other hospital,” says Guy. “I’m extremely fortunate to have found the place and the doctors who had the knowledge and tools at hand and were brave enough to treat me the way they did.”