David’s Story

The Case of David

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Patient Presentation

David is a 66 year old man living in British Columbia, Canada, who had been fighting an aggressive form of Squamous Cell Carcinoma (SCC) of the skin for many years.

Although the vast majority of cases of SCC do not metastasize beyond the skins outer layers, and are therefore not considered deadly, David’s cancer had become hyper-aggressive and had metastasized throughout his body.

After a post treatment PET/CT scan showed an increase in some very aggressive tumours, David’s oncologist suggested that he contact us in the hopes that we could help uncover the mechanisms for the transformation of his deadly cancer, and offer him some respite and extra time with his family.

How we helped David using our 4 step system

1. Introduced Advanced Diagnostics

First of all, we obtained a sample of David’s tumour tissue and sent it for tumour DNA sequencing. We decided to use the Foundation One tumour DNA sequencing assay because unlike many other tumour DNA sequencing assays, it reports mutations that have not yet been characterized and proven to cause cancer. This is an important consideration as this test can reveal mutations that, while they have yet to show a proven role in cancer, can indicate the loss or gain of important cancer-causing signalling pathways.

We looked for cancer-causing mutations in the DNA of over 340 genes involved in cancers. Unfortunately, David’s F1 assay did not show any well known and targetable mutations. However, it did uncover a unique mutation in a member of the epidermal growth factor family, which contains the well-established HER2 (HER2 positive breast cancer) and EGFR (EGFR mutated lung cancer) genes.

2. Conducted Patient Specific Research

Since the specific mutation in David’s HER4 gene had not yet been characterized, we used sophisticated computer modelling and virtual biology computer simulations to determine that this mutation was potentially oncogenic.

Our research also uncovered data indicating a strong association between mutations in members of the epidermal growth factor family of genes, and transformation of SCCs from the outer skin layer to those that have metastasized to within the body.

Based on the data suggesting that this mutation could be playing a role in the aggressive transformation of David’s cancer, we researched drugs that could potentially target it.

Our research further uncovered examples and case studies showing examples of patients with aggressive SCC being treated with drugs that target the epidermal growth factor family of genes. Interestingly, we also uncovered research showing a strong synergistic benefit in some of these patients when these drugs were combined with radiation therapy.

3. Interim Treatment Support

Next, we researched the British Columbia Cancer Agency’s (BCCA) treatment guidelines for advanced skin cancers, to see if any of the drugs we had identified had provisions in the guidelines to treat patients such as David. Although we found no such provisions, we did find provisions for these drugs when used to treat patients with EGFR mutated lung cancers.

This was an important finding, as the many years of damaging chemotherapy and radiation therapy that David had endured had left him with a variety of health issues, including a weak heart, and as such, he was not a candidate for further treatment with the approved chemotherapy drugs commonly used to treat his form of cancer.

4. Clinical Trial Support and Advocacy

We immediately wrote up a patient report for David’s health care treatment team, and his community oncologist was able to prescribe one such EGFR targeted drug called Tarceva.

Furthermore, his oncologist was able to get the cost of the drug covered by his extended health care plan.

Since David was also offered palliative radiation therapy to reduce the pain and slow the growth of his larger tumours, we coordinated with David to ensure that any radiation treatments coincided with his Tarceva treatments.

After a short time on this combination, David’s oncologist reported back to us indicating that the synergistic combination had resulted in a remarkable reduction and disappearances of the tumours that had been targeted with radiation, and even some that were in the field of minimal radiation exposure. His oncologist also happily stated that David was for the most part pain free.


While David did enjoy a temporary reprieve from his disease thanks to the benefits of this combination therapy, his body was too weak to resume further treatment, and David sadly succumbed to his disease a few months later.

Since the Tarceva was covered by David’s extended health care plan, he got the treatment he needed with much less stress and financial strain.

We believe that had David and his oncologist reached out to us at an earlier date, David may very well been alive today, as the treatment that was able to be performed resulted in a significant resolution of the tumours that were treated with the combination of Tarceva and radiation therapy.


As you can see, CTOAM’s advanced diagnostics, records review, and consultations can result in significant benefits to a patient’s outcome. Having access to a team of knowledgeable scientists, doctors and patient advocates that WORK FOR YOU and NOT THE MEDICAL SYSTEM can make all the difference in the outcome of your disease!

If you or a loved one is fighting cancer, give us a call so we can do a brief review of your medical records. It is important to be sure that you KNOW that you are doing all you can, and that you have access to the best treatments for your own unique case. (778) 999-5463