DAVID’S STORY

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David was a 66 year-old male with superficial spreading melanoma (SSM) and whom based on a recent biopsy, was graded as pT3a stage of progression. Based on this diagnosis, David’s oncologist had prescribed the standard treatment involving surgical excision of sentinel (closest to the tumor) lymph nodes and adjuvant IFNα/IL-2 therapy should biopsies of the removed lymph nodes indicate cancer.

After a review of David’s medical records and life history our research showed that for David, the removal of four of his lymph nodes might not be necessary. Accurate diagnosis requires the use of multiple medical imaging and diagnostic modalities and an assumption of the degree of metastasis should not be extrapolated from biopsy results alone.

Furthermore, apart from being mostly ineffective, adjuvant treatment with the toxic IFNα/IL-2 combination produces many negative side effects and metastatic patients typically progress within a few months to a year.

We came up with a new plan for David. Firstly, we ordered a PET-CT to confirm whether his disease was metastatic, rather than removal of his sentinel lymph nodes that may or may not contain cancer.

Secondly, if David did have metastatic disease, then we would test his tumor DNA for the BRAF V and E600 mutations, which are commonly found in his specific form of melanoma and which effective targeted (non-standard chemotherapy) drugs exist. The benefit of targeted drugs is that they only kill cancerous cells with the mutation and not normal cells, therefore reducing many of the toxic side effects of standard chemotherapy regimes.

If David was found to have BRAF mutated metastatic melanoma, we suggested that he try “Dual BRAF and MEK inhibition”. Recent data indicate that combined Dabrafenib (BRAF inhibitor) and Trametinib (MEK inhibitor) therapy is superior to monotherapy as response rates with the combination therapy were 76% compared with only 54% for Dabrafenib monotherapy (P = 0.03). Furthermore, this combination reduces the cutaneous squamous-cell carcinoma that can accompany treatment with BRAF inhibitors to 7% versus 19% receiving monotherapy (P = 0.09) (Flaherty et al., 2012).

And finally, we created a gene-targeted nutraceutical diet to help slow the rate of David’s cancer including foods and supplements that have been proven to inhibit the genes and molecular processes that caused the type of melanoma that David’s had.

Luckily, David’s PET-CT indicated that he DID NOT have metastatic disease and the painful surgical removal of his sentinel lymph nodes was completely unnecessary! At this point, David requires no further treatment but we suggest that he be monitored using PET-CT.

Interestingly enough, David’s case is not unique. In fact, we have even seen more than a few cases where patients where being treated with harsh chemotherapy for cancers that a subsequent PET-CT indicated they did not have!

If you have had a cancer diagnosis without a PET-CT, contact us immediately and we can arrange a private scan for you.