When Don Rhodes learned his lung cancer was back, his first thought was: “How is this going to affect my diving?”
Scuba diving and underwater photography have been passions for the Keys resident for 40 years. It’s more than a hobby. He’s a master instructor who once wrote a diving column. From Australia to Mexico to Bimini, he has explored reefs and shipwrecks and photographed swarms of hammerhead sharks.
(Watch now: The Baptist Health News Team hears from patient Don Rhodes and his oncologist, Paul Kaywin, M.D., about his treatment for lung cancer at Miami Cancer Institute that involved genetics and leading-edge “targeted therapy.” Video by Carol Higgins and George Carvalho.)
Rhodes’ oncologist, Paul Kaywin, M.D. [1], of Miami Cancer Institute [2], understands the role diving plays in his life. Their relationship goes back to 2011, when the lung cancer was first diagnosed as a stage one adenocarcinoma, a type of non-small cell lung cancer. A lobectomy was performed to remove part of Rhodes’ right lung, followed by chemotherapy.
According to Dr. Kaywin, when the cancer recurred in 2016 as a stage four, Mr. Rhodes determined that his treatment would not hinder his life’s passions. “Don became very involved in making decisions about his treatment,” recalls Dr. Kaywin. “He is 76 years old and he’s most interested in maintaining his quality of life. He was very clear that he didn’t want anything that could somehow risk a punctured lung or otherwise impair his ability to dive.”
Genetic Research Drives New Lung Cancer Treatments
Significant advances have been made in the way lung cancer is treated in the years since Rhodes’ first brush with the disease. Sophisticated genetic molecular testing – next generation DNA sequencing – is now the standard of care for patients with adenocarcinoma of the lung. This testing can be performed on-site at the Institute’s molecular biology laboratory, which is equipped with the latest gene sequencing technology.
“We analyze those results and present them at our molecular tumor board where all the experts meet to strategize the best available targeted treatment based on the mutations,” says Dr. Kaywin.
Don’s cancer had a genetic mutation called Exon 19, a so-called driver mutation, which can be treated by targeted therapy drugs. Dr. Kaywin explains that a driver mutation acts like a foot pressing on a car’s gas pedal, driving the cells to grow and divide and behave as cancer cells. Targeted therapy drugs can shut down the abnormal function of the mutant gene, essentially taking the foot off the pedal and putting the cancer into remission.
“Don started on the drug afatinib in December of 2016 and by February of 2017 his scans showed a complete remission,” says Dr. Kaywin. “He had an excellent response to treatment, tolerated it well and maintained an excellent quality of life.”
Because targeted therapy drugs work specifically on cancer cell mutations, their side effects are less severe than chemotherapy, or in Rhodes’ words, “They don’t make me more bald than I already am and they have side effects that you can deal with. Chemo is much worse.”
The cancer remained in remission until early 2018, when scans revealed new nodules growing in the right upper lung. After discussing radiation and other options, the decision was made to treat him with a third-generation targeted therapy medication, osimertinib. A few months after the switch in drugs, the new nodules had disappeared.
“I dwell on what I can do while I’m still here.”
Dr. Kaywin considers Rhodes an excellent example of an intelligent patient who’s actively involved in his care. “He does his own research. He sent me articles. He knew a lot about the option of trying this other medication and he’s also aware and he’s very realistic that his cancer ultimately may not be curable.”
Mr. Rhodes keeps a positive attitude, but remains realistic about his outlook.
“I understand that each of these targeted therapy drugs have an average expectancy for how long they’re going to work,” says Mr. Rhodes. “I don’t dwell on ‘oh-oh, I’m gonna die from this stuff.’ I dwell on what I can do while I’m still here. I ride a motorcycle, I ride a bicycle, I kayak and I’m still able to scuba dive. That’s what keeps me going.”
Nonetheless, Dr. Kaywin says advances in targeted therapies has extended survival rates substantially in patients with late-stage lung cancer.
“It’s very gratifying to see how with the advances that we’ve made with these treatments, how he’s been able to benefit and live his life and do the things that he wants to do,” Dr. Kaywin says. “In the past, the prognosis for people who had stage four lung cancer was six months. Now, it’s possible they can live for years and be able to keep the cancer under control.”