Screening, immunotherapy make the difference for patient with dual cancer diagnosis

Andy Abrams likes to say he’s the poster child for routine cancer screenings. Oncologist John Wrangle, M.D., on the other hand, would say that Abrams is a poster child for the incredible difference that immunotherapy has made in treating many cancers.

Either way, Abrams is glad for the chance to come to MUSC Hollings Cancer Center for infusions every three weeks. Granted, it’s not how he would otherwise spend his retirement, but he feels lucky that his cancer was caught before he started having symptoms, and that he hasn’t felt any side effects from the treatments.

He feels so good that people are often surprised when he tells them he’s headed for his cancer treatment, he said. But he thinks it’s important to talk about.

“You’ve got to talk about this stuff. It’s scariest when you treat it as if it's some evil lurking out there somewhere,” he said.

“‘I’m going down (to Charleston),’” he tells people. “I say, ‘Here’s what I’ve got. Here’s how they caught it, and how wonderful they were able to catch it, and how wonderful that we live in a time and age and place where they can treat it.’”

Abrams has the distinction of being treated for two unrelated cancers at once. The first, colon cancer, was detected thanks to routine colonoscopies.

Abrams said his brother-in-law, Hollings director Raymond N. DuBois, M.D., Ph.D., has always impressed upon him the importance of screening colonoscopies.

“That was drilled into me from adulthood, frankly, by Ray, because his area is colon cancer,” Abrams said. “The point that Ray brought home was that there are so many cancers out there that are not detectable until you're symptomatic, and then you have a huge problem. But colon cancer is one where, if you simply get the routine colonoscopies, it could be detected early enough that it’s readily treatable.”

During an early routine colonoscopy, his physician found a polyp. Polyps are noncancerous growths – but left on their own, they can develop into cancer. Doctors remove them during colonoscopies so they don’t have that opportunity to become cancerous. Because he now had a history of colon polyps, though, Abrams was put on a three-year schedule of screening colonoscopies rather than the typical 10-year schedule. And two years ago, doctors detected cancer.

“The doctor walked in, and I made some kind of glib comment about, ‘I guess everything's OK.’ And she looked crestfallen. She said, ‘No, we found a mass,’” Abrams said.

"It's another type of cancer where immunotherapy flipped the script on traditional stories of how lethal a particular kind of cancer is.”

John Wrangle, M.D.

That set in motion a series of tests and introductions to new doctors, including surgeon Virgilio George, M.D., who specializes in colorectal surgery.

One cancer is enough to process – but during the testing to determine whether the colon cancer had spread, doctors found two spots on Abrams’ lungs.

Those spots turned out to be a separate issue. Abrams is prone to a type of skin cancer called squamous cell carcinoma, a very common and treatable form of skin cancer. In his case, however, some of the cancer cells had migrated into his lungs.

With pulmonologist Gerard Silvestri, M.D., quarterbacking his lung care, Abrams was referred to Wrangle because of Wrangle’s expertise with immunology. This type of cancer has traditionally not responded well to chemotherapy, Wrangle said. On the other hand, it’s very responsive to immunotherapy.

Immunology is a broad term that covers a variety of therapies that harness the body’s own immune system in some way to attack the cancer. With some cancers, the cancer cells essentially trick the immune cells into seeing them as friends, rather than foes, by giving a special handshake. Cemiplimab, the drug that Wrangle started Abrams on, blocks the cancer cells from shaking hands with the immune cells, allowing the immune cells to recognize the cancer cells as foreign and attack them.

“It's another type of cancer where immunotherapy flipped the script on traditional stories of how lethal a particular kind of cancer is,” Wrangle said. “We started him on immunotherapy, and he's had just an absolutely marvelous response. And we expect that response to be durable.”

Abrams can’t stop singing the praises of Wrangle, George and the Hollings staff.

"From the time you check in, the people are just friendly and kind and caring and compassionate,” he said. “The staff is so remarkable and thoughtful.”

"You've got this right here in the state of South Carolina, in our backyard. You can get world-class treatment from world-class doctors."

Andy Abrams

Sitting in the infusion room with other patients, he sees a microcosm of society – people of all races, economic statuses and educational backgrounds end up there. And Abrams says they’re all fortunate to be able to access top-notch care here at home.

“You've got this right here in the state of South Carolina, in our backyard. You can get world-class treatment from world-class doctors. I mean, cancer's disruptive, but it was manageable because I didn't have to go away,” he said. “And my care team doesn’t operate in silos. No one was saying, ‘Well, I don't worry about that. I'm just dealing with your colon.’ Or, ‘I don't worry about that. I'm just dealing with the lungs.’ I think everyone is very focused on the patient holistically.”

Abrams was so impressed with his care at Hollings that he continued to come here, even after he and his wife decided to retire and split their time between Davidson, North Carolina, and Toronto, Canada.

"Virgilio George is as good a surgeon as there is. John Wrangle is an unbelievable world-class oncologist with a specialty in immunotherapy. And Gerard Silvestri is a masterful diagnostician and quarterback. So, I think when you get that kind of world-class treatment, from preventing it to the surgery to the treatment, and it's right here in Charleston, South Carolina – it’s hard to beat that.”

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