Defying Grim Prognosis to Celebrate a 20th ‘Cancerversary'

Medscape

6 days ago

In 2005, Roy Brosgole, then 38, was a busy working parent. He commuted about an hour each way to a teaching job in New York City and took care of his children — then 4 years and almost 2 years — in the evenings. His lifestyle then kept him sitting in the car for hours daily, so it didn't surprise him that his back often ached.
One morning Brosgole got up, went to the bathroom, coughed, and then found himself lying flat on the floor in blinding pain. After he tried and failed to stand, his wife Lori called 9-1-1.
In the emergency room, Brosgole was triaged and — without any imaging — diagnosed with back spasms. He recalled that the attending physician ordered a strong steroid and pain meds, but neither of these treatments helped relieve the intense discomfort.
'The doctor said, 'Wow that's really strange. You should be able to get up and walk around now.' I said, 'Well, I can't.' The doctor's exact words — I will never forget them: 'Don't worry about it. It's not like you have back cancer or anything,' Brosgole recalled, in an interview.
A few days later, an MRI ordered by Brosgole's orthopedist would prove the emergency room physician's statement wrong. The imaging of Brosgole's back showed a plasmacytoma on his sacrum, which doctors told him could be a precursor to multiple myeloma or lymphoma.
'The tumor was growing into the sacrum like Swiss cheese,' Brosgole said.
He then consulted Patrick Boland, MD, an orthopedic surgeon at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City. His appointment fell on a Tuesday, he was admitted immediately, and his tumor was removed the next day. Brosgole was diagnosed with IgG kappa multiple myeloma, International Staging System stage II.
His myeloma carried two chromosomal abnormalities, deletion 13 and deletion 17p, both associated with aggressive disease and poorer long-term prognosis. Brosgole's condition was designated as high risk, so he was told he might have only a few years to live.
Fast forward to 2025, as Brosgole is celebrating his 20-year 'cancerversary.' He credits his survival to clinical trials and new standards of care for myeloma.
Chemotherapy and Stem Cell Transplants: Finding a Balance
Multiple myeloma was fairly uncommon in 2005, when Brosgole was diagnosed. Today, the disease is more prevalent but still rare. About 36,000 people will be diagnosed with multiple myeloma in 2025— 20,030 men and 16,080 women. The disease currently has a 62% 5-year survival rate. When Brosgole was diagnosed, the 5-year survival rate was 56% for patients younger than 65 years and significantly lower for people with chromosomal deletions, like him.
Once the tumor was excised, Brosgole was put on a regimen of dexamethasone and thalidomide, alternating 4 days on and 4 days off. The treatments brought his cancer markers down significantly, but his doctors, noting that he was young and otherwise healthy, offered him the chance to participate in a clinical trial of tandem stem cell transplants. The study would assess if such treatment could improve long-term survival as compared with a single autologous stem cell transplant.
The first transplant took place in November 2005, with Brosgole's doctor harvesting his stem cells. Next, he underwent high-dose chemotherapy. Just 3 months later, in February 2006, he went through the entire process again. That treatment was successful for 18 months, he said.
'Then all of a sudden, my numbers — M spike protein levels, immunoglobulins, protein electrophoresis — started to climb,' Brosgole said.
When his MSKCC oncologist agreed that he had relapsed, Brosgole was started on a new intravenous chemotherapy cocktail of Velcade (bortezomib) and Revlimid (lenalidomide) with dexamethasone. That treatment worked for a while, too. His tumor markers stayed stable for nearly a year, but his MSKCC care team wanted to add another treatment: Allogenic bone marrow transplant. That procedure took place in May 2011.
In the years since then, Brosgole's cancer has often recurred, but donor lymphocyte infusions (DLIs) have brought him back into remission.
'I had 10 DLIs: December 2011, April 2012, September 2012, March 2013, November 2013, January 2014, August 2015, September 2015, and November 2015,' Brosgole noted. He was also given an immunomodulatory agent, lenalidomide, which he took until March 2021. Then he transitioned to a different immunotherapy drug, Pomalyst.
Today Brosgole has no detectible levels of multiple myeloma in his body. 'If you do a blood test, there's no way you could tell that I ever had multiple myeloma,' he said.
Treatment for Multiple Myeloma: 2025
When you look back at Brosgole's earlier treatments, they differ significantly from today's standard of care, said Hamza Hashmi, MD, a hematologist-oncologist at MSKCC. Hashmi, Brosgole's current doctor, said that allogenic bone marrow transplant comes with the risk for graph-vs-host disease.
'The mortality rate of allogeneic transplant procedures is somewhere around 30-40%,' Hashmi explained. 'Back in 2011, we were pursuing heroic measures for patients like Roy in their 40s, hoping to put myeloma into a deep and durable remission. Someone who is diagnosed today with multiple myeloma would start with a four-drug cocktail of chemotherapy — combinations of chemo and immunotherapies that target the cancer in a very intuitive way that can actually lead to very deep, durable remissions.'
If patients relapse, they move on to chimeric antigen receptor (CAR) T-cell therapy, which was first FDA-approved in 2017 for treatment of acute childhood lymphoblastic leukemia. 'It has shown very promising efficacy, with very tolerable or minimal toxicity or side effects, in comparison to the allogenic transplant, which can be very difficult to go through, especially if a patient is elderly, frail, or has many different comorbidities,' Hashmi explained.
Other drugs on the horizon may push the needle even further. One new drug, teclistamab, is already helping patients who have stopped responding to three previous therapies or treatments. A phase 2 clinical trial, published in The New England Journal of Medicine in June 2022, found that nearly 40% of study patients saw complete eradication of their disease.
In addition, monoclonal antibodies such as daratumumab are added to the standard-of-care drug combinations. Finally, bispecific antibody drug treatments, which recognize antigens on both the patient's T-cells and the myeloma cells, are shrinking tumors for people who stop responding to other treatments. Unlike CAR T-cell therapy, which requires removal and manipulation of the patient's T cells, bispecific antibody treatments are available immediately.
These innovative treatments have transformed life expectancy, Hashmi said. 'In 2025 we are saying that average survival for a myeloma patient is beyond 15-20 years. And when I say survival, I mean a 70-year-old man, so you can imagine if someone is 40 years old when they get diagnosed, they may actually be able to live another 30-plus years of their life with their cancer in control and remission,' he said.