October 20, 2017 - Precision medicine trial offers hope for patient
Three days before the arrival of Hurricane Nate in October, 71-year-old James Dukes of Loxley was on a customer’s roof trying to repair it before the expected onslaught of rain.
This activity was in stark contrast to his arrival by wheelchair at an appointment at USA Mitchell Cancer Institute in January of 2017, 50 pounds lighter and facing a grim future.
Dukes, a contractor and minister at Spanish Trail Baptist Church in Daphne, was initially diagnosed with prostate cancer in 2010, but it had resisted treatment and progressed to Stage 4. The cancer had metastasized, spreading to his bladder and bone. Chemotherapy had failed to turn it around. He was out of options.
Complications made it difficult to walk. Dukes was suffering from massive lymphedema, or swelling, in his legs from tumors in his pelvic and regional nodes. He wore split croc shoes that allowed him to walk, but with great difficulty. According to his prognosis, he was months from death. While spiritually Dukes was prepared for death, he also had a lot to live for, including his congregation and loving family.
There was one possible chance at life, participation in a clinical trial. But first, he had to qualify.
“(Mr. Dukes) had an unusual prostate cancer in that the tumor had invaded the bladder, and therefore was accessible for biopsy via cystoscopy and available for tissue biopsy,” said MCI oncologist Dr. David Clarkson, explaining that tissue analysis was needed to enroll Dukes in the trial. “So we were in luck.”
The tissue underwent a gene-sequencing assay test at MD Anderson in Houston to see if there was a targeted drug for his type of cancer. Dukes qualified for a National Cancer Institute MATCH study that was available back home at MCI.
MATCH, or Molecular Analysis for Therapy CHoice, is a precision medicine clinical trial. Patients are assigned to receive treatment based on the genetic changes found in their tumors. For Dukes, this meant treatment with the drug Optivo, normally used to treat lung cancer.
The trial offered hope, a word that was also embroidered on a small blanket that was given to Dukes during his treatment. He slept with the blanket every night.
Dukes had a strong will to live, bolstered by support from his wife and family, and congregation. He started treatment in January and eventually received eight cycles of the drug. He slowly started to gain weight. His scans improved. The cancer in his bladder shrank. Some affected areas showed complete resolution.
While the trial has produced encouraging results, Dr. Clarkson cautions that Dukes’ prognosis is still undetermined, as it is too soon to know the long-term effects. But his dramatic improvement has allowed him to return to what he loves doing most -- working, preaching and being a proud grandfather.
"This has extended my days here until Jesus calls me home," he said. "I am excited to be the hope of others who are struggling for better health and thankful to the doctors and nurses at MCI who have steered me through my treatment.”
Photo: Rev. James Dukes and his wife, Rheada, will celebrate their 50th wedding anniversary in December 2017.