When 76-year-old Don Rhodes was diagnosed with stage one lung cancer in 2011, doctors removed part of his right lung and followed the lobectomy with chemotherapy.
Back then, in his late 60s, the active diver and underwater photographer tolerated the side effects of nausea and hair loss, but hoped he’d not have to endure such treatment again.
So when his cancer returned as stage four in 2016, the Keys resident, an avid diver and underwater photographer for four decades, decided his quality of life was too important to risk a punctured lung or other negative fallout from a more scattershot approach to treatment.
Enter precision medicine; enter targeted genetic therapy to treat lung cancer, the most fatal of all cancers.
Rhodes’ oncologist, Dr. Paul Kaywin of the Miami Cancer Institute, part of Baptist Health South Florida, said by 2016 significant advances had been made in the way lung cancer is treated since his patient’s 2011 diagnosis. Next generation DNA sequencing — sophisticated genetic molecular testing — showed Rhodes’ cancer had a genetic mutation called Exon 19, which Kaywin called a “driver mutation” that can be treated by targeted therapy drugs.
“It’s like a foot pressing on a gas pedal. The mutation drives the cells to grow and divide and act like cancer cells, but targeted therapy drugs shut down the mutant gene, essentially taking the foot off the pedal,” Kaywin said.
Rhodes started the targeted therapy drug afatinib in December 2016. Two months later, his scans showed a complete remission.
“I got lucky with the mutation. I was back to diving the wrecks and everything else [kayaking and motorcycle riding] in two and a half months,” said Rhodes, who lives in Tavernier, between Key Largo and Islamorada, and regularly bicycles up to eight miles a day.
Over the past 40 years he has explored reefs and shipwrecks and photographed swarms of hammerhead sharks from Australia to Mexico to Bimini. Exploring the ocean is an integral part of this master diving instructor’s life.
In early 2018, Rhodes received more bad news. Scans revealed new nodules growing in the upper right lung. As Rhodes and his doctors discussed treatment options, they decided to pursue a third-generation targeted therapy medication.
“Mr. Rhodes’ story illustrates many of the advances that have taken place in the treatment of lung cancer and how our understanding of lung cancer has translated to being able to find personalized medicine treatments that really make a difference in people’s lives,” Kaywin said.
Dr. Luis Raez at Memorial Healthcare System said when he started out as a lung cancer doctor some 20 years ago, it was common for patients to only live for a year and a half with the treatments of the time. Now, with so many options for targeted therapies, people are living many more years with a higher quality of life, thanks to the minimal toxicity.
“With chemotherapy, we didn’t know which patients were going to respond and who’s not going to respond and that’s been the practice of oncology for the last 100 years,” he said.
However, with the development of precision medicine, medical professionals have been able to discover six different genes that can cause lung cancer, and they have engineered a specific therapy for each gene. Patients are given a pill that is specific for each genetic aberration, he said.
“You are going to respond. The chance of success is more than 70 percent. These drugs markedly prolong life in patients and have even cured some metastatic patients,” Raez said.
Since May 2018, Rhodes has been taking the third-generation targeted therapy medication. As of July 2018 his scans were clear.
“So far, it’s stayed away,” said Rhodes, whose most recent scans in March showed no signs of cancer.
When asked whether he was a former cigarette smoker, Rhodes said it was something he did here and there in the Army more than 50 years ago. He hasn’t picked up a cigarette in half a century, and, given what he’s gone through the last few years, Rhodes will make a comment to young people from time to time when he sees them smoking.
Naturally, he said laughing, they’ll look at him like, “What do you know?”
While he prefers to live in the now rather than fixate on the “what ifs,” Rhodes acknowledges the very real possibility that his cancer may not be curable and another mutant gene could pop up.
“It’s like when you’re hoping the governor commutes your sentence. But so far, so good,” he said.