Meet Lory Molesky
Lory Molesky, a healthy and fit software engineer, thought his uncomfortable chest pressure was a case of the flu. He tried playing soccer but couldn’t take three steps without becoming winded. A trip to the Lahey Outpatient Center in Lexington started a remarkable journey involving a devastating cancer diagnosis, a successful leading-edge treatment, and a dedicated medical team led by a physician who went above and beyond for his patient.
“I feel as if I’ve dodged a bullet – or maybe a land mine”
Lory’s heart rate was extremely elevated and an EKG showed an abnormal heart rhythm. An urgent ambulance trip brought him to Lahey Hospital & Medical Center, where he was diagnosed with cardiac tamponade, a potentially fatal condition in which fluid collected in the sac surrounding his heart, and pleural effusion, in which fluid collected around his lungs and caused his left lung to collapse. The medical team searched for the cause of his condition, which could have been a bacterial or viral infection – or cancer.
“Here was this extraordinarily fit man who was into biking, competitive soccer, double-diamond skiing, and was very successful in his profession, and he was in imminent danger of death.”
A Shocking Diagnosis
Lory, a married father of two college-age children and who has never smoked, was diagnosed with stage 4 lung cancer that had spread to other areas of his body, including to 12 sites within his brain and to his bones. Whole-brain radiation could be used to try to shrink the tumors, and chemotherapy could be given to attack the rest of the cancer. But the side effects of this double treatment could be debilitating, with extreme fatigue and an impact on brain function. What’s more, they couldn’t be given at the same time – and time was in short supply.
“It was pretty much the worst news you can hear. Things didn’t look very good for me at all.”
Finding Another Way
Lahey medical oncologist Paul J. Hesketh, MD, looked for a better treatment option. “Today we can molecularly interrogate tumors to look for mutations which, if present, could respond to precisely targeted therapies,” he explained. These new therapies work in part by targeting the specific acquired genetic changes that lead to the development and growth of these cancers. A molecular analysis of cancer cells is typically sent to a specialized laboratory and can take up to three weeks for the results, but Dr. Hesketh knew that time was the enemy. He contacted a local biotech laboratory, which jumped at the chance to help and sent a courier to pick up the cell sample. The lab took the sample on a Friday, and Dr. Hesketh had the results by Tuesday.
“It’s all about tailoring therapy for each individual, taking into account each patient’s disease and lifestyle, and trying to marshal the enormous advances in science.”
A Targeted Therapy
The results showed Lory had a type of cell mutation called ALK, an acquired genetic change that occurs for unknown reasons. The good news was that targeted therapies exist to treat this type of cancer and generally have fewer side effects than chemotherapy and radiation. The bad news was that the most appropriate therapy in this case, a drug called alectinib that is a pill taken twice a day, is not approved as a “first-line treatment” for cancer and is intended to be used only after the currently approved therapy fails. But Dr. Hesketh felt strongly that alectinib was the best option. So once again he took action, advocating strongly to obtain the necessary approval for it to be used as a first treatment – and he was successful.
“Dr. Hesketh had to go through hoops and consult other lung cancer experts and my insurance company to get the approval for me to take that drug. He knows how much I greatly appreciate his care and personal connection.”
Within five days of starting alectinib, Lory’s breathing improved and his pain was relieved. Less than a month after starting the drug, Lory was back to weight training and playing soccer. Today, the cancer in his brain and bones is undetectable, and the cancer’s primary site in his lung is much smaller. He is feeling well, exercising regularly, and recently took a week-long ski trip to Colorado. He ultimately may need chemotherapy down the road if the effects of alectinib wane. But by the time that becomes necessary, there may be more medical advances and other drugs to treat his type of cancer.
“While advanced lung cancer isn’t yet curable, today’s therapies can keep it under control so people can live out their lives.”