It was on a fateful weekend in August 2016 when Lory Molesky, a healthy and fit Principal Software Engineer with a doctorate in computer science, thought he was coming down with the flu. He had to sleep sitting up to ease his uncomfortable chest pressure. He tried playing soccer that Sunday but couldn’t take three steps without becoming winded.
A Monday-morning trip to Lahey Outpatient Center, 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.
When Mr. Molesky arrived at the outpatient center, his heart rate was elevated and an EKG showed an abnormal heart rhythm. An urgent ambulance trip brought him to Lahey Hospital & Medical Center, where cardiologist Ajay Sharma, MD, quickly diagnosed cardiac tamponade, a potentially fatal condition in which fluid collects in the sac surrounding the heart and dangerously compresses it.
Mr. Molesky also had a pleural effusion, in which fluid collected around his lungs and caused his left lung to collapse. Nearly a liter of fluid was drained from his body, and the medical team searched for the cause of his condition, which could have been a bacterial or viral infection – or cancer.
Pretty Much the Worst News
A married father of two college-age children, Mr. Molesky, who has never smoked, was diagnosed with stage 4 lung cancer that had spread to 12 sites within his brain and to his cervical bones. “It was pretty much the worst news you can hear,” he recalled. “Things didn’t look very good for me at all.”
Lahey medical oncologist Paul J. Hesketh, MD, who took over the case after the diagnosis, recalls how ill Mr. Molesky was when he first arrived at Lahey.
“He presented in about as dramatic a fashion as you can,” Dr. Hesketh said. “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.”
In a situation such as this, 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.
“I’m more of a logical-type person, not really an emotional type,” Mr. Molesky reflected. “I was thinking of how much time I have left and what to do with it.”
Finding Another Way
Dr. Hesketh looked for a better treatment option.
“Everyone’s cancer is different, but today we can molecularly interrogate these 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 out to pick up the cell sample personally.
“They took the sample on a Friday, and we had the results by Tuesday,” he said.
The results showed Mr. Molesky 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 without having to put Mr. Molesky through toxic chemotherapy and potentially harmful radiation, and would be more effective than the targeted drug currently approved for initial treatment of ALK mutant lung cancer. 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.
Within five days of starting alectinib, Mr. Molesky’s breathing improved and his pain was relieved. When Dr. Hesketh saw him a week after that, his patient was feeling even better. And two weeks later – less than a month after starting the drug – Mr. Molesky was back to weight training and playing soccer.
“I’ve been in this field for a long time, and seeing a pill have this kind of impact on cancer is really remarkable,” Dr. Hesketh said. “He’s had no major toxicities. The main effect is that it makes him sleepy for several hours after taking it.”
Today, the cancer in Mr. Molesky’s brain and bones is undetectable, and the cancer’s primary site in the lung is much smaller. He is feeling well, exercising regularly, and recently took a week-long ski trip to Colorado. He works from home in the mornings until the sleepiness from the drug wears off, and then goes into his office at Oracle in Burlington in the afternoons.
“I feel as if I’ve dodged a bullet – or maybe a land mine,” he said.
Beating the Odds
The average survival rate for stage 4 lung cancer is less than a year, but Mr. Molesky certainly seems to be beating the odds. 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.
“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,” Dr. Hesketh said.
Mr. Molesky watched his daughter graduate from Tufts University last spring and helped her relocate to her job in California, where his son is at Cal Tech. He remains grateful to his Lahey caregivers and especially to the oncologist who has worked so hard on his behalf.
“Paul Hesketh had to go through hoops and consult with experts to get the approval for me to take that drug,” he said. “He knows how much I greatly appreciate his care and personal connection.”
For more information on Lory’s journey, check out the Cancer Institute.