Immunotherapy combination enables melanoma survivor to sail through retirement

A cancer diagnosis is never good news, but Paul McKinney knows that his stage III melanoma diagnosis at least came at a “good” time in terms of progress in treating the disease.

Thanks to a clinical trial led by Rodabe Amaria, M.D., Paul received a new immunotherapy combination that completely cleared his cancer after two doses and has allowed him to enjoy retirement cancer-free. Recently, Amaria’s team reported that the immunotherapy combination resulted in significant tumor shrinkage for more than half of patients in the study.

The Phase II clinical trial tested the combination of an immune checkpoint inhibitor called nivolumab and relatlimab, a new form of immunotherapy called a LAG-3 antibody, in patients with stage III melanoma who could safely receive the drugs before surgery to remove their cancer. The Food and Drug Administration (FDA) approved the same combination in March 2022 for inoperable stage IV melanoma.

“We feel very blessed to have had the opportunity to participate in the trial,” Paul says. “If we hadn’t gone down to MD Anderson, we wouldn’t even know about immunotherapy and all the possibilities.”

An unusual “pimple” that turned out to be cancer

Paul’s journey to MD Anderson began with a routine dermatologist visit in late 2017. What he thought was a pimple on his temple turned out to be melanoma. Paul’s doctor referred him to a plastic surgeon who said that removing the cancer would require cutting though a nerve above his eye and that he might have permanent facial paralysis. Paul and his wife Mary decided to travel from their home in Fort Worth, Texas, to Houston, for a second opinion at MD Anderson.

“We’ve known other people who’ve had very good experiences down there,” Paul says. “We knew MD Anderson was a cutting-edge research facility, and that’s what you want when you’re dealing with cancer.”

In January 2018, the McKinneys met with head and neck surgeon Randal Weber, M.D., who said he didn’t need to cut through the nerve to remove the melanoma tumor. After meeting with Dr. Weber, Paul and Mary were confident that they needed to be at MD Anderson.

“Dr. Weber and his team do that type of surgery every single day,” Paul says. “In the area where my cancer was, there are some hugely important nerves that affect your face and speech and everything else. It took me a while to fully recover all of my facial expressions after surgery, but I’m fully recovered now.”

Immunotherapy clinical trial brings hope after melanoma recurrence

After two surgeries with Dr. Weber, Paul showed no signs of cancer for about a year and a half. In June 2019, a lump appeared “almost overnight” on Paul’s neck. He knew the cancer had returned. When the recurrence was confirmed, Paul was devastated. But the clinical trial Amaria described gave him and Mary hope.

“Dr. Amaria didn’t promise anything; she presented the trial as a possibility if Paul qualified,” Mary says. “It felt like it was the greatest treatment based on the latest research.”

Paul received two infusions of the immunotherapy combination four weeks apart before his surgery in September 2019 to remove the melanoma from his neck and shoulder, plus several lymph nodes. Paul remembers that it took several weeks to receive the surgery results, but it was good news: “When they took the tumor out, they determined all the cancer cells were dead from the immunotherapy. I was thrilled and relieved.”

Paul was among the 57% of patients in the trial who experienced a pathologic complete response. That means no cancer cells were found at surgery. To help prevent the cancer from returning again, Paul received an additional 10 infusions of the immunotherapy combination every month after surgery.

“MD Anderson is very good about scheduling so everything runs smoothly,” Mary says. “During one of our trips to MD Anderson, we learned about a family emergency and needed all of our appointments rescheduled ASAP. The team worked to have us done by 2 p.m. that day so Paul could still get his infusion on time and we could leave to be with our family.”

Sailing through retirement, cancer-free

Since completing his last dose of immunotherapy in August 2020, Paul has remained cancer-free. He  returns to MD Anderson twice a year for follow-up appointments.

In between, he spends time on his boat. Shortly after his cancer diagnosis, he and Mary retired and bought a 43-foot catamaran. (Paul spent much of his career as a ship captain in the United States Merchant Marine.)

After his first surgery with Dr. Weber, they sailed the ship through the Panama Canal, and began what has now been a four-year journey to complete the “Great American Loop,” a 6,000-mile continuous route circumnavigating the eastern half of the United States.

As they cruised up the Intracoastal Waterway, across the Canadian border, through the Great Lakes and down the Mississippi and Illinois rivers, Paul and Mary have spent time exploring cities along the way and visiting family and friends. After the holidays, they’ll return to the boat, currently docked in the Tennessee River, to finish the loop in spring 2023 and earn “Gold Looper” status.

“It’s our retirement, not a race,” Paul says. “We’re just so glad that the timing worked out, and I was able to get in on the clinical trial. The immunotherapy worked really well, and we hope it keeps working – for me and others with melanoma.”

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