Immunology treatments providing hope for late-stage melanoma patients

"I had done research knowing it might be cancer and at the time I knew that with melanoma, they could cut it out and it would be gone," Simmons said. "And that's exactly what happened -- at first."

By 2015, however, Simmons was not feeling well, even though the screenings he had every three months following his original diagnosis and treatment had not indicated any problems. He returned to Wake Forest Baptist Medical Center in Winston-Salem for a PET scan, a type of imaging that studies metabolic changes in an organ or tissue at the cellular level.

The scan revealed that the melanoma had returned in several places in Simmons' body, eliminating surgery as an option. He was at stage IV, the most advanced cancer stage, with melanoma under his collarbone, in his hip and in his lymph nodes.

But Simmons, 56, has since been treated at Wake Forest Baptist with therapies that are giving new hope to late-stage melanoma patients.

In December, Simmons began an immunotherapy regimen -- intravenous doses of ipilimumab, a drug that helps bolster the body's immune system to limit the growth of cancer cells, and injections of a clinical-trial drug called HyperAcute Melanoma (HAM) vaccine, which is designed to help the immune system attack cancer cells.

These days, Simmons is feeling much better and doesn't at all look like a patient with stage IV cancer.

"I've been extremely fortunate," he said. "Other than fatigue and a rash, I haven't suffered any side effects."

Joyce Fenstermaker, a registered nurse at Wake Forest Baptist who sees Simmons for the HAM trial, said improvements in melanoma treatment over the past few years have been remarkable.

"Patients who have tumors that can't be removed surgically often respond to immunotherapy and can work and live a very good life taking these agents," she said.

Approximately 70,000 new cases of melanoma are diagnosed in the United States each year. In 2015, former President Jimmy Carter brought heightened attention to both the disease and recent advances in treating it. Carter announced in August that he had metastatic melanoma that had spread to his brain and liver. But in December, after undergoing surgery, radiation and immunotherapy treatment, he revealed that he was cancer-free.

Melanoma typically occurs on the skin, where it is easily noticed. Pierre Triozzi, M.D., a Wake Forest Baptist hematologist and oncologist who specializes in melanoma, said surgery has always been the best treatment option for the disease. When it is caught early, the prognosis for recovery is excellent.

By stage III, however, melanoma is in the lymph nodes, and at stage IV it has spread to other organs. At that stage, Triozzi said, chemotherapy and radiation directly targeting cancer cells can produce some shrinkage of melanomas, but neither therapy is known to prolong survival.

That's where immunotherapy has made an impact.

"It's not treating the cancer, but focusing on the host," Triozzi said. "The immune system kills viruses foreign to the body."

Still, immunotherapy doesn't work for many cancer patients because cancers are "of the body" and not necessarily seen as foreign by the immune system. Immunotherapy has proven effective, however, against certain types of cancer, especially melanoma.

Studies suggest that sun exposure and ultraviolet light, the typical causes of melanoma, damage cells in such a way that they appear foreign to the body's immune system. That, in turn, makes the immune system's response likely to be more effective when boosted by existing drugs and clinical-trial medications such as HAM, Triozzi said.

"Most of the time in the past when you had melanoma at an advanced stage, there were not a whole lot of options," Triozzi said. "Now, with all the new treatments available, there is reason for optimism. It may be too soon to speak the word cure, but with these new treatments we are seeing people even in stage IV cured of their melanoma."

Simmons said that when the HAM trial was suggested to him, he didn't hesitate to sign up.

"I said if I qualify, I'll be glad to," he said. "Even if it doesn't help me, maybe it would help somebody else."

Simmons said he willingly shares his story with his students at Ashe County High School in West Jefferson.

"I have two or three students going through cancer. We talk a lot," he said. "Maybe they can gain a boost from me."