Checkmate: a Life-or-Death Chess Match with Melanoma

Patrick Rebholtz learned the hard way that a patient should be his own advocate when it comes to melanoma. He had a basal cell carcinoma and then a squamous cell carcinoma, but he didn't realize that he now had an increased risk of developing melanoma.

He became diligent about checking his skin and in 2017 discovered a lesion that worried him and immediately booked an appointment with his dermatologist. The doctor assured him it was nothing to worry about, but a year later his primary care doctor became concerned and sent him back to the dermatologist.

Still believing it was nothing, the dermatologist removed the lesion. Patrick was dismayed when the lesion tested positive for Stage 2 melanoma. The dermatologist had completely missed it. Patrick was shocked.

He underwent surgery and presumed a plastic surgeon would use a skin graft to close the lesion to minimize scarring, but this was not done, and a week later he developed an infection. Healing was a slow process and Patrick was left with a disfiguring scar that he feels plastic surgery could have avoided.

As part of the surgical procedure, a Sentinel Lymph Node Biopsy (SLNB) was performed to check if the melanoma had spread to his lymph nodes. The biopsy came back positive and his condition was upgraded to Stage 3. The surgeon recommended removing all lymph nodes from his groin and thigh region, but Patrick wanted a second opinion.

He had met another cancer patient who was doing remarkably well. "This guy went from Stage 4 cancer to today being cancer-free," recalls Patrick. "I wanted to see his doctor."

Patrick met with Dr. Adil Daud, a medical oncologist at UCSF Helen Diller Family Comprehensive Cancer Center, who suggested a different approach. Instead of surgery, he recommended starting a year-long course of nivolumab with the goal of removing any trace remains of cancer in Patrick's body.

Eight months later scans showed new and growing tumors, and Dr. Daub then steered Patrick towards a clinical trial using TAVO, an experimental therapy from OncoSec that is injected directly into tumors and incorporates short energy pulses to aid its transmission.

Seeking further information about the trial, Patrick visited the City of Hope National Medical Center in Los Angeles, where the oncologist ultimately agreed with Dr. Daud's treatment plan. Trial results published in 2020 confirmed that 41% of patients had a good response, and 36% had a complete response to the treatment.

Agreeing to join the trial, Patrick received Keytruda infusions every three weeks plus TAVO injections to readily accessible lesions. He found the electrical pulses painful, but they only lasted a few seconds. Thankfully there were no other side effects.

After six months, Patrick's melanoma was clinically stable. Patrick muses: melanoma is a moving target. It's a life-or-death chess match. It's a creative and devious disease. He remains diligent and will continue to advocate for his own treatment.

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