Fourth Time’s a Charm

Four Cancers Cannot Stop Retired Dentist and Avid Hunter, Tom Evans, From Living Life to the Fullest

C3Fall2013_Final-12

Tom and Bev Evans at their house.

At the end of 2012, Dr. Tom Evans was hauling wood for a new deck up the mountain behind his house in Genesee— a climb he’d done almost every day since 1997—when his body told him to stop. He was fatigued and short of breath.

“I was doing fine—walking a few miles every day and hunting,” Tom says. “One day I couldn’t walk up the mountain to save my soul. I was exhausted. I knew something was wrong.”

At 75, Tom knows his body. He’s spent his life being active— biking up Lookout Mountain, hunting around the world, playing handball at the Colorado School of Mines, and farming in Nebraska. He’s no stranger to knee surgeries; he’s had four. One of his ankles has been fused. And he’s already heard the words “you have cancer” three times.

While many would shrug off not making the climb to being out of shape, Tom was far from it. He knew it meant trouble. He just didn’t expect cancer. Not again.

After a trip to his primary care physician and a bone marrow biopsy, the news was bleak. Tom had acute lymphoblastic leu­kemia (ALL), a fast-growing cancer impacting a type of white blood cell called lymphocytes, which help the body fight infec­tions. When lymphocytes become cancerous they grow quickly and crowd out the bone marrow, preventing it from making normal red blood cells, white blood cells and platelets. Tom was not the average patient; the cancer is most common in children under the age of 15.

Yet, despite the news, Tom said, “Let’s get’er done.” His life had already handed him many challenges. He and his wife, Bev, were ready to fight one more cancer.

A Long History Of CancerC3Fall2013_Final-13

After graduating from the University of Nebraska Medical Center College of Dentistry, Tom moved to Colorado in the 1960’s to open his own practice.

“I wanted to be in the mountains,” Tom says. “Back then I’d go up to Longs Peak for the hell of it. I had $5,000 saved so I set up an office in Golden, but I didn’t have any patients.”

As luck would have it, the Colorado School of Mines was a few blocks away. With no patients and a lot of free time, Tom started playing handball with the professors. Within a few months, he’d “recruited” his first patients.

By 1998, more than 30 years later, Tom knew it was time to retire. He was diagnosed with prostate cancer. Managing treatment and his practice wasn’t an option. Tom sold his practice and focused on beating cancer. After a radical prostatectomy and radiation, he was a first-time cancer survivor.

Seven years later cancer returned. This time he was diagnosed with squamous cell cancer at the base of the tongue. Large doses of chemotherapy and radiation were needed. Tom was fed strictly through a feeding tube and lost more than 10 pounds on his already small frame. Yet again, he survived. Doctors caught the cancer early.

Then in early 2012 Tom noticed a spot on his nose. Cancer again. Since he’d spent so many years in the Colorado sun he wasn’t surprised by the diagnosis. More surgery would be needed. This time he’d have reconstructive surgery, essentially sculpting a new nose on his face. As the caregiver, Bev recalls this time as beyond trying.

“He was quite the sight to see,” Bev recalls.

“The nose wasn’t a big deal,” Tom chimes in.

“Oh no, it was a big deal,” she says. “It wasn’t easy.”

Having survived a third cancer, Tom and Bev thought they were in the clear. Tom was feeling and looking great. A few months later, however, they received the ALL diagnosis. Doctors thought Tom’s ALL could have been due to all his previous cancer treatments.

“It’s hard,” Bev says. “Every time he has been diagnosed with cancer, I just say ‘no, no, he’s got many more years to live.’ This one has been very tough. I didn’t think we could make it through.”

Just One More

When the couple received the news, they were sent to the University of Colorado Cancer Center to see Dan Pollyea, MD, MS, clinical director of leukemia services, and Jonathan Gutman, MD, clinical director of allogeneic transplantation. Both are members of the integrated Blood and Marrow Transplant Team, a specialized group of blood cancer doctors and transplant specialists working together to develop comprehensive treatment plans for their patients.

C3Fall2013_Final-14“In other cancer centers the transplanters and non-transplanters often work separately,” says Gutman. “At CU Cancer Center our team works together very well, which in turn allows us to move quickly to treat our patients.”

The doctors informed Tom and Bev that treatment options were risky due to Tom’s age. A phase I clinical trial was his best option; chemotherapy could take his life. However, Pollyea and Gutman agreed to treat him.

“They told me it wasn’t good, but that they’d give treatment a go,” says Tom. “I told them I didn’t have a choice. I felt like hell.”

Tom was enrolled in the team’s phase I clinical trial using two drugs: entinostat and clofarabine. Entinostat is believed to stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. In tandem with clofarabine, a drug used in chemotherapy that kills and stops cells from dividing, entinostat is believed to kill even more cancer cells.

At first the two drugs worked for Tom; the leukemia cells went into remission, but then started to come back. The next option was chemotherapy. Although Tom was older, his good health and success in the clinical trial made him eligible for chemotherapy. After one dose the leukemia went back to remission—a surprise to both Pollyea and Gutman.

“Most patients in Tom’s age group have to endure at least two to three rounds of chemotherapy before we see the cancer go into remission,” Pollyea says. “With Tom it happened right from the start, which we attribute to the success of the clinical trial he was previously on.”

After 30 days in the hospital and countless side effects, Tom was ready for step three of treatment—a stem cell transplant. Luckily, Tom’s brother was a perfect match.

A “Gentle” Transplant

The common treatment for leukemia is to hit it with massive amounts of chemotherapy and radiation followed by a stem cell transplant, says Gutman, but this type of aggressive treatment can be too much for older patients to withstand.

Though transplants are not common in Tom’s age group, Gutman believed he could benefit from an non-myeloablative or “gentle” allogeneic stem cell transplant, where stem cells from a healthy person are given to a patient after mild chemotherapy.

On May 7, 2013, Tom received his brother’s stem cells.

“Patients of Tom’s age historically have a very poor prognosis, but he’s been able to take advantage of several of the clinical trials we have to offer,” Gutman says. “We were able to work smoothly and efficiently to move him on a trial and then seamlessly take him to stem cell transplant.”

But Tom and Bev didn’t want to stop at the transplant. They wanted something to increase Tom’s choice of cure. Turns out, Pollyea and Gutman were recruiting patients who were at high-risk of post-allogeneic stem cell transplantation relapse for a new clinical trial. Tom was one of the first to enroll.

“We figured why not try a drug that has the chance of cancer never reoccurring,” Bev says.

Mopping Up The Disease

Earlier this year, with grant funding from the Leukemia & Lymphoma Society, Pollyea started the first clinical trial focused on finding a maintenance therapy for patients post-transplant. Currently, no maintenance drugs for the post-transplant setting exist.

He decided to approach Pfizer about using their investiga­tional drug PF-04449913. The drug has been shown to inhibit the hedgehog signaling pathway, which tells cancer stem cells to regenerate killed cancer tissues.

“In a healthy person the hedgehog signaling pathway is only activated when you are a fetus. During the rest of your life it is minimally active,” Pollyea says. “In adults an abnormal activation of the pathway can lead to various cancers through the transfor­mation of adult stem cells into cancer stem cells.

Pollyea and Gutman hope PF-04449913 will “mop up any leftover disease,” says Pollyea. While doctors always hope to cure patients afterC3Fall2013_Final-15 transplant, they know relapse is a possibility.

“As a physician, most of the time we let our patients go after their transplants and simply wait and see if the leukemia comes back,” Gutman says. “If our experiment with maintenance therapy works, we’ll be able to offer a pill to our patients and decrease the risk of relapse.”

Currently, the trial is being expanded to the Fred Hutchinson Cancer Research Center in Seattle, Wash., so that more patients can be recruited. They intend to recruit 28 patients.

Beyond providing a maintenance drug, Pollyea hopes the study will help them get better at predicting which patients will benefit from using it. In order to do so they’re continuing to look at what risk factors make patients more prone to relapse.

Only time will tell if the transplant and drug are working for Tom.

“It’s going to be a year before we know that the transplant worked,” Bev says.

And if it doesn’t, Tom says, “There are no other options.”

Slowing Down

In the meantime, Tom and Bev have been continuing to enjoy life, checking off items from their bucket list left and right. They’ve traveled to Indonesia, Turkey, Costa Rica, India and Vietnam, to name a few. But their main passion has always been hunting. After all, an elk hunting trip in below freezing weather in the early 1990’s is what brought the two together.

“When she went elk hunting with me for the first time and camped out in the snow, I knew she was the one,” says Tom. Despite being a petite woman, Bev can hold her own in the wilderness.

Over the years, they’ve been able to combine their love of hunting and travel on several international hunting trips to Zambia, Tanzania, South Africa and Argentina. They even renovated their old cabin to showcase the many animals they’ve accumulated.

However, all the adventures stopped after Tom’s diagnosis. Tom has had to learn to sit still.

“It’s really hard to not be active. I’d walk to the top of the mountain every day. Now I just sit around,” Tom says. “I can’t wait to start lifting weights and walking again. You go crazy sitting around all day.”

The one thing the couple has kept up with is visiting their two farms in Nebraska—a place where Tom finds rest or where Bev tries to keep Tom from mowing the yard and riding the tractor. Tom says getting back to his farm is on the top of his list.

“I’ve hunted plenty,” he says. “I don’t need any more heads.”

Instead he needs his farm and his tough wife to keep him going.

“She’s really protective,” says Tom. “If it wasn’t for Bev, I would never be able to take care of myself—I couldn’t even remember to take all those pills.”

As for Bev, she’s become the expert caregiver after all these years. “He’s gotten through all of the other cancers, but I really thought this was going to be it,” she says. “It’s been a long haul, but we’re now starting to see the end of the tunnel.”

The end of the tunnel is May 2014—a year post transplant. If Tom’s leukemia comes back, it will come back within the first couple of years. Until then, Tom’s learning to rest and finding more to add to his bucket list.

“I’ve gotten beat up all these years, but I’m still kicking,” Tom says. “I’ve got a lot left on my list to complete.

“I may not make it another year, but I sure hope so.”

FacebookTwitterGoogle+Share

About the author: Kim Chriscaden

Kim Chriscaden is the former communications manager for the University of Colorado Cancer Center.

Comments are closed.