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David D. receives immunotherapy for melanoma

He rides with purpose. Along the rural stretches of Snoqualmie Valley, David Dunnington rides for hours and miles in his steadfast determination to make inroads against cancer. “When I'm riding my bike, I’m thinking—I’m back. I think about what it feels like — the wind in my face. I feel how lucky I am to have gotten to this place. I just feel very grateful.”

He rides with purpose. Along the rural stretches of Snoqualmie Valley, David Dunnington rides for hours and miles in his steadfast determination to make inroads against cancer. “When I'm riding my bike, I’m thinking—I’m back. I think about what it feels like — the wind in my face. I feel how lucky I am to have gotten to this place. I just feel very grateful.”

David’s life took an unexpected turn in 2012 when he was diagnosed with Stage IV acral lentiginous melanoma, the rarest and most aggressive form of melanoma.

It started with a discolored patch of skin, a lesion on the bottom of his right foot and spread quickly. Unrelated to sun exposure, David’s condition is so rare it strikes less than five percent of the population. Surgeries and radiation treatments failed to bring his cancer under control.

With time running out and no effective treatment in sight, David said his hope was diminishing.

Doctors would have to amputate his leg, starting from below the knee because of the radiation damage suffered while treating the melanoma. “I wasn’t doing very well,” he said.

Lesion An area of abnormal tissue. A lesion may be benign (not cancer) or malignant (cancer). Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
David D receives immunotherapy for melanoma

Trial helps President Carter

At the same time, he learned of an investigative immunotherapy drug underway, one that could possibly help him at Seattle Cancer Care Alliance (SCCA). “Until recently the widespread use of immunotherapy in cancer treatment was unfathomable. But, the dogged persistence of the believers in immunotherapy is now making a huge difference for patients,” said Dr. Shailender Bhatia, a medical oncologist at SCCA. Dr. Bhatia treated David and it was his investigative therapy that saved his life.

This new therapy would revolutionize melanoma treatment and be used to treat former President Jimmy Carter, who was diagnosed with Stage IV metastatic melanoma in 2015.

“Because of its success, immuno-oncology is now a standalone medical field and most major pharmaceutical companies are rapidly building up their immunotherapy research efforts. New immunotherapy drugs are being approved rapidly and are being used not just to treat established cancers, but also to prevent recurrences and, amazingly, even the initial development of certain cancers,” Dr. Bhatia said. “And we now know from our experience with immunotherapy and these drugs that it is not at all unrealistic to think President Carter’s amazing response could continue for months or even years. This was almost unthinkable a decade ago.”

Melanoma has a predilection for spreading — to metastasize in medical terms — to challenging locations such as the brain, Dr. Bhatia said. In President Carter’s case, metastatic disease involving the brain used to have an average survival of only a few months. As recently as 2010, treatment options for metastatic melanoma mostly included chemotherapy, which was usually ineffective, and sometimes surgery or radiation to extend the patient’s life or to transiently relieve symptoms.

“Seattle Cancer Care Alliance has been a strong believer of immunotherapy from the very beginning,” said Dr. Bhatia. “It was based on a strong belief that our immune system has the power to eradicate cancer cells completely. What we have seen over the last few years is that indeed, when stimulated the right way, the immune system can work really well.”

Hope and relief

New immunotherapies render hope for long-term survival even in the direst circumstances.

David details the hope he has given:

“The clinical trial involved a blood draw and a visit to the infusion center at SCCA. I started with four infusions three weeks apart. Once the drug was mixed and placed into my arm it took 30 minutes to drip into my vein.

“To stay on the trial the target tumor had to have shrunk substantially like about 45 percent. Mine had shrunk by 50 percent and thus I was allowed to stay on the trial. The side effects were rash on my leg and some fatigue but nothing like the side effects from previous treatments.

“It was fantastic to have such great results and not feel sick. After the 12 weeks I had a CT scan and that is when at the appointment to review the first results, Dr. Thompson said ‘Well I have good news; all of your tumors have shrunk by 50 percent.’ He was so happy and needless to say so were we.”

“The experience was a mixture of anticipation, hope, and with the first results complete relief. Like a huge weight of worry was lifted and I could breathe again. Life is very precious and to have it back again is a gift.”

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Infusion An injection of medications or fluids into a vein over a period of time. Infusion An injection of medications or fluids into a vein over a period of time. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Melanoma Cancer that begins in the melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but it can also begin in other pigmented tissues, such as the eye or the intestines. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Back on the road

Now, David’s giving back to the people who cared for him and to raise funds for lifesaving treatments that include immunotherapies.

“We’re in a golden age of cancer research,” David said. “They’re getting to the point now where all the years of research that was required is now yielding results.”

His gratitude extends across time and place; to his care team at SCCA, researchers at Fred Hutchinson Cancer Research Center, his wife, Janet, sons, Nathan and Spencer, family and friends who have so generously donated to his fund-raising efforts and to fellow cyclists, each devoting their time and muscle in the ride against cancer.

“What is important is keep up the awareness for cancer research and for survivors like me to know we have a lot to be thankful for and our success co,” he said.

David trained for six months to complete the arduous 100-mile trip during the fifth annual Obliteride, Fred Hutch’s fundraising event. He joined more than 2,000, riders and alone raised $7,000.

“I feel proud that I am able to ride my bike and go the long distance to raise money for research that saves lives,” David said. “These are miracles made by scientists who have dedicated their lives to discovering how to treat and maybe even cure some cancers in our lifetime. There is no other profession with a more noble purpose.”

Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies.