Remission Impossible?

By Holly Lang

Remission Impossible?

Pancreatic cancer survivor Howard Young has been running the race of his life

By Holly Lang

An avid hunter and golfer, a devout Christian, a busy executive, and a loving family man, Howard Young has always felt almost indestructible.

“Everybody’s bulletproof at 42,” says the tall, lean Young, who settles back into a chair in his office just northwest of downtown Atlanta, where he helps to run a beverage business called General Wholesale Beer Company. “The only time [I’d] been to the hospital was to get my wisdom teeth taken out.”

An owner of the company, Young often travels for work, and it was after a 2002 trip to Mexico that he felt unusually weak and tired, something he attributed to a possible bug he may have picked up while out of the country.

“I just figured it was something like that,” says Young, now 46. “That maybe I just needed a shot [of medicine], and it’d go away.”

Young booked an appointment with internist Lonnie Herzog, who has been the Young family’s doctor for several years. Once Herzog examined Young, he was immediately concerned.

“He just didn’t look right,” says Herzog. “He looked like he was losing some weight. He was jaundiced.”

After a negative hepatitis test, Herzog ordered a CT scan that showed a large mass in Young’s pancreas, a fish-shaped organ just behind the stomach that creates insulin and produces hormones that break down food in digestion. Young’s diagnosis, pancreatic cancer, was a surprise. He had always felt healthy, and was physically active. He knew of no one in his family who had had cancer.

Usually caught late, long after it has moved into other areas of the body, pancreatic cancer typically has few noticeable symptoms in its early stages. Though it’s often treated with an aggressive regime of surgery and chemotherapy, most patients do not live more than a year. In 2006, according to the American Cancer Society, an estimated 33,730 people will be diagnosed with the disease; an estimated 32,300 will die.

Young didn’t know any of this when he was diagnosed. “I knew cancer was serious, but I didn’t know how serious pancreatic cancer was,” he says. He quickly learned. “I was terrified. All the internet research [I did on the cancer], it was so negative.”

But ever the businessman, Young immediately looked toward solutions. “I never thought, ‘Why me.’ I just thought, ‘Okay, what do we need to do, what are our next steps, and how do we go about getting me well,’ ” he says.

For a pancreatic cancer patient, Young was one of the lucky ones: His cancer was stage I, contained in the pancreas. Doctors scheduled a Whipple procedure for Dec. 26, 2002, just seven days after Young’s diagnosis. The Whipple, the most common surgery used to treat pancreatic cancer, is named after surgeon Allen Whipple, who first described it in 1935. The surgery removes the head of the pancreas, a section of the small intestine and, frequently, a portion of the stomach. Surgeons also remove parts of other nearby organs and tissues. It’s estimated that only about 20 percent of all pancreatic cancer patients are eligible for the Whipple, which can’t be done if the cancer has spread.

Though Young remained in the hospital for only five days, complications kept him returning intermittently for more than a month. He shed more than 35 pounds and internal bleeding left him weak. Meanwhile, Young’s wife, Becky, took charge of the family, shuttling their three daughters—now 14, 18 and 21—to school and other activities before heading to the hospital to visit her husband.

“She was a like a rock for our children, emotionally,” Young says. “She was very stable, focused on getting them to school in the morning, even though I wasn’t there.”

“And the girls, I called them my ‘steel magnolias,’ ” he says, his eyes bright at the memory. “They were just so amazingly strong through all of it.”

At work, too, Young had help from family. “I was blessed to work in a family business so that I could take the time off to get well without fear of losing my job,” Young says. “I was able to pass things off … to my younger brother, who stepped in and took on my role at the company. It was nice to not have that worry.”

Throughout his treatment, Young was looking forward to returning to his busy life of travel and work, of hunting and golfing, and, most of all, to his family and church. He says this desire strengthened his will to overcome his cancer, and to regain his life.

Once recovered from surgery, Young underwent chemotherapy for 13 months. There was no sign of his cancer, but doctors told him the chances it could return were high. According to the National Cancer Institute, even after the Whipple procedure, five-year survival rates for those diagnosed with stage I pancreatic cancer range from 18 percent to 24 percent. “I was basically told that no matter [what we did], it could still come back, and I could still die,” says Young, who began to seek out other cancer patients and to research clinical trials and other options.

A fellow pancreatic cancer patient told Young about the Translational Genomics Research Institute, or TGen, and about Daniel Von Hoff, a medical oncologist who heads the institute’s pancreatic cancer research program. A nonprofit medical research institute in Phoenix, TGen attempts to use genetic information to diagnose diseases early and to develop new treatments. Among its projects are ones aimed at creating early detection tools and therapies for pancreatic cancer.

When researchers at TGen examined a sample of Young’s tumor, they discovered on the cancer cells certain proteins known as epidermal growth factor receptors, which play a role in how cells grow and differentiate. “They told me they had something that could target that,” says Young.

Though the U.S. Food and Drug Administration (FDA) hadn’t yet approved Erbitux (cetuximab) for commercial use, the researchers believed this drug—which interferes with the binding of molecules that activate epidermal growth factor receptors—might disrupt a tumor’s growth and prevent Young’s cancer from returning.

“I said, ‘Let’s do whatever it takes,’ and waited for it to be available,” says Young, who began taking the drug almost the day the FDA approved it—for colorectal cancer—in February 2004. Clinical trials testing Erbitux for pancreatic cancer have since been started.

Four years after his diagnosis, Young is now in complete remission, something he attributes to early detection of his cancer, an aggressive surgery team, and the use of Erbitux and a lung cancer drug, Iressa (gefitinib), which targets epidermal growth factor receptors. (Following disappointing clinical trials in lung cancer patients, the FDA decided that Iressa should be used only in clinical trials or by patients who have previously experienced improvement taking the drug.)

Young also cites his faith in God—and the prayers of others—as two driving forces in his recovery. He has started a Cancer Care Team with other members of the congregation at Peachtree Presbyterian Church, which he and his family regularly attend. The group reaches out to church members who have been diagnosed with cancer.

Young is also the chairman of TGen’s National Pancreatic Cancer Committee, for which Von Hoff serves as the scientific leader. The committee—one of TGen’s National Advisory Councils, which are headed by melanoma survivor Sen. John McCain of Arizona—works to recruit and support patient advocates across the country and raise money for TGen’s pancreatic cancer research projects. An occasional runner, Young brought in almost $60,000 for the committee through sponsors when he ran Atlanta’s 10K Peachtree Road Race in 2005—and $25,000 more in 2006.

On a more individual level, the Atlanta businessman fields calls from others who have been diagnosed with pancreatic cancer, offering his support. “Anything I can do to help someone feel better, to know there is a chance,” says Young.

While Herzog uses Young’s remission as an example of that small chance of recovery for some of his patients, he’s careful to do so with caution. “Almost all of my other patients have died,” he says. “It’s hard to use [Young] as a statistic, but you can use him as a hope, as a possibility, [because] when they say 99 percent of the people will die of the disease, that still means one in a hundred will live.”