Joe Roth and Brian Landers had similar diagnoses.
Both had recurrences of melanoma after an initial bout with the disease.
Both were treated at the University of California, San Francisco (U.C.S.F.).
The big difference was Roth, a star quarterback at U.C. Berkeley, received his diagnosis in 1976. He died from the deadly skin cancer in February 1977.
Landers, a fifth grade teacher in the San Francisco Bay Area, received his diagnosis in 2014. He survived and returned to the classroom this fall.
For decades after Roth died, there wasn’t much advancement in treatment for melanoma. Then, treatments involving immunotherapy came along.
That’s what saved Landers.
If he had had his recurrence even five years ago, he probably would’ve died.
If Joe Roth were being treated today would he have survived?
The answer is … maybe.
“No one knows for sure what would happen today,” said Dr. Len Lichtenfeld, the deputy chief medical officer at the American Cancer Society. “But the opportunities for treatment and the hope for a positive outcome are much higher today than they were back then.”
Melanoma Treatment in 1977
Roth starred as a quarterback at Granite Hills High School and Grossmont Community College, both in San Diego County.
While at Grossmont in fall 1973, Roth was diagnosed with melanoma. He received treatment and was given a relatively promising prognosis.
In fall 1974, he led Grossmont to the California community college championship. He was recruited and ended up going to University of California, Berkeley.
He led the 1975 Cal football team to an 8-3 record and a co-championship of what was then the Pac-8 conference.
U. C. Berkeley quarterback Joe Roth Image source: Robert Kaufman
Roth was getting noticed for his unflappable leadership on the field (he was dubbed “Joe Cool” a decade before Joe Montana earned the same moniker with the San Francisco 49ers). Before the 1976 season, there was talk of the Rose Bowl, the Heisman Trophy, and a first round pick in the NFL draft.
However, during that season Roth noticed some lumps and moles on his chest. After visiting the team physician and then a doctor at U.C.S.F., he was told his melanoma had returned.
He was told he probably only had months to live. Roth played the rest of the season. His abilities on the field declined, but he kept his diagnosis under wraps until January.
On February 19, 1977, Roth died at his Berkeley apartment at the age of 21.
A documentary about his life will air on the Pac-12 Network this weekend. On Saturday, the Cal football team will play its annual Joe Roth Memorial Game.
Lichtenfeld, who joined the National Cancer Institute in 1972, said there was little doctors could do for someone like Roth who had advanced melanoma in the mid-1970s.
“There really wasn’t much in terms of treatment,” Lichtenfeld told Healthline.
If the cancer was caught early enough, sometimes surgery would remove all the cells.
If chemotherapy was necessary, doctors had a drug called DTIC they could administrator. They could also try a compound called BCG, which basically involved injecting a patient with a modified strain of tuberculosis bacteria.
“The bottom line was we didn’t have a lot that was effective,” said Lichtenfeld.
What medical experts did have then, however, was a theory that would plant the seeds for today’s successful treatments.
In the early 1970s, Lichtenfeld said researchers recognized that a person’s immune system did recognize cancer cells as foreign invaders. However, cancer seemed to have a way to avoid being attacked.
“Interest was just starting then in finding ways to harness the immune system,” said Lichtenfeld.
Melanoma Treatment in 2015
Despite a huge amount of research, treatment for melanoma didn’t advance much in the first 30 years after Roth’s death.
Some vaccines to battle the cancer and boost the immune system were introduced, but had limited success. Eventually, drugs like interferon and interleukin-2 were approved. They too had only marginal success.
It was during this time that Landers had his first cancer scare.
In 1994, when he was in his mid-30s, the schoolteacher got his first melanoma diagnosis. Surgeons removed the cancerous cells and told Landers that it appeared the cancer hadn’t spread.
Landers lived a healthy life for the next 20 years until February 2014 when he ended up in the emergency room for massive bleeding in his gastrointestinal system.
Doctors had trouble finding the source of his bleeding, Landers told Healthline. They ended up cutting out more than 2 feet of his small intestine.
Brian Landers and his wife, Van Image source: Courtesy: Brian Landers
Eventually, they discovered the cause: melanoma had spread and formed tumors in his intestine, lungs, and bladder.
Landers was lucky. Had his melanoma spread at a typical pace, it would’ve killed him a long time ago.
Landers credits his naturally strong immune system for slowing down the melanoma spread and buying him enough time for research to catch up.
Lichtenfeld said the tide turned in the battle against melanoma around 2010, when immune therapy became a viable treatment.
In addition, Lichtenfeld said, scientific research on genetic markers helped doctors understand more about how cancer works.
Researchers found that cancer cells have a mechanism that essentially deactivates the immune system’s response to the deadly invaders, allowing the cells to grow and migrate.
Among other things, researchers have developed treatments that block this mechanism, permitting the immune system to attack cancer cells.
“It in essence takes the brakes off the immune system,” said Dr. Alain Algazi, an oncologist and melanoma specialist at U.C.S.F.
In May 2014, Landers went to U.C.S.F. to be treated by Dr. Adil Daud, the director of melanoma clinical research at the university’s Helen Diller Family Comprehensive Cancer Center.
The first intravenous drug they tried had no effect. So in July 2014, Daud gave Landers a brand-new experimental drug called pembrolizumab.
It didn’t take long for Landers’ tumors to shrink. They eventually disappeared. He said all that is left in his lungs, bladder, and intestines is scar tissue. He’ll continue the intravenous treatment every three weeks until August 2016.
“The timing was amazing for everything,” Landers told Healthline. “I feel incredibly fortunate.”
Hope for the Future
Despite all the recent advances, there’s still a lot of work to be done.
Lichtenfeld said there was almost zero chance of long-term survival in 1977 for any melanoma patient like Roth, even with chemotherapy.
Today, 35 to 40 percent of melanoma patients getting chemotherapy respond positively to treatment, he said.
But that still means 60 percent or more don’t.
“We’ve made substantial progress, but we recognize we have a ways to go,” Lichtenfeld said. “The treatments are still not helping enough people.”
Lichtenfeld said researchers are working in several directions.
One is the development of new drugs. Just this week, the Food and Drug Administration approved Imlygic for melanoma lesions in the skin and lymph nodes, and Yervoy, a drug that helps prevent melanoma from returning after surgery.
Then, in early November, the FDA approved Cotellic to be used in combination with vemurafenib to treat advanced melanoma that has spread to other parts of the body or can't be removed by surgery.*
Drug combinations, in fact, are being recommended more and more often.
Meanwhile, more research is being done to understand the mechanics of cancer, in hopes of providing successful treatments earlier to patients like Landers.
That’s what has happened with former President Jimmy Carter. The 91-year-old Carter was immediately started on a new radiation and drug combination therapy in August after it was discovered his melanoma had spread to his brain.
Landers is optimistic about his own future. He knows the cancer could reappear, but he’s confident medical research can keep up with his disease.
“I think cancer care is finally advancing in big steps,” he said.
*This story was updated with this development on Nov. 10, 2015.