James Mangan is a world-class rowing coach who has led elite teams in his native Ireland and in the United States all the way to the Olympics. So when he learned he had a serious skin cancer, he was concerned not only for his health but for his ability to continue the work he loved.
“To me, it’s not just a job or a career,” he says. “It’s something I’ve spent my whole life doing and become quite successful at, because I love coaching.”
James says he found a kindred spirit in head and neck medical oncologist Lara Dunn, MD, as she laid out a treatment plan for the squamous cell carcinoma, a type of skin cancer, which had spread to his parotid, a salivary gland. “As a coach, you have to be very honest with athletes but also empathize with them and kind of manage their emotions,” he says. “With her, it was like I was with a good coach. She’s one of the most amazing people you can meet.”
For Dr. Dunn, their rapport grew as they talked about their families. “I really want to know what’s important to my patients,” Dr. Dunn says. “Cancer may be very dominant at the time we meet, but it is only a small part of who they are as a person.”
Helping Head and Neck Cancer Patients Get Back to What They Love
Dr. Dunn is one of more than 70 doctors, surgeons, and other experts on the head and neck cancer team at Memorial Sloan Kettering Cancer Center (MSK). The MSK Head and Neck Service was founded in 1914 as one of the first in the U.S. to specialize in the treatment of head and neck cancers, which now encompass more than 20 types of malignancies affecting the vocal cords, sinuses, oral cavity, salivary glands, ears, and more.
MSK specialists are globally renowned for their expertise and for their work in pioneering research and clinical innovations that continually improve the lives of patients.
The bedrock on which everything rests, says head and neck surgeon Richard Wong, MD, Chief of the Head and Neck Service, is a determination to help patients regain their health while also living their best lives after cancer.
“If this was your own mother or brother,” he says, “what do we think would work best?”
Finding Alternatives, Like Immunotherapy to Life-Altering Head and Neck Surgery
For James, the answer was immunotherapy, which uses the body’s own immune system to help fight cancer.
James’ cancer journey began when he was diagnosed at home, in Ireland, after he noticed lumps on his neck. Doctors in Ireland concluded he had skin cancer that had spread and recommended major surgery to his head and neck region.
“They were talking about doing some really severe surgery,” James recalls, “which is something I don’t like thinking about anymore.”
Friends encouraged James to get a second opinion in the U.S., where he lived for 20 years. He eventually came to MSK for a consultation with Dr. Wong. He found that the cancer was extensive and in close proximity to a facial nerve. The two facial nerves each control the motion of one side of the face and are critical for smiling, blinking, and facial expressions.
Surgery to remove the cancer might involve removing the facial nerve, which would be severely disfiguring. “If you cut a facial nerve,” explains Dr. Wong, “the entire side of the face becomes paralyzed and drops, similar to a stroke.”
Instead, he thought James was a good candidate to try immunotherapy, in the hope it might shrink the cancer enough to reduce the severity of surgery. Dr. Wong sent James to Dr. Dunn, whose research and clinical expertise includes immunotherapy.
Dr. Dunn put James on a medicine called cemiplimab (Libtayo®). This is a kind of immunotherapy known as a checkpoint inhibitor, which makes tumor cells easier for immune cells to identify and destroy. The results were — in a word — remarkable.
The cancer shrank significantly in a matter of months. James then underwent a much smaller operation to remove a tiny focus of residual cancer. And his facial nerve remained completely intact. James was also able to avoid receiving radiation therapy after his surgery.
He’s now cancer free.
“We explained the options to James, and he decided that he wanted to stay with immunotherapy alone and not have a larger surgery or radiation,” says Dr. Dunn. James continued on the cemiplimab for eight more months and has now completed his treatment.
“I was so relieved when they told me they couldn’t see any more cancer,” recalls James. “I told Dr. Dunn I almost couldn’t believe it. Now that’s what you call quite a good day.”
James returns to MSK periodically for exams to make sure the cancer has not come back. “He leads an active life as a coach, and we hope this immunotherapy approach will benefit him for a long time to come,” says Dr. Dunn.
Thyroid Surgery That Considers Life After Cancer
Dr. Wong says finding the right balance between treatment and quality of life is an MSK expertise. “We’re always very focused on what life may look like for a patient after treatment,” he explains.
Thyroid cancer is another of many examples where doctors offer successful treatment while minimizing side effects. “We do a high volume of thyroid cancer surgeries here and manage patients with aggressive disease,” says Dr. Wong. “However, many other people have very small thyroid cancers that can remain dormant for many years and pose no threat. For these people, MSK offers thyroid cancer active surveillance programs where we monitor the disease but don’t treat it unless necessary. Many patients are able to avoid surgery completely.”
MSK’s Expertise in Minimally Invasive Surgeries for Skull Base and Vocal Cord Cancers
Many surgeries have been modified to focus on minimizing side effects and to expedite more rapid recovery. Skull base tumors present a particular challenge, since these are located below the brain and near the eyes, in anatomic areas that are difficult to access. Minimally invasive approaches to removing skull base tumors now make it possible for skull base surgeries to be performed through the nostrils, using intraoperative imaging, to avoid facial incisions. Similarly, selected vocal cord cancers that impair a person’s voice can be removed with special techniques using a microscope and laser.
Game-Changing Head and Neck Clinical Trials at MSK
Another pillar of excellence is research that stretches from the laboratory to patient exam rooms.
“We’re curing more patients, so they live longer and better,” says medical oncologist Alan Ho, MD, Chief of the Head and Neck Oncology Service. “Having said that, it’s quite clear that the existing options are just not good enough. And that’s where clinical trials come in.”
Dr. Ho’s research focuses on targeted drugs that attack the molecular characteristics driving a patient’s tumor, which can play a role in fueling cancer’s growth.
He is encouraged that the pace of research for head and neck cancers at MSK is constantly improving, bringing new treatments to patients sooner. “In the past 15 years, we’ve done over 10 trials involving different salivary tumor types,” he says. “And those trials have really moved the needle in helping patients.”
Improving quality of life and reducing side effects is also a major focus of research for the radiation oncologists. Dr. Ho praises the “game-changing” clinical trials for patients whose cancers are positive for HPV — the human papilloma virus — that are led by radiation oncologist Nancy Lee, MD, Service Chief, Head and Neck Radiation Oncology. “She and her team are dramatically reducing the amount of radiation we give to these patients without reducing the cure rate,” says Dr. Ho.
It’s more evidence, he says, “that how our patients live after treatment is a very close second to curing them. It’s just so important.”
Living Life Fully Recovered From Head and Neck Skin Cancer, Thanks to MSK
For James, life after treatment remains active and full, including spending time with his family and raising money for cancer research. He continues to coach high-level rowing teams, which he says is more rewarding than ever. “I really feel I’m mentoring and developing young people.”
He’s also very conscious of remaining healthy. “I take care of myself by staying out of the sun and eating right. Coaches don’t live a very crazy life anyway,” he says with a laugh.
He believes in minimizing stress and credits Dr. Dunn for her calming influence.
“If I have questions, I know I can ask. I feel comfort knowing I’m in the hands of Dr. Dunn and the people of MSK.”
Dr. Wong’s research is supported by the MSK donor community, including The James & Judith K. Dimon Foundation and Leerom and Karolina Segal.
Dr. Wong holds the Jatin P. Shah Chair in Head and Neck Surgery and Oncology.