In April of 2013, Deborah was a busy mother of two young boys living in Brooklyn when a spot on her back came back positive for malignant melanoma. A sentinel lymph node biopsy was clear, but the pathology noted "melanoma in transit" — malignant cells already on their way to other parts of her body.
By September of 2014, the "bad stuff" had landed in her lungs. Her oncologist recommended a clinical trial combining a short course of radiation with a novel immunotherapy drug named Ipilimumab (Yervoy). But after just two infusions, Deborah developed severe, life-threatening colitis, forcing her team to halt the therapy entirely.
Then came the spring of 2015. Just days after being told her lungs showed No Evidence of Disease, Deborah woke up and realized she couldn't find the words to speak. An emergency MRI revealed nine active brain tumors.
In this first part of a special two-part feature, host Dr. Randi Paynter sits down with Deborah to trace a medical timeline that broke the speed limit of standard textbook guidelines. It is a story of rapid clinical pivots, genomic sequencing, and a quiet, non-invasive laser surgery where physicians played "Space Invaders" with her tumors while Deborah listened to Satie.
We also bring back The Epi Edit, a recurring segment where Dr. Paynter steps outside the conversation to analyze the epidemiology and science behind the lived experience. In this episode, we explore the biology of Immune-Related Adverse Events (irAEs) and why severe immunotherapy toxicities are historically correlated with exceptionally strong tumor response rates.
In this episode, we discuss:
• The "In-Transit" Alert: Why a skin lesion that refuses to heal is a critical warning sign.
• The Trial Experience: Why Deborah immediately agreed to be a clinical "guinea pig".
• The Epi Edit: The clinical paradox of high-grade immunotherapy toxicities and long-term survival.
• Gamma Knife Surgery: Demystifying non-invasive laser-guided brain surgery.
• Steroid Mania: Navigating the sleepless, hyper-chatty reality of high-dose dexamethasone.
• I'll Live: How Deborah used writing as a cognitive lifeline and connected with a patient in Northern Ireland.
-- Go to ChangedByCancer.com for show notes, blog links, and resources
Research articles & links referenced:
• Deborah's Blog: I'll Live https://ill-live.com/
• Gamma Knife Overview: A patient-friendly guide explaining how focused radiation beams treat specific brain areas without incisions. https://www.mayoclinic.org/tests-procedures/brain-stereotactic-radiosurgery/about/pac-20384679
• Understanding Immunotherapy: What Is Immunotherapy? — An accessible overview of how these treatments utilize the body's own immune system to recognize and fight cancer cells. https://www.cancer.org/cancer/managing-cancer/treatment-types/immunotherapy.html
• Targeted Cancer Therapies: A clear explanation of how "precision medicine" drugs are engineered to block specific proteins that allow cancer cells to grow. https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies
• irAEs and Response Rates: Fan Y, et al. Association of Immune Related Adverse Events With Efficacy of Immune Checkpoint Inhibitors and Overall Survival in Cancers: A Systemic Review and Meta-analysis. Front Oncol. 2021 Apr 12;11:633032. doi: 10.3389/fonc.2021.633032. PMID: 33912454; PMCID: PMC8072154. (Frontiers in Oncology, 2021). https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.633032/full
Changed By Cancer is hosted by Dr. Randi Paynter, a cancer epidemiologist. This podcast shares personal experiences and systemic issues in healthcare. It is not medical advice. Please consult your own medical team for health-related decisions.
