“You don’t know how strong you are until being strong is the only choice you have.”
Those words grace a sign hanging in Matteo Abbruzzese’s house in Saratoga, Wyo. The phrase follows him as he trains horses, crafts tried-and-tested rawhide and leather products for other working riders, and cooks dinner for his wife Samantha and their twin sons. And those words have echoed in his head since 2013, when he was first diagnosed with Stage 3 melanoma at the age of 23, and during a cancer recurrence in 2015 that nearly killed him.
“The level of care at Mass General gave me a future. It’s why I’m still alive.”
Thanks to Teo’s strength —physical, mental, emotional — and the relentless, creative tenacity of Donald Lawrence, MD, and the cancer team at Massachusetts General Hospital, the road didn’t end in 2015. Teo became one of the first patients to undergo a novel combined immunotherapy treatment for melanoma, an incredible breakthrough that Dr. Lawrence says has transformed the disease from incurable to potentially one of the most curable cancers. With the scientific evolution that began with Teo’s case, Dr. Lawrence has high hopes for future cure rates that could reach 75 percent.
“The science that has gone on over the last five to 10 years has been incredible,” Dr. Lawrence says. “We’ve been seeing miracles like Teo’s case for a decade, and we’ve almost gotten used to it. But there’s a ceiling to patients who can benefit. With the promise of new therapies we’re exploring, we’re starting to chip away at that ceiling.”
“The level of care at Mass General gave me a future,” Teo says. “It’s why I’m still alive.”
Much Too Young
After graduating in 2013 from Colorado State University with a master’s in agriculture, Teo moved next door to his parents’ farm in Turner, Maine, to raise a grass-fed cattle herd on their property. But his parents, Chris and Kate Abbruzzese, were more concerned with Teo’s shoulder than the steers that would soon graze outside: he had a large mole with the hallmark warning signs of skin cancer.
A dermatologist in nearby Lewiston confirmed it was melanoma. Surgeons at the local hospital excised the mole, grafted skin from Teo’s waist to his back and, because of the mole’s large size, removed 12 lymph nodes for a biopsy. One node came back positive, which meant Teo’s melanoma was classified as Stage 3. His oncologist in Maine told him he had two options: begin an immunotherapy called interferon, the standard melanoma treatment at the time, or contact Mass General about a clinical trial for a drug called ipilimumab, which at that point had been approved only for Stage 4 cancers. To measure outcomes, half the participants in the trial would receive ipilimumab; the other half would receive interferon.
“It was almost a no-brainer,” Teo says. “We knew interferon outcomes weren’t always great for my case, but it was the only option we had that might work. We decided to go for the trial and hope for something new.”
What Teo was randomly assigned in the trial, though, was interferon. Dr. Lawrence and Riley Fadden, NP, a nurse practitioner on the melanoma team, told Teo the goal was make it through a year of the treatment. Many patients only reached eight or nine months because of the treatment’s side effects, which could range from flu-like symptoms and autoimmune reactions to anxiety and depression. Teo completed eight months — seeing a counselor in Lewiston and taking seven pills a day, including anti-anxiety medications, antidepressants and sleep aids, to manage the side effects — before the team decided to end the treatment in summer 2014. Fortunately, after stopping therapy, his scans were clear.
“They wanted to treat the cancer, and the only thing that was going to stop us was something that was more harmful in the mental health department,” Teo says. “I had never had anxiety or depression, and it was so strange to be in a situation where it was induced by cancer drugs. It was slowly dragging me down.”
The Fever
Once his treatment ended, Teo wrestled with his identity and direction post-cancer — normal questions for a 24-year-old, thrown into sharp relief by the lingering mental health effects he experienced with interferon. So, when he started feeling ill at the beginning of 2015, he decided to wait and discuss his symptoms at his next regular appointment with Dr. Lawrence.
When Dr. Lawrence heard Teo had been experiencing nausea, vomiting, coffee-colored urine, jaundice and fainting, he reviewed Teo’s bloodwork and ordered an MRI of his liver. Teo’s regular CT scans, because they were designed to show contrast, hadn’t revealed what the MRI did: that Teo’s liver was almost uniformly cancer.
For Dr. Lawrence, the situation became all-hands-on-deck. He went back to Teo’s original biopsy and discovered Teo had a BRAF mutation, a gene mutation that can cause melanoma.
Because the cancer was metastatic, Dr. Lawrence enrolled Teo in a clinical trial where he would receive nivolumab — a new immunotherapy drug — and ipilimumab. He also identified a BRAF inhibitor medication available through a pharmacy in Michigan. The infusions needed a couple of weeks to begin to work, and Teo’s rapid deterioration meant he might not have that much time unless he also took the BRAF inhibitor — but taking the inhibitor would kick him out of the trial. Dr. Lawrence decided to see if Teo’s liver numbers stabilized first so he could continue the trial.
“He was so certain and knowledgeable about what we should do,” Teo says. “I felt safe with him and the team.”
Teo was able to receive one infusion before tumor lysis syndrome — an oncologic emergency in fast-growing cancers that occurs when tumor cells die and release their contents into a patient’s bloodstream — sent him to the emergency room in Maine on April 16, 2015. Doctors there told Teo’s parents he would be on a ventilator within 24 hours. They should prepare to say goodbye to their son.
Outside the hospital, Teo’s mother Kate called Dr. Lawrence in tears to relay the news. “All he said was, ‘We’re not done yet,’” she says.
One Small Miracle
They weren’t done at all. Dr. Lawrence and his team worked directly with the pharmaceutical and insurance companies to ensure Teo could receive nivolumab and ipilimumab outside of the strict regulations with the clinical trial, which meant he could also take the BRAF inhibitor. The family had the medication shipped overnight and it began to work within hours. Teo went from a 103-degree fever and a resting heart rate of 140 beats per minute on April 17, with his family meeting with hospice care down the hall, to being discharged from the hospital on April 21.
Innovations in medicine can happen in minutes and evolve over years, where the inventiveness of clinicians like Dr. Lawrence mirrors the intricate creativity of Teo’s leatherwork creations. Thanks to the dogged efforts of Mass General’s melanoma team, Teo became one of the first patients to receive this combination of treatments, helping set the stage for numerous breakthroughs in melanoma science. According to a study published in The Lancet, patients with advanced melanoma in 2013 had a median overall survival of about 11 months. In 2019, that number rose to 32 months.
In this continued evolution, Dr. Lawrence sees promise in another new therapy called tumor infiltrating lymphocyte therapy (TIL), which uses a patient’s immune cells as a living drug. The Food and Drug Administration (FDA) approved the first cellular therapy for melanoma earlier this year, and Mass General is now one of 30 centers in the U.S. to offer the treatment.
“We’re just scratching the surface of what we can do with cellular therapy,” Dr. Lawrence says. “The next generation of TIL is on the horizon and even more effective than what we’re doing now. We’re seeing durable remissions in 20 to 30 percent of people who didn’t respond to other therapies.”
Starting Over
Nearly 10 years after his recurrence, Teo has no evidence of disease progression. The novel immunotherapies caused minimal side effects, with a lack of sweating being his biggest issue. Sam, the girlfriend who spent sleepless nights on couch cushions next to his hospital bed, is now his wife, and the couple moved from Maine to Montana to Wyoming, where they are now raising their boys. Teo still takes his BRAF inhibitor medication daily and gets scans locally every six months. Even 2,000 miles away, he considers Mass General to be his oncology care team.
“Dr. Lawrence has seen and knows so much,” Teo says. “Whatever we needed, he always gave us time. We always felt like we were his top priority. It was hard to think about moving away from New England, but he told me, ‘We’re your care team until you don’t want us to be.’
“If something came back again, I’d fly back to Boston as soon as I could,” he adds. “If we have to get back into the fight, I know I’m coming here.”
To support melanoma research at Mass General, click here.
Editor’s note: The writer is Teo’s sister. The Abbruzzese family is forever grateful for the lifesaving care that Dr. Lawrence, Riley Fadden, Christine Freedman and the Center for Melanoma team provided to their favorite cowboy.
