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Janet Mazzurco was diagnosed with melanoma seven years ago, which later developed into stage IV metastatic disease. Fran Collichio, MD, began treating Janet with a checkpoint inhibitor drug called ipilimumab and her disease is now in remission.

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Janet Mazzurco, “I’ve learned to live every day as if it’s the last day.”
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Fran Collichio, MD

For decades, scientists have been trying to figure out how to use the body’s own immune system to fight off cancer. After all, our immune systems can fight off all kinds of other health threats, so why not this disease? But nothing seemed to really work – that is, until the 1990s, when researchers began expanding the use of a treatment called ‘‘immunotherapy’’ that resulted in slowed tumor growth and longer patient survival rates.

An important part of the immune system is its ability to tell the difference between normal cells in the body and those it sees as ‘’foreign.’’ This lets the immune system attack the foreign cells while leaving the normal cells alone. However, scientists recently discovered that cancer has the ability to put on what some call an ‘‘invisibility cloak.’’ Simply put, cancer can disguise itself and prevent the immune system’s attack, which keeps the patient’s body from healing. Fortunately, thanks to a breakthrough in therapies called ‘’checkpoint inhibitors,’’ scientists have found a way around one part of the invisibility cloak.

Checkpoint inhibitors are drugs that turn off the invisibility cloak so some cancers can’t hide from the immune system. Researchers are thrilled that these drugs seem to be working for up to one quarter of patients with advanced cancer — melting away the toughest tumors, such as some melanomas, which are the deadliest kind of skin cancer.

Janet Mazzurco: “Dr. Collichio never gave up hope.”

Janet Mazzurco’s seven-year battle with melanoma began with a simple biopsy at her dermatologist’s office in December 2009. What she thought was a small spot on her right arm – just the size of a pencil eraser – turned out to be an extremely deep melanoma that required surgery under general anesthesia. “My surgeon had to cut through muscle to get the cancer, removing three lymph nodes in the process,” says Janet. “Those lymph nodes were negative, but I decided to come to UNC Lineberger for a second opinion.”

When UNC oncologist Fran Collichio, MD, did a PET scan on Janet, the results showed no visible signs of cancer, so Janet returned home to Greensboro, believing her bout with melanoma was over. But on July 4, 2014, she awoke with a splitting headache. “I went to our local emergency room the following day, where they performed a CT scan,” Janet explains. “They told me I had a large tumor on the back of my cerebellum. I was terrified.”

“Studies are being done on the combinations of these checkpoint inhibitor drugs so that in the future, doctors can determine the best course of treatment for each specific patient.” – Fran Collichio, MD

A month later, neurosurgeon Henry Elsner, MD, removed the mass on Janet’s brain, and pathology reports confirmed Janet had stage IV metastatic melanoma. Within weeks, she underwent stereotactic radiation surgery, a targeted form of radiation to obliterate a small remaining lesion without subjecting her entire brain to unnecessary treatment. Unfortunately, subsequent scans showed the lesion had doubled in size, and in December 2014, her surgeon operated again. “Still, the cancer grew, and I was getting sicker,” Janet says. “There was nothing else my Greensboro medical team could do, so I came back to see Dr. Collichio. She ran more tests and found the cancer had spread to my liver and lungs.”

As luck would have it, a checkpoint inhibitor drug called ipilimumab (known commercially as Yervoy) had just come out of clinical trials and was approved by the Food and Drug Administration (FDA). Collichio immediately prescribed a series of four treatments – each four weeks apart – that began in January 2015. By May, Janet’s tumors began disappearing.

“I was very pleased with Janet’s progress,” says Collichio, a UNC Lineberger member and clinical professor of Hematology and Oncology at UNC – Chapel Hill. “After four months, her scans showed obvious disease regression, and by March 2016, there were no visible tumors. Her LDH levels, which are markers we use to evaluate a patient’s response to treatment, fell into the normal range. I was thrilled to give Janet the news: she was in remission.”

However, Janet’s recovery wasn’t without its struggles. After her last treatment, she was plagued by colitis, which is a known side effect of ipilimumab. “I was hospitalized four times because I was so sick, but, thankfully, steroid treatments were effective. And other than having a bit of fatigue, I’ve done really well.”

Janet is slowly but surely returning to the things she loves to do. She and her husband Tony own a marble and tile company as well as a home renovation and construction business. Public service is also high on Janet’s list of priorities. She was just reappointed to a three-year term on the Greensboro Zoning Commission, and she proudly serves on UNC’s CCNE board as a patient advocate, sharing her first-hand experiences as a metastatic melanoma survivor.

“I’m a survivor because of my faith in God, and I also have great faith in Dr. Collichio,” says the 56-year-old. “She is absolutely amazing – an attentive, compassionate, brilliant doctor. But there’s no ego. She’s always treated me as an equal, and she respects my thoughts and opinions. Most importantly, Dr. Collichio never gave up hope, and as someone who knows what it’s like to face cancer, that’s all I could ask for.”