Surviving melanoma: California woman marks five-year milestone with 76-mile trek

Napa, Calif.

- Stage 4 melanoma survivor Kari Worth, 41, marked her five-year triumph over the disease with a five-day, 76-mile walk, ending with a trip across San Francisco’s Golden Gate Bridge to deliver a bottle of champagne to her oncologist.

Kari Worth (rear, second from left) is welcomed on her arrival at California Pacific Medical Center by (front) her children, Calem and Emilia, and (rear, from left) her mother, Marilynn Schuster; her father, Michael Worth; and her husband, David Dennis. Photo: Kari Worth

Accompanied by her father, Worth set out May 1 from her hometown of Napa. She finished her trek May 5 - designated as this year’s Melanoma Monday by the American Academy of Dermatology.

During the final stage of the walk, she crossed the Golden Gate and walked to California Pacific Medical Center to deliver a bottle of champagne and sunscreen to David R. Minor, M.D., her oncologist.

"My prognosis is great," Worth says. "I just met my five-year mark, which is the exception to the rule."

Worth’s journey actually extends back some 20 years.

Dr. Minor, assistant clinical professor at University of California, San Francisco, says Worth first was diagnosed with melanoma involving her left ear in January 1987. It was treated with a local resection.

Worth had a local recurrence in March 1991, he says. Then, in April 2003, she developed metastases to lymph nodes in the left neck, right axilla, right lung and right femur, as well as subcutaneous metastases. The cancer, at that point, did not present cutaneously.

"So she had a little bit of melanoma everywhere," Dr. Minor says. "I cannot really judge whether the surgery in 1987 was inadequate. Possibly, if she had had a more radical surgery in 1987, she would have never had a local recurrence, and it never would have spread."

Biochemotherapy route

The oncologist, who says he sees many patients with stage 4 melanoma, decided Worth was a candidate for an interleukin-2 based biochemotherapy program - a regimen patterned after the biochemotherapy program started at M.D. Anderson Cancer Center about 15 years ago.

He says Worth received three chemotherapy drugs - temozolomide, cisplatin and vinblastine - and two biological agents, interleukin-2 and alpha interferon.

"She got the five-drug chemotherapy-immunotherapy combination for five months and was in the hospital six times, for five days each time. She had quite a bit of nausea and vomiting," Dr. Minor says.

Still, the drugs were working to shrink the tumors. Worth still had a residual tumor in the right lung, and, in March 2004, she had that surgically resected; she then underwent 18 months of maintenance immunotherapy, according to Dr. Minor.

Hope for late-stage melanoma

The biochemotherapy regimen, Dr. Minor says, is standard (of practice) at several melanoma centers in the western United States, but some centers elsewhere continue to shy away from the approach because of previous bad outcomes.

"Biochemotherapy got a bad rap because the phase 3 trials were not done correctly," Dr. Minor says. "(Subjects) did not get enough of the immunotherapy component and were not treated long enough, so when the phase 3 trials were reported in 2003, most of the oncologists quit using it."

But those centers that have continued the therapy are seeing long-term survivors, he says.

"We have treated 145 patients with this therapy over the last six years - all (with) stage 4 melanoma. We find that if patients are going to relapse, all relapse within those first 30 months.

"During that time, they either relapse or do not respond," Dr. Minor says. "But (with) patients like her, even those who need surgery like she did to get rid of everything, we have not had any relapses in up to six years. They are free of disease after 30 months.

"We have long-term survival of about 15 percent to 20 percent. That’s a lot higher than has been reported."

The message

Dr. Minor says the message to dermatologists is that immunotherapy with interleukin-2 - either the high dose by itself or in combination with biochemotherapy - has the potential for long-term survival benefit for melanoma. Dermatologists should be referred to centers that know how to give that sort of treatment in the appropriate patients.

Worth says she discovered the grape-sized lump on her shoulder one day as she went to scratch her neck. She went to her primary care doctor, who was convinced it was a cyst and tried to aspirate it.

"(The doctor) sent me home and said just watch it and wait for six months," she says. But she thought, "‘No, do we want to wait six months? It doesn’t seem right,’" Worth says.

"I had to push quite hard to get a biopsy. I was working through a general physician who just wanted to do a needle biopsy, and I said I wanted it removed. And it came back in the operating room as malignant."

She describes her months having biochemotherapy as unbearable.

"I had a 1- and 2-year-old, and was not able to parent my children. I lost 50 pounds and all my hair. But everybody’s experience is different," she says.

The fair-skinned redhead says melanoma has not been in her family tree, but she wonders whether growing up lathered in Coppertone 4 on California beaches might have played a role in her disease.

Years of good health have made the experience all but a memory. Worth says that she completed the 76 miles of walking not because she’s a great athlete - rather, she is determined.

"I was perfectly positive that having cancer gave me an advantage as an athlete, because it is a mental game. When you are lying there sick for the 390th day, there is a much stronger mental thing that goes on.

"I’m not an athlete by any stretch, I’m just determined," she says. DT