Targeted therapy keeps pedal to life’s metal

Experimental drug keeps man on the road of life
October 27th, 2015

The vehicle’s 3,450 pounds are evenly distributed between front and rear axles, a detail that put the battery and washer-fluid reservoir back in the trunk. The supercharged V6 cranks out 340 horsepower and 336 foot-pounds of torque. That whisks the carriage from zero to 60 in five seconds en route to a top speed of 162 mph. The eight-speed automatic transmission has Normal, Sport, and Dynamic modes – Sport holding each gear longer and Dynamic tightening the steering and adding throttle sensitivity to Sport. The color is Italian Racing Red.

Matt Mikulich with his “self-prescribed, self-administered cancer therapy.”

Matt Mikulich rattles off these and many more facts about the Jaguar F-Type he took delivery of in August, and you wonder how much of his focus has gone into these wheels. Then you learn a bit more about him and realize that it’s really not about the car. His is one of those rare minds of encyclopedic command. And you learn that this British beauty and its driver would not be here if not for three little white pills taken once a day, with food.

On this sunny afternoon, the food is a Panera sandwich that looks to be filled with salad but which he insists contains turkey. We are seated outside, across Colfax Avenue from the Anschutz Medical Campus, Mikulich having driven me over in the Jag’s two-seat leather cockpit. His wife, Donalyn, has walked across the sky bridge to this lunch spot. She has been here many times before. They have been to University of Colorado Hospital many times before.

Mikulich,73, was diagnosed with stage 3B non-small-cell lung cancer (NSCLC) in February 2009. Following chemo and radiation therapy, his cancer spread, and by April 2010, the diagnosis worsened to stage 4. Mikulich had a 1 percent chance of surviving for five years, according to the American Cancer Society.

To no small degree, Mikulich and his bright-red ride owe their presence to another British export: Ross Camidge, MD, PhD, the Joyce Zeff Chair in Lung Cancer Research at the University of Colorado Cancer Center. Camidge is leading a national trial focusing on those three little pills Mikulich takes.

Targeted therapy

The pills deliver an experimental drug called brigatinib, a second-line targeted therapy for ALK-positive NSCLC, which means the cancer is driven by a fusion of the anaplastic lymphoma kinase (ALK) gene. Roughly 85 percent of all lung cancer patients have NSCLC; of those, perhaps 5 percent are ALK-positive. But with a disease as common as lung cancer, those numbers still add up to around 10,000 people a year diagnosed with ALK-positive NSCLC in the United States alone. Mikulich, who never smoked, is one of about 20 UCH patients on the trial. The drug’s striking performance with Mikulich and other late-stage lung cancer patients has earned brigatinib “breakthrough status” with the U.S. Food and Drug Administration, Camidge says.

“This status, while not yet a license to prescribe, means the FDA is taking a paternalistic interest in its success,” he says.

Mikulich with CU lung cancer specialist Ross Camidge, MD, discussing Mikulich’s professionally prescribed therapy, the experimental drug brigatinib.
Mikulich earned his doctorate in geophysics at the University of Utah in 1971 and went to work as an exploration geophysicist for Chevron, rising through the ranks until he was corporation chief geophysicist and principal technical advisor when he retired at age 57 in 1999. In 2003, to be closer to their son and daughter in metropolitan Denver, he and Donalyn moved from California’s Bay Area to Buena Vista, into a log home Mikulich designed. They have five grandkids now.

With the stage 4 cancer diagnosis in 2010, Mikulich initially started more chemotherapy, combined with an experimental drug that worked for a short time. By early 2011, however, his cancer was progressing again. He entered a clinical trial for a different experimental drug, crizotinib, that March.

Crizotinib was the first drug designed for ALK-positive NSCLC. University of Colorado Cancer Center researchers were not only among those at just a handful of sites worldwide involved in the initial development of crizotinib, they also were instrumental in developing the diagnostic test to spot the ALK fusion. For two more years, crizotinib kept Mikulich’s cancer in check.

Many hats

He made good use of his time. He and Donalyn have traveled around the United States and, once or twice a year, to Europe, focusing on places of historical significance. He guest-lectures on science, energy, and mining topics at Regis Jesuit High School (he is well-qualified, having lectured at more than 25 universities around the world in addition to being an adjunct professor of geophysics at both the University of Utah and Virginia Tech University). He performs at local festivals, hospitals, and nursing homes as a folk singer and guitarist, doing hour-long shows that combine mining songs with a history of Colorado mining or songs that tell the story of the American cowboy.

In 2013, he took up poetry, writing verse on topics ranging from his experience hiking Hadrian’s Wall in 2013 to his beloved 1965 Triumph TR-4, a car he’s owned for a half century. He spent time with his grandkids.

But late-stage cancer finds ways around even the best therapies. He didn’t need a scan to tell him that. The loss of appetite and weight, and dearth of energy were enough. “When a drug stops working, I know it,” Mikulich says. In early 2014, he did more radiation therapy and more chemotherapy, but the cancer continued to progress.

Camidge wanted to put him on the brigatinib trial. The drug is designed for ALK-positive NSCLC patients for whom crizotinib has stopped working. But Mikulich had to wash the prior ALK drugs from his system and go through several days of pre-trial testing: PET and CT scans, heart tests, eye tests, blood and urine tests.

“By that time, I’m really sick,” he says.

He had been too weak to leave the house for two months when, in mid-December 2014, he finally took his first three little white brigatinib pills. By early February, he says, “I started coming around.”

Panels from the nearly-complete lectern for St. Rose of Lima, which Mikulich aims to finish by the end of the year.

The altar in St. Rose of Lima Catholic Church in Buena Vista, most of which Mikulich built and carved after his lung cancer diagnosis in 2009.
There have been side effects, though nothing like those following chemotherapy: most notably nausea, fatigue, and a sporadic neuropathy that manifests in what feels like stabs by a hat pin. But it’s a small price to pay, he says. In addition to traveling, teaching, writing, and performing, Mikulich is wrapping up a new lectern in hardwood cherry which he designed, built, and carved for his local church, St. Rose of Lima in Buena Vista. It will match the altar he started right around the time of his initial cancer diagnosis. The Most Rev. Michael J. Sheridan, bishop of the diocese of Colorado Springs, consecrated it in 2010.

Roll on

In September, Mikulich brought a folder to his monthly clinic visit with Camidge. Often, patients who do this proceed to talk about some miracle cancer cure they’ve found on the Web. Mikulich opened to a photo of a bright-red Jaguar F-Type. “This is my new, self-prescribed, self-administered cancer therapy,” he told Camidge.

“As far as I’m concerned, anything that makes people with cancer happy and moving forward with joy is a good thing,” Camidge says. “I think his attitude to self-prescribing a little bit of fun for himself is, ‘If not now, then when would be a better time?’ And I get that.”

Mikulich says he sees two big messages in his own story. The first applies to those battling cancer.

“You can live a good life with cancer. I’ve lived a full life with it for seven years,” he says. “You don’t have to crawl into a corner and cover yourself with a towel.”

The second applies to everybody.

“No matter who you are, you should live for today – maximize your contributions to your family, friends, the world, and yourself,” he says.

Heeding the first helps with the second. As Donalyn puts it, “I can’t let myself look too far into the future because you don’t know what’s going to happen and you have to enjoy each day as it comes.”

But they do plan, too: for trips to Arizona and the city of Reims in northern France next year; for the forthcoming publication of his first poetry anthology, “Reflections from a Cobweb.”

They know that the brigatinib will one day fail, too.

“We have hope that when this stops working, Camidge will start me on another one,” Mikulich says. He has finished his salad-sandwich.

“He’s still got much more to do,” Donalyn says.

“So much more to do,” Mikulich says. He stands and smiles. “We’ve got to put some miles on the Jaguar.”