From Checkmate to Road Trip (Part 3)
A Veteran’s Life is Extended through PCF-Funded Science
Part Three: Well Enough for a Cross-Country Adventure
There was never a time when Rodolfo LLobet’s prostate cancer was not worrisome. It was discovered when he went to see an orthopedist for pain in his left hip. “I thought, ‘Oh, woe is me! I’m going to have to get a hip replacement,’” Rodolfo recalls. But an MRI showed that instead of joint damage, there were some suspicious spots in his left hip that turned out to be prostate cancer metastases.
“The insurance I had (from his job as an airline pilot) paid for PSA testing once a year,” he says. “When I did my annual physical, it was one day shy of a year – so I couldn’t get the PSA test. My previous PSA was 0.8. By the time I got my next PSA test it had been 17 months since the last one. In that time, cancer had flowered and spread. More frequent testing would have been a nice thing in my particular case.”
Kelly LLobet adds: “We were diagnosed in April.” Like many cancer spouses, she uses the plural pronoun because they are in it as a team. On April 10, “we started on a hormone deprivation clinical trial. That was our 20th anniversary. We never thought we would get to our 25th – because when Rodolfo was diagnosed, it was aggressive off the charts, and the doctors said we really need to live as much life as we can in a short period of time. Over the last six years, we’ve been on nine different treatments. We’ve been on this really fast ride since the beginning.”
In early 2024, Rodolfo’s situation did not look good. He had metastases everywhere, including in the brain, and had been hospitalized to get his symptoms under control. On January 30, Kelly says, “we got Rodolfo out of the hospital, came home, and there was a letter in the mailbox. We homeschool our children. The school, based in the Northwest, had sent an invitation for a graduation ceremony in June. We had a senior in high school and one graduating out of eighth grade,” but June was a long way away, and Kelly didn’t know whether Rodolfo would be able to go. She put the letter aside and the decision into God’s hand with prayer.
Less than a month later, Rodolfo became the first man with prostate cancer to be treated with T-DXd. This antibody-drug conjugate targets HER2, a protein made by some cancers – but not previously thought to be a treatment possibility in prostate cancer. Rodolfo, a Navy Veteran, had previously seen DC VA Hospital medical oncologist Maneesh Jain, M.D., and had kept in touch with him. Jain is co-Principal Investigator of the Edward P. Evans-PCF Precision Oncology Center of Excellence at the DC VA Hospital and George Washington University. In work funded by PCF, Jain had been using an old-school approach called immunohistochemistry to study proteins produced by prostate cancer cells. He believed Rodolfo’s cancer – which, he had found, expresses HER2 – might respond to T-DXd.
So Many Reasons to Celebrate
“We started T-DXd on February 22,” Kelly continues. “We had a really good response almost immediately.” She got a reminder email from the school, asking her to RSVP for the graduation. The ceremony was perfectly timed – right in between three-week cycles of T-DXd. “I’m looking at Rodolfo, I’m looking at the email, and I thought, ‘We might be able to do this!’” Rodolfo was all for it. “We took all four of our sons,” he says, “rented a vehicle and we drove around the Northwest for two weeks. We saw God’s country out there. It’s gorgeous!” They sent celebratory pictures of their trip to Jain and the team at the DC VA, and returned home just in time to start the next round of treatment.
In April 2024, they celebrated 25 years of marriage, and in August 2024, they celebrated Rodolfo’s 60th birthday. “Our sons will never forget this trip,” says Rodolfo. “We won’t. That’s something that really sticks with you. If it weren’t for PCF stepping up and funding Dr. Jain and Dr. Subrahmanyam and their research, we wouldn’t have made these milestones and done these really neat things.”
PCF, Rodolfo notes, “has been woven through this journey for us since the beginning. Kelly has been forwarding articles from PCF since my diagnosis. It’s been a good source of information and debunking bad ideas.” Otherwise, he adds, patients “get a diagnosis and where do they go? Dr. Google. Dr. Google is a bad doctor. He doesn’t have a degree. Why did I look there? ‘You’ll be dead in a year.’ No, I don’t want to hear that!”
Kelly adds: “The nutrition information alone from PCF is valuable. What they did for us,” the PCF-funded research, the articles about prostate cancer, and the partnership with the DC VA Hospital, “we can never thank them enough. We’re eternally grateful.”
T-DXd is a targeted therapy – the rifle instead of the shotgun approach to killing cancer cells. It only kills cells that make HER2 and those in the immediate vicinity. Because of this, says Rodolfo, “I don’t have a lot of side effects that I would have if I were getting chemotherapy, and that’s a huge difference. I have some fatigue and muscle weakness, which I’ve been dealing with, so it’s nothing new. But there’s nothing beyond that, which is a miracle in and of itself.”
Advice for Patients and Caregivers
With Jain and Ramesh Subrahmanyam, Ph.D., who manages the DC VA’s Hematology Oncology Research Program, “we have really become a team,” says Kelly. “Not only are they good men that you can talk to, but they’re also ready to teach you, so you can trust what’s going to happen. This is important as a caregiver, because I can anticipate what Rodolfo’s symptoms might be.” Jain and Subrahmanyam “made it so that I could understand, then I brought it home to our sons, and we sat around the kitchen table,” where she explained and drew pictures showing “what is going to happen with this medication. We talked about it. So being able to help the children understand helps make for a more stable patient, also, because they’re not wondering what’s happening with Papa. They feel part of it, too. So it’s not just me, it’s the whole crew behind us, and that’s super important for families.”
Kelly’s advice for other caregivers: “Build a relationship with the doctors, the technicians, the nurses, with every single person” involved in the patient’s care. “They all come to work because they want to help people. They want to know how things are going, how the family’s doing, what I’m crocheting. If you build that relationship, they’re looking out for you because you’re caring about them.”
Also: Educate yourself as much as possible, Kelly continues. “Read the emails from PCF. Look things up. Ask questions. Go to clinicaltrials.gov. Find out what can be done for your loved one. A faith community is key: you need all of that support. If you’re holed up in a corner, not talking to anybody, then that’s not possible.”
Rodolfo says the worst time for him was the diagnosis. Then it was time to get busy. His advice for patients: “Once that scare pinnacle has come and gone, go to your doctors, go to PCF. Don’t be afraid to ask questions and find out what your resources are, because you might be missing out on something.” If you’re a Veteran, see what the VA has to offer. “The VA has gone leaps and bounds in providing resources. You don’t feel like a number. It used to be different,” but now “it’s not a fight: it’s a coordination. Go out there and be bold! There’s a plethora of things out there for us, all sorts of choices to be made and people to help us make those choices.”
Part Two: Dramatic Improvement and a New Clinical Trial
Part One: Game-Changing Discovery
