By Michael B. Atkins, MD
Stan Collender was a man of many remarkable talents. Among
his many achievements, he was widely recognized as one of the foremost
authorities on the federal budget earning himself the moniker, “The Budget Guy,”
and in 2012 receiving both the prestigious Howard Award for lifetime achievement in federal budgeting
from the American Society for Public Administration and the James L. Blum Award
from the American Association for Budget and Program Analysis. Stan was
also my longstanding patient- an immunotherapy pioneer and an advocate whose
experience and efforts taught us much about the impact and limitations of immunotherapy.
Stan died May 3, 2019. Below is his cancer story from my perspective.
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| Stan Collender |
I first met Stan in 2012 when he presented to my oncology
practice status post resection of a Merkel Cell Carcinoma (MCC) on the bridge
of his nose. We reviewed his history and the pathology and recommended a wide
local excision and a sentinel lymph node biopsy. On hearing this recommendation,
he joked that he was a local television celebrity so needed to protect his
looks. I assured him that the plastic surgeon was up to the challenge.
After the successful surgery, we followed Stan at regular
intervals. About 1 year later we noted he had developed an enlarged neck lymph
node. Upon hearing this news Stan became diaphoretic, pale and promptly fainted.
While he was out cold lying on an exam table and then gradually regaining consciousness,
I remember thinking, “this is not going to be easy.” But I never anticipated the novel,
groundbreaking twists and turns Stan’s case would take, nor the heroic role he
would assume as a patient advocate, or that I would be writing this posthumous tribute
to a man I came to admire and care deeply about as a courageous colleague and friend.
Despite Stan’s tremulous start, he was an absolute rock
thereafter. He underwent lymph node dissection and post-operative radiation
therapy without a hitch. He subsequently developed a solitary brain lesion,
which was also resected and treated with adjuvant stereotactic radiation to the
resection bed. Unfortunately he developed widespread systemic disease six
months later. In weighing treatment options available at the time, I recommended
he participate in a clinical trial involving a then experimental immunotherapy,
pembrolizumab, that we’d had good experience with in patients with melanoma,
but had yet to test in patients with MCC. He volunteered for the clinical trial
without hesitation, despite it being conducted in Seattle. He was literally Patient
# 1 - a pioneer- on this important Cancer Immunotherapy Network (CITN) trial led
by Drs. Paul Nghiem and Shailender Bhatia. Every 3 weeks he flew from DC to Seattle
to receive his experimental treatment. The pembrolizumab worked well: after two years
of treatment his disease there was no visible signs of residual disease on
imaging studies- his disease was apparently gone. Not only did this treatment help Stan, but based
on the results of this groundbreaking clinical trial, pembrolizumab receive FDA
approval and is now the standard of care for patients with treatment naïve advanced
MCC, providing benefit to countless patients with this disease.
Stan embraced this treatment success and his new lease on
life with his typical gusto. He wrote an OpEd in the New York Times where he
described his clinical trial experience. Rejecting the concept of being a
guinea pig, he wrote he felt more like Chuck Yeager breaking the sound barrier and
going where no one else had gone before. He encouraged others to participate in
clinical trials and became a leading spokesman and a tireless advocate for the
immunotherapy, MCC and cancer clinical trials communities. Just like Chuck
Yeager in aviation, in MCC and immunotherapy circles, he became a national hero.
With his cancer in remission, Stan and I moved beyond our traditional
patient-physician relationship: we became collaborators and friends. When Stan joined
the Georgetown faculty, teaching public relations and public policy classes, we
officially became colleagues. Over
lunches we strategized on how we could best represent the value of
immunotherapy relative to other cancer treatments, as well as how to encourage
cancer clinical trials participation and more public private partnerships such
as the CITN trial he’d participated in.
Stan was frequently in attendance when I gave educational briefings
to Congressional staffers, and welcomed me singling him out as Patient #1 on
the MCC CITN trial. We served together on SITC committees focusing on measuring
the value of immunotherapy, where Stan’s personal experience and budget expertise
were both unique and invaluable. When I received my endowed chair, I was
honored to have Stan and his beloved wife Maura, join me at the dinner ceremony
and celebration.
In 2017, Stan was invited to give the Keynote lecture at the
annual American Association of Cancer Institute’s meeting in DC. He talked
about his views of the upcoming federal budget and its potential impact on
cancer research funding, but he also described his personal battle with cancer,
his experience as a survivor, and thanked me publicly for having encouraged him
to pursue the CITN trial. Sitting in the audience, I felt both like a proud
teacher witnessing my prized pupil excel, and grateful to see him healthy and
choosing to apply his experience, talent and renewed health to benefit others.
Over lunches, we talked about his potentially running for Congress
in the Virginia 6th in 2018 and how wonderful it would be to have a
vocal cancer survivor and immunotherapy and clinical research advocate in Congress.
He ultimately withdrew this pursuit, but came to my house for a gathering of
concerned voters in his ex-candidate’s capacity to discuss the race and promote
the candidacy of Jennifer Wexton - who ultimately was elected to serve the
district.
And so it went. Stan and I had developed a shared mission
and fought together on several fronts for its success. I thought we’d be doing
this together for the rest of our careers.
Then all hell broke loose. Stan was almost 2 years out from his
last therapy, a time when we usually consider patients who have responded to
immunotherapy to be cured. So it was a shock when he presented in December 2018
with hand weakness, headaches and difficulty swallowing and a head MRI which
showed that his lateral ventricles were packed with tumor. I had never seen
anything like this presentation before and had no idea that MCC could do this.
His tumor had recurred exclusively in one of the few places where the immune
system doesn’t reach.
The word spread like wildfire through the MCC and
immunotherapy communities. It was devastating. The pioneer/ hero- MCC patient #
1 - had relapsed. I was once again thrust into action as his physician,
proposing a variety of approaches all focused on trying to get his immune
system re-activated and into his ventricles where the tumor was hiding. A lot of
my proposed treatments were quite involved and associated with considerable risk,
but Stan was always positive. He would respond to my carefully chosen words of
encouragement such as, “I hope this
works” or “This could work” with an optimistic “It is going to work” and a
courageous “Let’s do it!” Although Maura
was more attuned to the uncertainty in my recommendations, Stan’s optimism
usually prevailed.
Ultimately, the tumor could not be controlled and we ran out
of both treatment options and optimism. Maura and Stan decided to focus on
comfort measures. Stan passed away peacefully at home on May 3rd,
2019.
At his memorial celebration a few weeks later, person after
person spoke about how they knew Stan, each describing a unique contribution he
had made during his remarkable careers in Government, public policy, public
relations, as well as in intramural football and as a family man. Clearly Stan was
a true “mensch” with his many interests, passions and strong commitment to
both his family and the world around him. His impact on the MCC, immunotherapy
and cancer clinical trials communities was profound and enduring. Even in death,
Stan remains a teacher and an advocate: his cancer taught us about potential
new obstacles to effective immune therapy and like Chuck Yeager, his legacy as
“Patient Number 1” will undoubtedly inspire research efforts to overcome them. I
will miss this remarkable man- rest in peace my friend.
