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Forging ahead despite advanced mesothelioma

Steve McGrew’s move from from Spokane, Washington, to a neighborhood near City of Hope’s Duarte, California, campus is a story that’s part karma, part dogged determination. It’s a case study in what’s possible when individuals and institutions resolve to press forward when a pandemic turns everything upside down.
 
McGrew moved here temporarily to take part in a potentially life-changing clinical trial to treat his Stage 3 mesothelioma. He might never have come to City of Hope if not for one of his students, who wanted to learn how to make knives.
 
McGrew built a comfortable career developing tech applications for industry and government; things like security holograms and microbial detection systems. It came naturally to the ever-curious McGrew, who enjoys “making things” and isn’t intimidated by complexity. He once repaired a $40,000 laser with a paper clip.
 
That was his day job.
 
On the other hand, his “hobby,” now a full-time pursuit, dates back thousands of years. He is, quite literally, the village blacksmith, heating and pounding metals into knives, swords, works of art and more. He doesn’t take shortcuts. McGrew built his own forge and designed his own anvils. He creates and sells blacksmithing tools online. And he teaches the craft to a lucky few who travel across the country to spend time in his workshop.
 
One of those lucky few was Yuman Fong, M.D., chair of City of Hope’s Department of Surgery  and the Sangiacomo Family Chair in Surgical Oncology. A mutual friend brought them together. Fong is a self-described “dabbler” who seeks out master teachers to instruct him in new disciplines. Their relationship yielded some brand-new handcrafted knives for Fong. It would give McGrew much more.

Exposure Unknown

He’s not sure how or when exposure to asbestos — the primary cause of mesothelioma — ultimately made him ill. As a child, McGrew and his friends crawled through an attic with asbestos insulation. He remembers odd jobs: cutting asbestos boards and inhaling the dust, and demolishing an old Army barracks (the military was a heavy user of asbestos). Or perhaps it happened when his dad, a paleontologist, brought home a tool of his trade — plaster laced with the deadly material. It could have been any of the above; mesothelioma has a latency period as long as 50 years.
 
He was 74 when his chest began to feel strange and he started losing weight. A few months later, he was vacationing in Mexico when he became short of breath and couldn’t eat. Tests detected a pool of fluid squeezing his right lung. A CT scan and biopsy revealed so many mesothelioma tumors in the lung’s lining that his doctor nearly gave up on McGrew right then and there.
 
Yuman Fong, M.D., Chair, Department of Surgery at City of Hope
Yuman Fong, M.D.
“He said all I had left was palliative care,” McGrew remembered. “I didn’t like the sound of that, so I started looking for alternatives.”
 
Enter Yuman Fong. Again.
 
“I heard from our mutual friend that Steve had a ‘lung problem,’” Fong said. “In seconds I knew it was mesothelioma.” He also knew how rare and deadly this disease can be.

What Fong Knew

Most important, Fong knew what McGrew’s doctors in Spokane didn’t. A clinical trial at City of Hope was combining immunotherapy with chemotherapy, followed by surgery, then more immunotherapy afterwards The new approach was improving outcomes and extending life expectancy.
 
Fong urged McGrew to come to California. “We’ll get you into that trial,” he promised.
 
But by now it was March 2020 and the rampaging coronavirus was changing everything.
 
To prepare for the trial, McGrew needed exploratory surgery to make sure his disease hadn’t spread further. But before City of Hope thoracic surgeon Jae Kim, M.D. could operate, he and several colleagues were forced into quarantine because of a possible exposure to COVID-19.
 
“It was early in our experience with the pandemic and we were being very cautious,” Kim recalled. “It turned out that I wasn’t actually exposed, but it was eye-opening and it helped us reevaluate our safety protocols.”
 
McGrew was reevaluating, too. The quarantine delay left him with much less time to reach City of Hope before the trial’s enrollment window closed. But with COVID-19 wreaking havoc with air travel, there was no way he’d get on a plane. And all the while Fong was telling him, “Get here now!”
 
He had just one option.

A Long Drive

“We drove,” he said. “Myself, my wife and the dog. Twelve-hundred miles in three days. We slept in the car. We ate food out of a cooler we’d brought along. We wore gloves to pump gas.”
 
They made it. Barely.
 
“We signed up for the trial 30 minutes before the deadline,” he said.
 
When McGrew arrived, he found a campus fully prepared to deal with pandemic issues. From masks to temperature screenings to repeated coronavirus tests, City of Hope built on its long experience with immune-compromised patients to keep everyone safe without compromising cancer care.
 
“As a major cancer center, we protect patients really well,” Fong pointed out, adding that coronavirus concerns forced other hospitals to cut cancer screenings by as much as 90%. “We are still on mission, still delivering the highest level of care.”
 
“Cancer won’t wait for the pandemic to be over,” added McGrew’s oncologist, Marianna Koczywas, M.D. “If the patient waits too long, cancer can recur or worsen.”
 
McGrew’s clinical trial consists of four cycles of the checkpoint inhibitor atezolizumab (Tecentriq) plus the chemotherapy drugs pemetrexed and cisplatin. “The goal is to shrink his tumors and make surgery more effective,” explained Koczywas, adding that McGrew will keep receiving atezolizumab after surgery for up to a year, “to help him continue to improve and to prevent regrowth.”
 
It’s working.
 
“I’ve improved even more than they expected,” said McGrew. “The tumors have shrunk. And I feel great. Almost normal!”
 
He’ll be ready for surgery soon, and it will be extensive, involving removal of the lining (or “pleura”) around his lung, heart and diaphragm. His surgeon is confident McGrew can handle it. “Steve is a very smart, positive person with a lot of inner strength,” said Kim.
 
None of this is a cure, and McGrew knows it. This blacksmith with the high-tech mind researched his disease and City of Hope’s track record as carefully as any project he’s ever undertaken. He liked what he saw. And he likes his chances.
 
“I’m ready for the best- and worst-case scenarios,” he said. “Could be five years. Could be one year. And then we’ll try something new!” And yes, he fully expects to see that “something new,” because at City of Hope he’s surrounded by “doctors and researchers who always know what’s coming."
 
“There’s no better place in the country. I’m in the best possible hands.”