An NCI-designated Comprehensive Cancer Center
By Michael Easterling | March 12, 2020
For as long as he can remember, Jeff Carpenter wanted to fly. In November 2004, he set about building an airplane, dreaming of the day he would be soaring over the Grand Canyon or Yellowstone with his wife and children.
 
He built the plane in a warehouse space just outside his office, and after about 10 years, he was able to move the plane to the local airport and start putting the big pieces together. He spent every free moment working on his dream project, and by December 2015, his four-seat, single-engine plane was completed and certified by the FAA.
 
But in that moment when his life should have been coming together, it seemed to be coming apart. He started having panic attacks and irregular heartbeats, and his behavior became increasingly erratic. “I became obsessed with social media. I was jealous,” Carpenter said. “I remember my wife saying, ‘This is not like you. I think you have a brain tumor.’”

Not Just Anxiety

Carpenter chalked up his symptoms to anxiety and tried to treat them with diet and exercise. But then, on Nov. 30, 2016, everything went wrong.
 
“My office suddenly filled with glare,” he said. “Only little spots of what I was reading came into focus. I thought I was just dehydrated.” A glass of water and a walk returned his vision to normal. But the next day it happened again, and this time, when he was talking to a customer, his words were coming out in the wrong order.
 
“I could hear myself saying them wrong,” he said. “I laughed, repeated what I was saying to the customer, and the words came out wrong again. I told my doctor what happened, and he told me to go straight to the ER and get an MRI.”
 
After being examined at his local hospital emergency room, Carpenter said he noticed a lot of mumbling and commotion outside of the exam room.

‘You Have a Brain Tumor’

“I remember every little detail of that day,” he said. “The MRI tech would not look me in the eyes. The floor doctor came into my room, looked down, and said ‘Mr. Carpenter, I don’t know how to tell you this: You have a brain tumor.’”
 
A CT scan would reveal a mass in Carpenter’s right lung: lung cancer that had metastasized to his brain. He had never smoked.
 
“I called my wife. ‘I have a brain tumor,’ I said. I told her to call my parents.”
 
After receiving the devastating news on a Friday afternoon, Carpenter’s parents called some friends of theirs who had recently been treated at City of Hope.
 
By 8 a.m. Monday morning, Carpenter received a call.
 
“City of Hope called me,” he said. “I had appointments scheduled the next morning with Dan Raz, Behnam Badie and Ravi Salgia. “I called my personal doctor, who was putting together an ‘A-Team’ for me to treat this thing. I told him I had my own ‘A-Team’ already at City of Hope.”
 
Carpenter’s first appointment was with Dan Raz, M.D., M.A.S., co-director of the Lung Cancer and Thoracic Oncology Program. A few minutes into their discussion, Carpenter said the phone rang in the office. “It was Dr. Badie, asking Dr. Raz to send me over right away. He said they were going after the brain tumor.” Behnam Badie, M.D., is The Heritage Provider Network Professor in Gene Therapy and chief of neurosurgery.
 
A week later, at 7 a.m., Carpenter went in for surgery. “The nurse told me they had the OR reserved until noon, but she said, ‘Dr. Badie usually knocks this sort of thing out in 45 minutes. You’ll be back in recovery by 8 a.m.’ And she was right.”

ALK Positivity Informs Treatment

That brain surgery was the second week of December 2016. Two weeks later, Carpenter began radiation treatments under the supervision of Savita Dandapani, M.D., Ph.D.
 
In addition to Raz, Badie and Dandapani, Carpenter’s care team includes dermatologist Badri Modi, M.D., who specializes in high-risk skin cancers, endocrinologist Azarmindokht Khosravi, M.D., and gastroenterologist Trilokesh Kidambi, M.D.
 
Throughout his surgery and appointments, Carpenter said he was struck by how comprehensive his care was.
“All my doctors talked to each other,” he said. “Everyone looked me in the eyes.”
Ravi Salgia lab coat Ravi Salgia, M.D.
Carpenter’s primary physician and oncologist is Ravi Salgia, M.D., Ph.D., the Arthur & Rosalie Kaplan Chair in Medical Oncology. It was Salgia’s office who called him in early January and told him to come in right away. When Carpenter arrived, Salgia told him he had very good news.
 
“You are ALK positive,” he told him. “It means we can treat you with targeted therapy.”
 
“I said, ‘What does that mean?’ and Dr. Salgia said, ‘It means it’s not chemo. They are pills you take at home.’ And I said again, ‘What does that mean?’”
 
“What it means is we are cautiously optimistic that we will still be treating you in five years,” Salgia told him.
 
“ALK-positive cancer describes cancer cells that have a change in the structure of the anaplastic lymphoma kinase — the ALK — gene, or a higher than normal amount of ALK protein on their surface,” Salgia explained. “In normal cells, ALK helps control cell growth. With Jeff's diagnosis, the ALK enzyme gets revved up and normal cells keep reproducing and those cells can become cancerous. By identifying Jeff as ALK-positive through genomic testing, we were able to put Jeff on a targeted therapy. City of Hope takes pride in having world-class experts in genomic testing.”

Targeted Therapy Shrinks Tumors 96%

As good as Salgia’s news was, Carpenter said it is important to note that anxiety doesn’t just go away.  
“There is a kind of traumatic stress that comes with a terminal diagnosis,” Carpenter said. “I couldn’t stop thinking about it. There was a constant tightness in my chest. Each little sensation seemed to be the progression of this thing inside my body that was killing me.”
 
Carpenter was given his first targeted therapy in February: one pill in the morning, one at night. After three weeks, he began experiencing liver failure and was quickly taken off of it. After a brief break to recover, he began a new therapy in mid-March 2017. It began working.
 
“Jeff has done incredibly well,” Salgia said. “It is not uncommon to see this kind of progress with lung cancer using a targeted therapy.”
 
Three months into Carpenter’s treatment, in June, his scans showed that his tumor was 76% smaller.
 
By September, 82%.
 
Then 88% smaller.
 
Then 92%.
 
“I started having days when I didn’t think about my disease at all,” Carpenter said. “And that is when, finally, I started to realize how fortunate I am to be treated at City of Hope, by these doctors and this staff. People who keep smiling and keep looking me in the eyes. They face the mountain that is cancer every day, get up the next morning and they start climbing again.”
 
In January 2019, more than two years after he was given six months to live before coming to City of Hope, Carpenter had his first PET scan since his diagnosis.
 
There was no cancer.
 
On his way to his same-day, follow-up appointment with Salgia, he ran into him in the stairwell.
 
“I had a look at your PET scan,” Salgia said. “It’s completely clean. There is no evidence of disease. Isn’t that wonderful?”

‘You are not a statistic'

“I wanted to be sure I understood what this news meant,” Carpenter said. “I said to Dr. Salgia, ‘So this does not mean I am cured, that it can come back, statistically.’ ‘You are not a statistic,’ he told me. He hates when I talk statistics.”
 
“I told Jeff to go live his life and to keep taking his medication,” Salgia said. “And if and when his cancer returns, we will deal with it then. Having a great quality of life only comes if you get life. That’s how we practice medicine at City of Hope.”
 
“My chances of living a reasonably long life are at least as good as others around the world who don’t have my diagnosis,” Carpenter said. “And it’s because I am being cared for at City of Hope.”
 
Today, Carpenter is healthy, happy, back at work and living his best life. He had to stop flying planes when he got sick, but he is realizing another dream. Ten years ago, he and his family rented a cabin in the White Mountains just north of Bishop, California, about four hours from City of Hope’s main campus in Duarte. They dreamed of building their own place there one day. They have since closed escrow on a piece of land where their cabin will be, and construction is scheduled to start in a few weeks.
 
“This dream of ours is possible because of City of Hope,” Carpenter said. “I want to thank Dr. Salgia, my care team and everyone at City of Hope for giving me the opportunity to dream again.”
 

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