An NCI-designated Comprehensive Cancer Center
By Maxine Nunes | February 28, 2020
Erminia Massarelli, M.D., Ph.D., profile photo Erminia Massarelli, M.D., Ph.D., M.S.
After years of battling squamous cell cancer — years of hope followed by crushing defeat — it looked like game over for Michael Langer.
 
“A lot of people had me down for the count,” he said. “Family members were planning my funeral.”
 
And the truth is, he was in pretty bad shape.
 
Langer’s first bout with the disease, in 2004, was a squamous cell carcinoma on his tongue. It was surgically removed along with his neck lymph nodes, which were clear, and no other treatment was needed. For more than a decade he remained cancer free.
 
Then in 2015 it returned with a vengeance, and this time it had spread to his lymph nodes. After surgery and tongue reconstruction, he underwent radiation and chemotherapy. His follow-up PET scan showed he was cancer free. Langer thought he’d beat it again.
 
Michael Langer | City of Hope

Michael Langer

Less than a year later, the cancer returned to his neck, but because of damage from the previous surgeries, the surgeon was not able to remove the entire tumor.
 
At that point, his brother-in-law, a radiation oncologist, suggested he go to City of Hope and see medical oncologist Erminia Massarelli, M.D., Ph.D., M.S.
 
“From the moment I met her, she conveyed to me a sense of empathy I had never experienced with any other physician I’d encountered,” Langer said. “As soon as she walked into the room, I felt a caring and a warmth.”

His last and only hope

Under Massarelli’s care, he underwent chemoradiation therapy. “It was a desperate attempt because after many recurrences, cancer usually becomes more and more resistant,” she said.
 
Unfortunately, that was the case for Langer. The cancer spread to the lymph nodes in his chest. In a last-ditch effort to save him, Massarelli tried a different combination of chemotherapy drugs, but the disease progressed.
 
The tumor in his neck was protruding, he said, “like a cauliflower.” It wrapped around his carotid artery, until he could no longer eat and had difficulty breathing. A feeding tube was inserted and he had an emergency tracheostomy.
 
“It was really a tragedy,” said Massarelli. “He was very close to the end.”
 
But Langer wasn’t ready to give up. He’d read an article in the New York Times, “Harnessing the Immune System to Fight Cancer.” It mentioned a drug called pembrolizumab (Keytruda), an immune checkpoint inhibitor that removes certain blocks that prevent the immune system from destroying cancer cells.
 
He was convinced this was the answer — but because of an unrelated condition, the side effects of pembrolizumab could prove fatal. It didn’t dissuade him.
 
“I was confident it would work, and I believed with all my heart that I wasn’t going to die,” he said.
 
Massarelli considered the drawbacks — but there really weren’t any other options. It was his last and only hope. She put him on pembrolizumab, and after two months, he had a PET scan.
 
“I was expecting to hear that the tumor had shrunk. But the news I received was beyond miraculous,” Langer said. “The cancer was just gone.”
 
For about a year now, he’s been eating without a feeding tube, and a few months ago the trach tube was removed and he’s breathing on his own.
 
“That’s very rare, almost unique, for a patient at that stage. It’s unbelievable,” Massarelli said.

His Progress Continues

Langer is on his third year of pembrolizumab and is still in remission, but the journey left him with some collateral damage.
 
Due to radiation, he has a paralyzed vocal cord. For Langer, a singer who recorded with the Tufts University Beelzebubs, this was like losing part of his identity.
 
“My voice sounds like a combination of McGruff the Crime Dog and Jimmy Durante,” he said.
 
He also has a wound on his neck where the tumor had been, and he hopes a graft with a skin substitute will be the solution.
 
With typical optimism and good humor, he is confident about the future, and just as he knew pembrolizumab would work, he’s certain these problems will also be healed. The ordeal of these side effects, though, made him a strong advocate for immunotherapy as the first line of treatment, and it became the standard of care for head and neck squamous cell carcinoma in June 2019.
 
He also expressed his gratitude for the City of Hope staff.
 
“I felt that Dr. Massarelli sincerely cared about my welfare, and that meant a lot. Mary Carroll, her nurse practitioner is a godsend, and the whole team is phenomenal,” Langer said. “That comes from the heart. I can’t sing their praises enough.”
 

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