Team Approach Helps Barrie Carr Beat Stage 4 Colon Cancer

As his 60th birthday approached in spring 2017, Barrie Carr decided to schedule his first colonoscopy.

Guidelines recommend initial screening at age 45, but Carr of Northampton felt good and expected to receive the best birthday present of all: a clean bill of health.

He was surprised when the colonoscopy showed unusual tissue growth, but his doctor said not to worry. Days later, though, the pathology report came back with bad news. Carr, who is a nurse at Lehigh Valley Heart and Vascular Institute, had colon cancer. “It was devastating news at the time,” he says.

Treatment teamwork

Carr was referred to Lehigh Valley Topper Cancer Institute surgical oncologist Aaron Blackham, MD, with LVPG Surgical Oncology, for additional tests. The news was about to get worse. He had stage 4 colon cancer, which had spread to both lobes of his liver where five tumors were growing.

Blackham met with the Cancer Institute’s tumor board (a multidisciplinary team of cancer specialists) to discuss Carr’s case. “In most cases of colon cancer, surgery is offered as the first treatment. However Barrie had multiple metastases in both lobes of the liver, and because of his advanced stage at the time of diagnosis, we recommended upfront chemotherapy. Our plan was to assess response after several months of treatment and reevaluate his surgical options at that point,” Blackham says. He referred Carr to hematologist oncologist Usman Shah, MD, with LVPG Hematology Oncology.

“Our goal was to prolong Barrie’s life and minimize symptoms for as long as possible,” Shah says. “But he had a good response to chemotherapy with considerable shrinkage of his tumors.”

In fall 2017, Shah encouraged him to take advantage of the Cancer Institute’s affiliation with the Memorial Sloan Kettering Cancer Alliance to explore a more aggressive therapy that could potentially cure him.

Top-notch partnership

Carr traveled to New York City for an evaluation at MSK. Medical oncologist Nancy Kemeny, MD, explained he was a potential candidate for a leading-edge treatment called hepatic arterial infusion (HAI) therapy, which delivers chemotherapy drugs directly into the liver via a small pump implanted in the abdomen. MSK is one of only a few cancer centers offering this therapy.

However, there was a caveat. Because doctors needed to cut tumors from both lobes of Carr’s liver, the small remaining portion would be at significant risk for damage from chemotherapy. He decided to hold off.

Then in December 2017, Shah discovered the tumors had shrunk further, meaning more of Carr’s liver would remain intact and boost his chances for success.

“I decided to take the gamble,” Carr says.

In February 2018, he underwent surgery at MSK to remove the primary colon tumor and the five metastatic liver tumors. Kemeny then implanted an HAI pump to destroy remaining cancer cells in his liver.

For the next six months, Carr traveled regularly to MSK where Kemeny oversaw his HAI therapy, while Shah continued providing systemic (intravenous) chemotherapy at Lehigh Valley Cancer Institute.

“They co-managed my care and made things as convenient as possible,” Carr says. “We’re extremely lucky to have great cancer care at LVHN and an alliance with MSK.”

A winning gamble

Today, Carr remains cancer-free. “Barrie decided on HAI therapy after many discussions together, and the gamble paid off,” Shah says. “I’m optimistic.”

Carr is now an advocate for regular colonoscopy screening, starting at age 50. “Don’t mess around,” he says.

He’s particularly grateful for the groundbreaking care that’s given him a second chance. “Without a doubt, patients get world-class care here in the Lehigh Valley,” he says.