Doctor Becomes Patient Fighting for Life with Lung Cancer

With the paralysis of his vocal cord, the voice of Michael Weitz, MD, is not what it used to be.

Although it’s not painful, it makes it a little harder for him to speak and project his voice. His swallowing is audible and at times he struggles to get his words across, but he has accommodated pretty well considering the hell his body has gone through after he was diagnosed with lung cancer.

Dr. Weitz came from a family of doctors. His older sister found her calling as an internal medical physician, while his father worked as an orthopedic surgeon, a path he initially thought would become his own.

Dr. Weitz had always wanted to be able to help and heal people, and viewed being a physician as “the noblest profession of all.”

When he completed his 2 prerequisite years of internal medicine and general surgery, Dr. Weitz discovered the emergency department was his holy grail.

“I just wanted to be the consummate physician, who whenever I walked in the door I could help people, whether it was a heart attack, a stroke, or diabetic ketoacidosis,” Dr. Weitz said. “I didn’t want to just write prescriptions, I wanted to do something functional and save lives.

“I wanted to help during critical situations by speaking with families and getting them through their emergency department journey. It’s a time of great stress. I felt I had the right personality to make sense out of chaos, to relieve pain and suffering, and to bring comfort to not only the patients, but also their family members.”

This life Dr. Weitz built for himself was exactly what he had strived for. He had become an emergency physician and rose to the position of associate director of the emergency department at Providence St. Johns Health Center in Santa Monica California.

Dr. Weitz was on the front lines of medicine, calling the shots and making diagnoses. He was a healer, a caregiver, a problem solver, and the one who looked to continually give people hope, no matter the circumstances.

But what happens when the healer becomes the patient? When the word cancer kept pounding against his brain on repeat.

Being a doctor, you learn to look for the red flags, and Dr. Weitz had one waving in his face when he started getting chest discomfort each time he swallowed cold liquids.

“This is how it begins,” he thought.

Tests and X-rays were performed immediately, followed by a cat scan and a bronchoscopy, which is what determined his diagnosis. The aftershock of the news he received would reverberate and control his daily existence in the days, weeks, and months that followed.

Dr. Weitz had stage IIIB non-small cell lung cancer and he had 3 to 6 months to live.

“In the beginning I couldn’t get it out of my head, it was lung cancer 24 hours a day,” he said. “Every time I woke up I thought it was a bad dream. I couldn’t believe it. Here I was at 49 years of age, I had never smoked; I had never even dreamed that I could have lung cancer.”

It’s unusual for lung cancer to be diagnosed in the early stages. Typically, symptoms won’t manifest until the disease has advanced significantly. Those who are fortunate enough to catch it early usually find it by chance, in a serendipitous way, while getting a scan or an X-ray for something else.

In the 9 years that followed his diagnosis, Dr. Weitz’s life has been filled with chemotherapy radiation treatments, targeted therapy, and surgeries.

The doctor started him off with chemotherapy, followed by radiation. Dr. Weitz even saw a thoracic surgeon, who said he would operate on him if he had the chemotherapy and radiation and if the disease didn’t progress.

“He didn’t say it had to get better, but if it didn’t progress, he would operate on me,” Dr. Weitz said. “I was of the opinion that I wanted to have surgery to de-bulk the tumor. To get it down to a manageable size, so that there wasn’t a whole lot of disease, and to get as much disease out as possible.”

After only 5 months of chemotherapy and radiation, Weitz had surgery, to remove his entire left lung. Initially, his doctor was going to try to cut out the cancer, but decided the whole lung needed to be removed.

“He told me up front that the margins weren’t clear, that they didn’t get it all, even after taking my entire left lung,” Dr. Weitz said. “That was devastating.”

Recovery from his surgery proved to be difficult at first, as he experienced trouble breathing, walking, and shortness of breath that forced him to be put on oxygen.

“Little by little I progressed,” Dr. Weitz said. “The body has a remarkable ability to adapt to situations. You can have a loss of a lung and still be able to function in a pretty normal fashion.”

When Dr. Weitz speaks about his targeted therapy drugs, he refers to them as a bridging medicine. It would work for a while, but eventually the body develops a resistance to them.

“They were like little bridges that enable you to get to the other side,” he said. “Some bridges were long, some bridges were short. But eventually all these drugs lead to resistance, and then you have to have the next thing to turn to. You have to kind of plan ahead and say, what will I go to next when this fails? Not if this fails but when this fails.”

At that time, doctors speculated that he might have a mutation called the Epidermal Growth Factor Receptor (EGFR). If this proved to be true, then it would make treatment much more responsive.

Initially, Dr. Weitz responded to the testing and was given the drug Tarceva (erlotinib), which he stayed on for a little over a year.

However, things started to go sour when Dr. Weitz was staring at his computer screen and experienced difficulty reading.

His first thought was, this has to be a brain metastasis. Dr. Weitz assumed he might have 1 or maybe 2 metastatic lesions, but when the doctors took a look they discovered he had too many metastatic lesions to even count. Dr. Weitz described this as, “the kiss of death.”

Prior research has found the 1-year survival rate after having a brain metastasis is approximately 2%. To attack this new threat, Dr. Weitz received whole brain radiation, followed by targeted radiation to the lesions on his brain.

“I tolerated that pretty well, I had some fatigue and I was certainly worried about cognitive deficits in the future,” he noted.

Fortunately, his radiation oncologist had the mindset that Dr. Weitz would live a long time. So he needed to preserve his brain capacity by reducing the radiation dosage, just as he avoided radiating his coronary arteries as much as possible during his initial chest radiation, so they wouldn’t be damaged.

Since he was now resistant to Tarceva, Dr. Weitz went on another clinical trial with a c-met inhibitor drug called Arqule 197 to help overcome this resistance. However, this only lasted for a year and he was soon running out of options.

In a way, Dr. Weitz’s mother is the one who came to the rescue after she saw a patient on ABC World News Tonight who had lung cancer and the extremely rare anaplastic lymphoma kinase (ALK) mutation. This patient had been on his death bed, and was given a new drug developed for ALK mutation. Within 6 weeks, the patient was out of the hospital with a significant reduction in his tumors.

Dr. Weitz jumped at the opportunity to talk to his doctor about being tested for the ALK mutation, even though it was extraordinarily rare.

Initially, his doctor was not on board. Although they had originally thought that he carried the mutation EGFR, it was discovered that Dr. Weitz actually carried the KRAS mutation, and it was mutually exclusive to have the ALK mutation.

Unfortunately, having the KRAS mutation is not ideal. Even today there is still no effective treatment for the mutation. Eventually it turned out that his KRAS mutation was a false positive.

The next day his oncologist came around, and sent it to the lab for ALK testing.

“At that time there was only 1 lab in the country, Massachusetts General Hospital that evaluated for this ALK mutation” he said. “They had very little support there and only a couple people in a lab. You couldn’t even get a printed report, and it took forever before it came back.”

When the results finally came back, Dr. Weitz was in shock. He had the ALK mutation, and suddenly everything seemed a little brighter. He could potentially go on the drug crizotinib (Xalkori), which at least offered the promise of a new hope.

“Crizotinib was a real game changer,” he said. “I was number 66 in the world on that drug, because this was a newly discovered mutation. Most people got resistance at around 10 months, but this was the longest bridge of all. “I was the first or second longest survivor that didn’t meet resistance on that drug for 4 ½ years.”

Although the rest of his body was doing better and didn’t show any signs of cancer growth, his brain had a few brain mets show up again.

Xalkori does not cross the blood-brain barrier well, which is something he knew, so it wasn’t all that effective at managing the metastatic disease in his brain.

Today, Dr. Weitz has been on alectinib (Alecensa) for more than 1 1/2 years, and because it crosses the blood-brain barrier exceedingly well, the treatment took care of his brain mets. So far he has not met resistance.

Even though Alecensa has been found to show some significant changes in his health, Dr. Weitz still is dealing with some health scares.

A couple of months ago, he was met with increased swelling in his brain called edema. His physicians thought it could be radiation necrosis, which is when you get dead necrotic material from lesions that have been treated with radiation. On the scans it looks like a mine field, with all these dark areas of previously treated metastatic lesions.

The radiation necrosis could be causing the swelling in his brain from a dominant lesion located near the right frontal lobe. Doctors also speculated that the cancer might be back.

“It just kind of came out of the blue and started spewing forth edema,” Dr. Weitz said. “Most of the doctors thought for this to happen so long after radiation, there must have been a return of cancer to that lesion. Typically, cancer causes edema and radiation necrosis can cause edema, but because of the exuberance of this they thought that it must be cancer.”

As the swelling continued to progress, it began pushing the right side of his brain to the left. Dr. Weitz started having difficulty with his balance and walking, and he said his personality somewhat changed.

“I realized it when I took a hike with friends and had to hold on,” he said. “I couldn’t walk over uneven surfaces, so that really brought it home. Those around me saw I was struggling.”

He was given steroids to decrease the swelling after it became intolerable. This proved to have little effect, however, and he eventually went in for neurosurgery.

His surgeons evacuated the debris, which turned out to be just an exuberant inflammatory response to his radiation necrosis.

Post-surgery, the swelling didn’t resolve right away, but little-by-little it got better. Dr. Weitz is able to walk, stand, and balance, and he said his personality has returned to normal.

Today, Dr. Weitz is still a practicing emergency physician, and remains the associate director and chief financial officer of the emergency department at Providence Saint John’s Health Center. He has also taken on more of an administrative role and spends a lot of time advocating.

Dr. Weitz joined the Lung Cancer Foundation of America, where he attends media events, speaks to reporters, speaks at conferences, and tells his story to give people hope.

“I’m a little over 9-year survivor,” he said. “I’m blessed to be a 9-year survivor. There aren’t too many of us, but there are a lot of people I’ve met in the lung cancer community who are doing quite well.”

For Dr. Weitz and his family, they have always wanted to keep spreading hope and to try and live a life of normalcy. To not let lung cancer define them.

“We didn’t’ want our kids to be affected,” he said. “We didn’t want lung cancer to define us. It’s part of life. I never felt like a victim. I never felt like ‘why me,’ it was always like ‘why not me?’ No one is entitled to good health, good health is a blessing.”

Today, the war on lung cancer is changing. More options are opening up thanks to targeted therapies and personalized medicine. Chemotherapy is no longer the only option and targeted drugs like Xalkori and Alecensa had minimal side effects, if any, for him.

“Chemotherapy is an equal opportunity destroyer,” he said. “It destroys all your cells, your healthy cells as well as your cancer cells. Your white cells go down, your red cells go down resulting in anemia and, your platelets go down as well. But the beauty of targeted therapy is you’re really only attacking your mutant cells in the cancer.”

Some advice Dr. Weitz has for those who are newly diagnosed is to have someone close to you such as family or friends, who will be an advocate for you and will chronicle what is going on. Most patients can barely grasp what is happening once they receive their diagnosis, so having an advocate is essential to help you navigate this journey.

Dr. Weitz also suggests patients be proactive, go to a thoracic oncologist, and get second opinions, as that is extremely important. He also suggests going to university-based centers conducting clinical trials.

“It’s so important for people to embrace clinical trials and to not fear them,” he said. “When I started alectinib it was in a clinical trial, and when I started crizotinib it was in a clinical trial. I wasn’t afraid of clinical trials. People are so afraid of them and don’t want to be a guinea pig, and I tell people to embrace the clinical trials, because that’s the best hope for them with the new emerging therapies.”

For Dr. Weitz, he isn’t looking for a cure, he is looking to bring people hope and to live this new life he was given.

“Now, the way I look at it, I know I’m never going to be cured,” he said. “I don’t focus on a cure. I don’t think that’s realistically going to happen, but what I do hold on to is the notion that I can successfully manage this disease.”

There is a parallel between his old life and his new. Even with his diagnosis, Dr. Weitz is still continually taking care of people and spreading hope. When he is not feeling his best, he is still encouraging others and sharing his story.

“So many people lose all hope, when oncologists tell them they have 3-6 months to live and it’s just not true,” he said. “No one can predict, no one has that crystal ball. Non-physicians think things are very black and white, but most of medicine is shades of gray. It’s not as definitive as people think. No one can predict how long you’re going to live, because each of these cancers has a unique genetic profile. It’s not just 1 size fits all, not all lung cancer is going to be equivalent.”

Navigating a diagnosis of lung cancer is never easy. There are so many different options and factors to think about. Dr. Weitz plans to continue advocating and look for ways to bring people hope.

“It’s really an art,” he said. “That’s why I don’t believe in cook book medicine, because everyone is an individual and everyone has to be treated as an individual. No one has the right to distinguish hope for people that go through this journey.”