Metastatic Prostate Cancer:  Astonishing Improvement and a Landmark Case

New research opens up a whole new avenue for treating advanced prostate cancer.

 One of the best things about working as a writer for the Prostate Cancer Foundation (PCF) is that I have gotten to interview scientists doing some of the most promising research on prostate cancer, a disease that I can’t seem to get away from.   But even better, I have met some incredible men and their families who are true warriors battling this disease.  The LLobets are right up there as some of the bravest, and Rodolfo’s has become a landmark case.  I wrote a much longer, four-part version of this story for PCF, which funded the research that has made such a difference in Rodolfo’s life.

Checkmate, and a Glimmer of Hope

 Early 2024 was a rough time for Rodolfo and Kelly LLobet, and for their family.  An airline pilot and U.S. Navy Veteran, Rodolfo was very close to entering hospice care for his metastatic prostate cancer.  After three clinical trials and nine treatments – none of which worked for longer than a few months – his doctors had run out of options.

It had been a long four years since his diagnosis at age 55 with stage four prostate cancer, and Rodolfo was battle-weary.  The disease had evolved into an even more aggressive form – neuroendocrine prostate cancer – and it was everywhere:  in his neck and brain, in his abdomen and in his bones.  After moving from one impasse to another, it looked like Rodolfo had finally reached checkmate.

            Then came a glimmer of hope:  Physician-scientist Maneesh Jain, M.D., medical oncologist at the DC VA Hospital and George Washington University, believed he had something that might help Rodolfo.  What he had to offer had never been tried in a prostate cancer patient:  off-label use of T-DXd, a drug approved for use in other cancers that produce a protein called HER2.

Jain told Rodolfo and Kelly: “’I’m not sure if this is going to work.  We don’t have any published data to show that this drug has been tried in prostate cancer.  But we see that your HER2 expression is high.  I think it’s worth a shot.’  The LLobets agreed, and here we are.”

In February 2024, thanks to support from The Edward P. Evans-PCF Precision Oncology Center of Excellence, Rodolfo became the first known patient to be treated with T-DXd for prostate cancer.  His improvement was so astonishing that this would become a landmark case.

What drew Jain to this drug?  In research funded by PCF, he happened to be looking at HER2 and other biomarkers using a process called immunohistochemistry.  With Ramesh Subrahmanyam, Ph.D., and colleagues, Jain he discovered that HER2 should be measured differently in the prostate than in other organs – and the team came up with a novel scoring system to quantify HER2 expression in prostate cancer.   (Note:  This is really important, because measuring systems that work in other cancers don’t pick up the true HER2 levels in prostate cancer.)

The drug’s approach, Jain explains, is based on one simple question:  do the cancer cells make HER2 or not?  If the answer is yes, T-DXd – like a heat-seeking missile – homes in on those specific cells using an antibody that singles out HER2.  Then it delivers a deadly dose of chemotherapy directly to those cells. “It’s an incredible drug.”

For Rodolfo, T-DXd did what no other treatment had managed to do:  made a spectacular difference in his cancer and gave him his life back.  After four cycles of T-DXd, Rodolfo showed a 57 percent overall reduction in his cancer, including metastases in the brain.  “His condition improved significantly, defying earlier prognoses that suggested a transition to hospice care due to a lack of treatment options,” Jain and colleagues wrote in November 2024, in a case report published in the Annals of Internal Medicine.  As of this writing, Rodolfo has been on this T-DXd therapy for more than a year. 

            Even after two cycles of treatment, Rodolfo had a “dramatic improvement in his fatigue and his appetite,” says Jain.  “His energy increased, because his hemoglobin increased.  There had been a huge tumor on the left side of his neck, and that shrank so that you could no longer palpate it.  He no longer had bone pain.  With that neck tumor, he couldn’t swallow well on that side, and his vision was impaired on the left side.  A lot of those symptoms went away within a few months.”

Road Trip in God’s Country

“We started T-DXd on February 22,” Kelly LLobet says. Like many cancer spouses, she uses the plural pronoun because they are in it as a team.  “We had a really good response almost immediately.”  So encouraged was Kelly that she began to think about an opportunity for a family trip that – just a month ago – she had not thought would be possible.  The Llobets homeschool their children, as part of a school based in the Northwest.  The school had sent an invitation for a graduation ceremony in June.  “We had a senior in high school and one graduating out of eighth grade,” but June was a long way away.  She had put the letter aside and the decision into God’s hand with prayer.

The graduation event was perfectly timed – right in between three-week cycles of T-DXd.  Rodolfo was all for it.  “We took all four of our sons,” he says, “rented a vehicle and we drove around the Northwest for two weeks.  We saw God’s country out there.  It’s gorgeous!”  They sent celebratory pictures of their trip to Jain and the team at the DC VA, and returned home just in time to start the next round of treatment.

In April 2024, they celebrated 25 years of marriage, and in August 2024, they celebrated Rodolfo’s 60^thbirthday.  “Our sons will never forget this trip,” says Rodolfo. “We won’t.”

Another bonus:  T-DXd is a targeted therapy – the rifle instead of the shotgun approach to killing cancer cells.  It only kills cells that make HER2 and those in the immediate vicinity.  Because of this, says Rodolfo, “I don’t have a lot of side effects that I would have if I were getting chemotherapy, and that’s a huge difference.  I have some fatigue and muscle weakness, which I’ve been dealing with, so it’s nothing new.  But there’s nothing beyond that, which is a miracle in and of itself.”

Advice for Patients and Caregivers

            Kelly’s advice for other caregivers:  “Build a relationship with the doctors, the technicians, the nurses, with every single person” involved in the patient’s care.

Also:  Educate yourself as much as possible, Kelly continues.  “Read the emails from PCF.  Look things up.  Ask questions.  Go to clinicaltrials.gov.  Find out what can be done for your loved one.  A faith community is key:  you need all of that support.  If you’re holed up in a corner not talking to anybody, then that’s not possible.”

            Rodolfo says the worst time for him was the diagnosis.  Then it was time to get busy.   His advice for patients:  “Once that scare pinnacle has come and gone, go to your doctors, go to PCF.  Don’t be afraid to ask questions and find out what your resources are, because you might be missing out on something.”

***Update:  June 30, 2025, very sad news. I just learned from PCF that Rodolfo has passed away.  God bless and comfort Kelly and his sons.  I am leaving this story posted because I believe there is potential to HER2-directed treatment for men with prostate cancer who express this protein, and if you have metastatic prostate cancer, you need to explore every avenue you can.  It may be that identifying HER2-positive cancers early on, and starting treatment with a drug such as T-DXd when the cancer burden is lower, could prolong survival and quality of life for significantly longer.  Just my two cents.

In addition to the book, I have written about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org.  I firmly believe that knowledge is power.  Saving your life may start with you going to the doctor and knowing the right questions to ask.  I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease.  Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington