Meet David Lahey, an entrepreneur who was in the prime of his life when he was given a 3% chance of surviving an aggressive cancer. Despite his diagnosis, David is beating the odds with the help of Dr. Lillian Siu and a world-class medical team who are using groundbreaking immunotherapy treatments to train his own cells to fight back.
Lisa: In 2020, David Lahey was in top form. He worked out three times a week with a personal trainer. His business, Predictive Success, an HR analytics platform, was thriving. He was about to become a grandfather for the first time. All in all, a pretty perfect life. Then David got a sore throat, so his doctor sent him for tests.
Lisa: Did you even imagine it could lead you down this path? Or were you just, “okay, I got another meeting. I got to get going. Just, do the test.”
David: Yeah, like a lot of entrepreneurs, I thought, well, we'll fix this quickly and we'll get back to work. I mean, you know, that's kind of my upbringing. That's what I am. That's my DNA.
Lisa: Things didn’t get fixed quickly.
David: Those words you don't want to hear that you've got cancer. And it's very aggressive.
Lisa: Was it terrifying the day he called you? And what do you remember about that call?
David: It was terrifying sitting around. He said where are you now. And so I went outside of my office in Whitby, Ontario, and I looked at the sun and I said, “wow, this is going to change. This is going to be a tough journey. This is going to be one that it's probably going to take a few years or maybe more.” But I knew in my mind that I had to get through this. And you know, it's throat cancer. 75% of people get through it. The next day, I got a call that changed my life.
Lisa: David fell into the 25% of people who don’t normally make it. He ended up in the palliative care ward, and was given just weeks to live. Then he was granted a reprieve. You could call it a miracle. A new treatment that some doctors believe will change the way we treat cancer forever.
Lisa: This is Carry The Fire, a podcast by the Princess Margaret Cancer Foundation featuring inspiring personal stories, about what happens when world-leading doctors, researchers and their patients come together to ignite breakthroughs in cancer diagnostics, research and treatment. This is a podcast about innovation and radical hope. I’m your host Lisa LaFlamme. In this episode, a lifesaving and increasingly new standard of care for cancer: immunotherapy.
Lisa: What David Lahey’s tests revealed was a tumour, two and a half centimetres long which required an immediate course of action - thirty-five weeks of radiation to try and shrink it.
Lisa: What's that like going through 35 weeks thinking, you know, I might be getting the stuffing knocked out of me, but it's all for a good cause, because when I come through it I'll have a healthy life.
David: You study every message and every nuance from your doctors. They come in and you are looking for good news. You were looking for some semblance of hope because it gives you strength to go on. I was getting none of that.
Lisa: Instead of shrinking, the tumour had grown to six and a half centimetres, eventually curling around his windpipe and jugular vein.
David: You know, they said I had a 3% chance of living.
Lisa: That is a stunning statement. You were given a 3% chance.
David: By the way, I didn't know now, but you don't come back from the 18th floor.
Lisa: The eighteenth floor of the Princess Margaret Cancer Centre is the palliative ward where they provide end-of-life care.
David: My brother asked a doctor, you know, how much time is he gone and left, and and he said 4 to 5 weeks. I couldn't walk down the hallway, you know.
Lisa: How much did you weigh?
David: I was 131 pounds and I'm normally 165. So, what happens is cancer when it attacks you, it doesn't go for your organs. It goes for your muscles first and then it goes to the organs. And so I lost all my muscular strength. At this point things were incredibly bleak.
Lisa: At this point, the tumour prevented David from speaking or swallowing.
Lisa: How did you treat your mental strength?
David: I mean, yeah, that's what everybody's diagnosed with cancer, especially
stage four. You have to have the big cry.
Lisa: What is it?
David:It's, you know, it's really a, you know, a deep, deep chested cry where woe is me. Why did this happen to me? I was in great health. I mean, it's just. Why why, why? Getting that off my chest was helpful. I mean, you have to go through this. Holding it in is not helpful.
Lisa: I have to ask you, just because I, I'm always interested and always challenged to find the right words, if someone has been given a diagnosis, is it hard when people, I mean, you're this guy who doesn't doesn’t suffer fools. Everything's real. When someone looks at you with, you know,
David: I call it cancer eyes.
Lisa: Okay, there you go. Tell me about that. How hard it is as the the
recipient of someone looking at you with cancer eyes?
David: Any cancer patient will know what I just said means to them is that people look, oh, well, he's gone. He's toast. And so as business people, you know, we never want to expose any weakness. And so part of me said, I'm not going to tell anybody about my cancer journey. I'm going to quietly get this done. And I went to a good friend of mine Gary Berenger and he said, listen, I've got two friends. One, shared it with his close friends and he got support, and the other one chose not to. The one that chose not to is no longer with us. And so that kind of made sense. So I chose the path of I'm going to share the story. I'm going to get support from my brethren and my colleagues and even my clients. And I was amazed at how much they supported me in my journey versus avoiding it.
Lisa: David says this is the moment his recovery started.
David: And, I just kept going to faith versus fear. I said, there's going to be a path forward.
Lisa: Can you explain that?
David: You know, it's interesting. I do believe that, you know, we're all here for a greater purpose and we forget that as people in our busy days, I certainly did as an executive. And so coming back to those roots gave me strength, gave me distraction, if you will. And gave me, you know, really this hope that things could get better, you know, the look of pain in my wife's eyes as she left when they said, this is it. You know, I saw her leaving and she had to drive all the way back to Whitby by herself so I mean that I don't want to ever see that look again. So I knew I had to be there for her, to get through this. So that was a those are very those are the deepest, darkest times in your life. And so to get through those, it just takes something bigger.
Lisa: Before we get into the specifics of David’s medical journey, he told me about another piece of advice that helped him through that awful time.
David: I had a psychiatrist come in and he said Dave, there's two different paths here. One path is you're going to die. And that's going to take some energy, is to plan your funeral, and then they'll take some psychological efforts. And the other path is you're going to live. From my experience, if we can just get the death plans out of the way, then you can focus on getting better. It was probably the best advice I ever had.
Lisa: Wait, explain that. So he basically said to you, plan your funeral, once that's sorted, we can move on to healing.
David: Yeah, we can step out of that. And so all that energy that you think is diverted from there to the healing process. Pretty simple path, but I did it. Only problem is I couldn't talk.
Lisa: David couldn’t talk so he wrote down what he wanted and asked his friend Todd to help him plan his funeral. He wanted a simple service with a bagpiper.
David: And so he took care of that and booked it for me.
Lisa: What a task to give your close friend.
David: It was tough for him. A few tears back and forth, but it gave me a sense of fulfilment, and that was done. And so there was one last thing for my family to worry about. And then I just turned right and said, I'm going down this path to recovery.
Lisa: And that's when Doctor Siu takes the steering wheel.
David: Yeah
Lisa: Dr. Lillian Siu is a medical oncologist at Princess Margaret Cancer Centre. She treats patients, and runs clinical trials.
David: We needed a new doctor, a new approach, and that's when we got to Lillian and she's an innovator. And so it's, you know without her on my team, I wouldn't be here today.
Lisa: She saved your life.
David: Yeah. She gets flowers every Easter and Christmas.
Lisa: And this particular Christmas was just before David’s 60th birthday.
David: I thought it would be my last birthday.
Lisa: But Dr. Siu had other plans.
Siu: It was not just me. It was a team. Obviously we needed the pathologist to help us get the tumour to get tested at very short notice. We have to get the drug ready, etc., etc.. So, I mean, it was clear that we could not wait till Christmas is over because he would not be well enough to tolerate the treatment. He was very borderline, to be honest. Even to be treated at that time. If there was only going to be even a 1% chance, we would go for it, of course.
Lisa: Dr. Siu and the pathologists started by testing something called the PDL levels in David’s tumour. PDL regulates T Cells from attacking healthy cells in your body. David had to have high amounts of PDL levels of 50% or greater to get this treatment. Luckily, those levels came back high.
Siu: He obviously was a very lucky man. We knew it was one that was going to respond very well to immunotherapy. At that time, a very, very new treatment. Not like now. We know a lot more about immunotherapy.
Lisa: The drug that Dr. Siu is referring to is Pembrolizumab, a type of immunotherapy.
Ohashi: Immunotherapy is using the immune system and in our context is using the immune system to fight cancer.
Lisa: This is Dr. Pamela Ohashi. She is a senior scientist at Princess Margaret Cancer Centre. She and Dr. Siu run the Tumour Immunotherapy Program and they co-led the groundbreaking INSPIRE study, a highly impactful clinical trial focused on the effects of Pembrolizumab, in patients with advanced solid tumours.
Ohashi: Normally the immune system really fights off viruses and keeps us healthy. And the whole idea that we can actually capture the system to use it to target and fight and kill cancers is really what all the excitement is about.
Lisa: I've heard this pretty good analogy. You know, the immune system is the superhero in an action movie and fights to protect your body from harmful invaders. But I also know that you have an even better analogy. That may have something to do with our national sport.
Ohashi: If we use the analogy of a hockey team, this works quite well because let's think about, how does the immune system kill cancer? It's really one type of cell. That's a T cell. It's a white blood cell. But we can think of this as a center ice person. And to kill the cancer would be the analogy would be the center ice hockey player goes in on goal shoots and scores. It's like killing the tumor can actually score a goal. So this is the idea that you want to have one cell killing the cancer. But if you think about hockey, it's not just all about the center ice guys, not just all about Auston Matthews. You need everybody else on the team to really get together and, allow or set up the play such that he can score. So we're talking about other cells like wingers. We have other cells called helper cells. There's defense, people that actually try and block the immune response from working. So these cells are regulatory cells. They are kind of bad guys, but they're defending the tumor in a sense. They're defending the goalie. So there's many, many components. There's also referees because they're there to regulate the game. So they're also saying, okay, if anything gets out of control the referees step in. So there's those kinds of cells as well. So when we think about immune therapy, we're not just thinking about the T cell that's going in to kill the cancer. We have to think about all these other things that are going on. And all of that together is going to determine whether or not a patient is going to have a good response when they're treated with immunotherapy.
Lisa: What an excellent analogy. It's so clear. And you may want to consider as a second career consulting the Leafs. I think that your analysis of how a good game and a good victory should unfold is brilliant.
Lisa: For years, Dr. Ohashi and Dr. Siu and their colleagues faced controversy and derision from some members of the broader cancer treatment community for even pursuing immunotherapy.
Ohashi: The field itself thought the immune system is evolved to fight viruses, and they completely believe that the immune system should not be fighting our body. It would be a disaster if the immune system turned against itself and fought the body, because then you'll have tissue destruction, you'll have organ destruction, and it's going to be a huge mess. And so the belief in the field is that the immune system has evolved and grown and developed in such a way in our body so that it has learned not to attack ourselves. So for decades and decades, people did not believe immunotherapy would work. And so I was part of that camp that always said, no, immunotherapy is going to work. And we just have to find the way to tweak the system
Lisa: And then how does a traditional therapy like chemotherapy or radiation interact with that tumour?
Ohashi: So radiation and chemotherapy target any cells that are rapidly growing. So it's nonspecific. So any cells that are rapidly growing are targeted by chemotherapy and will die and that's why you get side effects. So you have hair loss because those are the cells that are growing. So there are these side effects that are usually unwanted with chemotherapy treatments. So in this context if you have a tumour killing T cell it's only going to target the tumour. And no other cells. That's in the ideal world.
Lisa: So a white blood cell, aka a T cell, that normally kills off virus infected cells could also kill tumour cells. But it needs some help from that drug Pembrolizumob.
Siu: So it was I'm sure he told you it was Christmas.
Lisa: It was also his 60th birthday.
Siu: It was also his 60th birthday.
Lisa: You gave him the present of a lifetime.
Siu: Well, I think science did.
Lisa: This is Dr. Siu again. She and her colleagues had a sense that David’s T-cells were actually fairly healthy. They just needed a little push.
Siu: We decided that we would push for the treatment before the holiday closure, and, and we basically squeezed him into the treatment unit, literally, like, I don't know, December 21st or something.
Lisa: Immunotherapy. It was a hail Mary pass. One last chance for a quickly fading David Lahey.
David: All of a sudden it's starting to feel a little different. I get my hearing back because I couldn't hear. I get a little bit more energy and I start moving around in the bed. Within two and a half weeks, I’d gained so much energy back that I was allowed to go home. So I was taken off of palliative care, and then sent home and, within another two weeks, now I could start talking again so my speech came back, and then my ears popped. And so the tumour had grown around my eardrums and I could sense it was shrinking.
Lisa: But then, after a month, a setback: David started struggling to swallow again, like there was some kind of a blockage in his throat. The tumour had shrunk but what was this new complication? His family called 911 in a panic.
David: And as they arrived, I coughed up a tumour, a honeycomb tumour in the size of a loonie, and then another one behind it. And those were the actual tumours from my throat. Because of the immunotherapy had destroyed the cells and they were expelled from my body.
Lisa: That is an incredible story. Is that tumour in formaldehyde somewhere in one of these offices, or what do they do with that?
David: We brought it in to show Doctor Lillian. And she goes, oooh, and she threw it away. So, no, we don't have that anymore. Maybe we should have frozen it.
Lisa: With the tumour now cleared out of his throat, David still faced a long recovery.
David: Coming out of this, I could not swallow food. And my goal was, I have to be able to swallow food. Life is too short not to be able to enjoy, you know, a nice chicken or a glass of wine or what have you. So I hired a speech path, Lynn Varma based in Kingston, Ontario and Lynn taught me how to swallow, if you can imagine, from zero every day for one hour, Monday to Friday for two years. So it's very labour intensive, quite painful. But by taking, you know, small steps, you know, I'm able to now eat all three meals a day. It takes me longer but, I believe one day I'll be having, you know, a steak. That's my next goal.
Lisa: That's a good goal.
Siu: I think his recovery is important for us to learn what happens to patients who have benefited from immunotherapy. The so-called long term survivors who are not supposed to have long term survival? And we're all learning from cases like this, you know.
Lisa: According to Dr. Siu, immunotherapy is now being used successfully with some forms of rectal cancer, kidney cancer, lung cancer, triple negative breast cancer, head and neck cancers and more.
Dr. Siu: Will the cancer come back? Well, I don't know. I told David many times I don't know. And it could. But we hope not. And if it comes back what are we going to do? We probably got to try the immunotherapy again. Is it going to work again? I don't know.
Lisa: These are important questions that will be answered over time.
Siu: But I didn't expect, you know, fast forward four years, five years, he's, you know, back to work full time. And you know, he sends me pictures of him vacationing with his family. And you know, honestly, it's, I don't have that kind of success in every case. But this was a remarkable case.
Lisa: And this is Dr. Ohashi.
Ohashi: Many of us still think there is a huge potential to really cure many types of cancers. And so people have hesitated to use the word cure over the last 15 years or so. But the last five years, people are saying we have cured cancer with immunotherapy. We have so much to learn. I don't want to say we figured it all out. We're at a brink where we know this strategy will work. We need a lot more, basic science research. So fundamental science research to understand how all of this is coming together, how all the different cells that are orchestrating the immune response can be manipulated. But we see the light at the end of the tunnel. We know that there's potential. So we just have to learn how to tweak things. And soon, I don't know how long, but I really can imagine that we can learn how to tweak things in a way that many, many more people will benefit from immunotherapy.
Lisa: As for David I gotta say he looked the picture of health. He walked confidently into our interview on his own two feet, straight from work and was looking forward to a round of golf right afterward.
Lisa: Besides learning, relearning how to swallow, what changes in a person's life, in your life, when you are given really a death sentence and a pretty tight timeline. And now here you are, four years later. What else changes?
David: I try not to take anything too seriously. I think, you know, make fun happen. You know, certainly, faith versus fear everyday. I've spent a lot more time thinking about giving back to my community, in different ways. I sponsor a researcher at Princess Margaret every year. I give them $50,000, our pledges $1 million, to bring a researcher in. This lady is from Brazil this time, and she studies immunotherapy specifically for throat cancer. I would say give money to research hospitals. You know when you give back and you see an impact, I think that's so powerful. And in this case, the money that you give goes to save lives. I've seen it. I live that. I'm one of them. And that kind of makes sense. However, the longest living person with immunotherapy is seven years. I'm four, so maybe I only have 1200 days left. But I'm thinking that I have a lot longer than that.
David: I'm going to beat this record.
Lisa: David is counting the days but he’s also making the days count. He’s back on with the personal trainer, eating the right foods with the help of a nutritionist, continuing with the speech pathologist, practising his faith and above all, staying positive.
Lisa: Are you a bucket list guy?
David: No I don't. I think that's a waste, that's crazy. But I did go out and buy a 1969 Mercedes.
Lisa: Of course you did.
David: And, it's in my garage. I take that for a drive once every maybe three weeks or so. And I do, go to the cottage and north of Kingston and we, you know, sit there and, and have the odd glass of wine and, and go on a, on a boat tour.
Lisa: I hear there's also a pond up there that might see more action in winter than in summer with the odd hockey game.
David: Yeah, so, yeah this is interesting. Couple of years ago I put skates on. I used to play varsity hockey in the States at Hamilton College for four years. And I hadn't skated, of course, because of my illness. So I strapped on the blades and and we played pond hockey, six months after my immunotherapy and, we lasted for about five minutes.
Lisa: I was waiting for that.
Lisa: You’ve been listening to Carry The Fire from The Princess Margaret, a world leading cancer research centre. If you found this episode meaningful, please subscribe, rate, and leave a review. To learn more, check the show notes. And share this podcast with friends and family to help spread the hope for a brighter future. I’m Lisa LaFlamme. Thank you for listening.