The beeping monitor disrupts the stillness that fills Roger Bryant’s hospital room. Beth, his wife of 23 years, gently caresses his head as she shares stories of his life with the nurse adjusting his pain medication. Every now and then, Roger faintly smiles at something Beth mumbles, silently reassuring her that he will forever remember the moments. In the corner, Roger’s two sons watch him. Tears fill their eyes as they remember the memories of their hero and scoutmaster, but most importantly, their dad.
Scouting, according to the Boy Scouts of America website, is a commitment to adventure, family, fun, character and leadership. It’s a program that prepares children for life today and the unknowns of tomorrow. Roger, founder of Boy Scout Troop 25 in Waxhaw, North Carolina, embodied every part of that mission as he mentored many young scouts during his eight years as Scoutmaster. In keeping with the BSA mission, when Roger was diagnosed with cancer, he continued his valiant leadership with a commitment to helping further clinical research.
“Roger was the most selfless person, always willing to lend a helping hand to anyone,” described Beth. “He was an amazing father to our two sons, Matthew and Adam, and a deep friend to many. Over his years as Scoutmaster, Roger helped 12 boys attain the ranking of Eagle Scout – a testament to his leadership.”
In April 2016, Roger began complaining about severe abdominal pain and after many trips to his primary care physician, he ended up in the emergency room. Soon after being admitted, a nurse came in to inform the Bryant family that Roger, 49 at the time, had prostate cancer. The diagnosis came as a shock to Roger, who had no family history of cancer.
“Roger was always committed to overcoming barriers, no matter how they presented themselves,” described Beth. “There was a time in Scouts when Roger realized many kids were unable to attend activities due to transportation issues, so instead of leaving those children behind, Roger taught himself to drive a bus and purchased one for the troop. Cancer, to him, would be no different. He would not let this disease stop him from enjoying his life. It would not win.”
After scheduling an appointment with a local prostate cancer doctor, Roger was informed that he had a very aggressive, metastatic cancer that had already spread to his bones and lymph nodes. In the United States, five to 10 percent of men with prostate cancer present in metastatic disease from an original diagnosis.
He immediately began hormonal therapy and radiation with combined docetaxel chemotherapy. This treatment led his PSA to drop from 60 to 0.2, entering into remission for the next six months. Shortly after, his PSA began to climb again, indicating to doctors that Roger’s prostate cancer was hormone resistant.
With his cancer advancing, Roger was referred to prostate cancer specialist, Andrew Armstrong, MD, at Duke Cancer Institute. Roger was committed to advancing science, and the Bryant family wanted to provide him the best clinical access available.
Roger traveled to Duke and enrolled on a sequence of therapy that combined immunotherapy and hormonal therapy. Specifically, he received sipuleucel-T immunotherapy followed by enzalutamide, a recently approved androgen receptor inhibitor that improves survival in men with prostate cancer.
Despite the aggressive approach, Roger’s PSA continued to rise. It was time to turn to an out-of-the-box research approach that involved immunotherapy. Under the guidance of Armstrong, the Bryant family decided to participate in a clinical trial.
Roger was one of the first patients in the world to be treated with a Chimeric Antigen Receptor (CAR T-cell) therapy for prostate cancer, a therapy that has recently received FDA approval in patients with certain types of leukemia or lymphoma. This trial involved engineering T-cells to attack prostate-specific membrane antigen, a protein made by prostate cancer cells, and which is the target of new medical imaging PET scans that are able to better to visualize the spread of prostate cancer. This was an unproven therapy in prostate cancer but offered some hope, despite both known and unknown risks.
“We decided on the CAR T-cell therapy approach because of its safety, the lack of chemotherapy side effects and the hope that he would have some clinical benefits and remission from this therapy. Roger knew that there had been responses in other cancers and was willing to take a chance,” said Armstrong. “Our hope was that Roger’s reaction would be similar to what some patients with blood cancers are getting from this CAR T-cell therapy approach.”
Unfortunately, Roger did not respond to the CAR T-cell therapy and developed new liver metastases several months into the trial.
“The CAR T-cells were not attacking his cancer,” described Armstrong. “Prostate cancer is known to evade the immune system in many ways, one of which includes expression of PD-L1, an immune checkpoint, which permits cancer cells to survive T-cell attack and actually suppress and exhaust the function of these immune cells.”
Roger and his family returned to North Carolina and he enrolled on a Duke trial involving a new therapy that blocks PD-L1. This therapy is called immune checkpoint blockade and has demonstrated success in some men with prostate cancer.
“Research is an iterative process, of successes and unfortunately also lack of successes,” says Dr. Armstrong. “We learn from these studies about the disease, and how to better help our patients continue their fight against cancer and how the cancer develops resistance to these treatments. By doing these studies, we hope to overcome these barriers over time. Without clinical and basic research, we would not have the many breakthroughs that we have today for our patients.”
Roger’s cancer proved to be resistant to even the most innovative approaches, including immunotherapy. On May 19, 2018, Roger passed away after a two-year battle with prostate cancer.
“On behalf of Roger, researchers at Duke are conducting eight new immunotherapy trials in prostate cancer based on very strong science and of course, hope,” said Armstrong. “He was an inspiration to all, and he motivates me to strive to be a better researcher, and to do so quickly for my patients.”
At Duke, research trials offer investigators a better understanding of how prostate cancer spreads and why it resists the immune system. Scientists hope they are getting closer to the point where they can cure the disease, even if it is metastatic.
“He participated in all the research with the hope to save someone’s life one day,” said Beth, a tear rolling down her cheek as she remembered her husband’s greatness. “He refused to let the cancer win and helping to push research forward was his victory. Over the years he’s touched many lives, and we know he will continue to do that from up above. We are all sure he’s set up a tent in heaven with a sign that says, ‘Troop 25 meets here.’”