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10 | Health Matters: Providence St. Jude Medical Center E very pancreatic cancer case is different, and a treatment that fails in one patient may prove highly successful in the next. Rabbi Art Levine's case is a prime example of this, and his willingness to undergo innovative new treatments is among the reasons he's home with his wife today. From Cruise Ship to Chemo Diagnosed with pancreatic cancer in 2019 after returning home from a trip around the world, Art had stopped in England, Ethiopia and India before meeting his wife, Barbara, in Australia to lead religious services aboard a cruise ship. His wife hadn't seen him for a month and commented that he seemed lethargic and out- of-sorts, which he hadn't noticed. As the cruise continued, he began to feel ill-at- ease. He wasn't feeling pain or exhaustion, but he felt "off" in a way he couldn't quite describe. He visited the ship's infirmary, and the doctor, after running all available tests, didn't see any obvious cause for concern but did suggest that Art consult a doctor with more resources. Upon arriving home, Art's vague symptoms continued. But he didn't go a doctor until he began experiencing serious back pain when he'd lie down, having to sleep in a recliner rather than his bed. He scheduled a visit with his friend, a gastroenterologist, guessing only that he might have picked up something during his travels, as he'd contracted cellulitis in Ethiopia and been treated for what turned out to be a fistula in India. Art, 63, had been healthy his entire life, escaping the diabetes, high-blood pressure and cancer that had afflicted other family members. An MRI shockingly revealed tumors on his pancreas, liver and lymph nodes. A CT scan confirmed that he had metastatic pancreatic cancer, which is cancer that had already spread beyond the pancreas. It was too late for radiation or surgery. Art consulted pancreatic cancer specialists. The appointments were somber; Art was told that treatment options were limited, with his one-year survival odds no better than 50/50. "Friends were surprised that I wasn't traveling to a leading university or cancer research hospital for treatment, but I had learned that all would administer the same drugs as my local hospital," Art said. "So, for two years, I was able to treat only minutes from my home." First and Second Line Chemotherapy Treatments; "Flunking-Out " of a Clinical Trial Art started "first-line" (first treatment) chemotherapy using FOLFIRINOX, a powerful combination of drugs used to treat advanced pancreatic cancer. Side-effects are cumulative and many patients can't tolerate numerous infusions. But Art's went better than expected. "At the beginning, my wife stocked up on cleaning supplies – including a large box of gloves. But although I had a wide range of unpleasant side-effects, I only vomited once. I even managed to lead religious services on another cruise, the dates of which fell exactly between chemo infusions." After a year of every-other-week FOLFIRINOX infusions, a CT scan showed that they were no longer effective. In June 2020, Art's oncologist, Dr. David Park of St. Jude Providence Medical Center in Fullerton, California, switched him to a "Gemzar" combination, the only FDA-approved pancreatic cancer chemo regimen. This became Art's "second-line" treatment. Dr. Park also recommended that Art concurrently participate in a clinical trial that involved replacing his red blood cells through transfusion. A special "manufactured" blood product was overnighted from New Jersey. Unfortunately, Art "flunked out" of this trial, he says, when his body rejected the transfusions. "A Clinical Trial of One": Art Levine's Story Reprinted with permission from the SEENA Magowitz Foundation and the Levine Family. Clinical Trials extended Rabbi Levine's life, giving him the chance to do the things he loved, with the people he loved. Rabbi Levine passed away October 15, 2021, at the age of 66. Here is his story, printed August 2021.

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