Young Adult Successfully Treated for Colon Cancer Using Immunotherapy Borrowed from Other Cancers

In 2023, medical student Bret Hulick faced a challenging diagnosis: stage 3 colon cancer at just 24 years old. Initially, symptoms such as abdominal discomfort led him to the emergency room, where a CT scan suggested Crohn's disease or colitis. However, further examination revealed a tumor, prompting a diagnosis of advanced colon cancer with lymph node involvement. Hulick rapidly underwent surgery, which uncovered that the tumor had begun invading his stomach, complicating the procedure.

Post-surgery, Hulick was advised to undergo chemotherapy, a standard treatment for his cancer stage. Yet, the chemotherapy posed a significant risk of peripheral neuropathy—a condition affecting nerves in hands and feet—that could impair his future career as an emergency room physician. Recognizing this, his oncologist, Dr. Ibrahim Sahin, explored alternative options.

Hulick's tumor exhibited mismatch repair deficiency (MMR), a genetic feature that hampers DNA repair. A groundbreaking 2022 study from Memorial Sloan Kettering had demonstrated complete remission in rectal cancer patients with MMR deficiency treated with immunotherapy drug dostarlimab. Despite the absence of specific studies for colon cancer, Sahin considered this promising evidence and discussed with Hulick the possibility of using immunotherapy instead of traditional chemotherapy.

While some experts urged sticking to proven conventional treatments, Hulick opted for the experimental approach, valuing potential benefits over risks. His adventurous personality and desire for the best outcome motivated his decision. Over six months, Hulick received immunotherapy without interrupting his medical studies, and subsequent scans confirmed he was cancer-free.

Further testing revealed Hulick carried Lynch syndrome, inherited from his father, which increased his risk for colon and other cancers. His diagnosis prompted screening of his family members, leading to early detection and removal of a tumor in his father.

Hulick's case underscores the rising incidence of colorectal cancer among young adults—statistics show an increase from 11% in 1995 to 20% in 2019. Experts emphasize the importance of early detection and considering hereditary factors like Lynch syndrome. Hulick's story highlights how rapid advancements in cancer treatment, including immunotherapy, can provide new hope, especially when traditional options pose significant side effects.

Currently, studies are ongoing to evaluate immunotherapy for colon cancer, inspired by cases like Hulick's. His experience illustrates how personalized treatment decisions, driven by genetic insights and innovative research, can dramatically improve outcomes for young cancer patients.