Rikki Rockett is probably best known as the drummer for the band Poison. (You may remember their big hits in the 1980s, including “Every Rose Has Its Thorn.”) But Rockett also introduces himself another way — as dad to seven-year-old Jude and three-year-old Lucy.
Jude and Lucy were top of Rockett’s mind a little over a year ago when, complaining of what he thought was a never-ending sinus infection, he was instead diagnosed with oral cancer — squamous cell carcinoma of the tongue.
Star pupil
In late 2015, Rockett endured several grueling months of chemotherapy and radiation near his home in Los Angeles. He didn’t have the energy he needed to take care of his children. All of the other things Rockett loved to do also became impossible — playing the drums, Brazilian Jiu Jitsu and riding his motorcycle. He could only manage to eat nutritional shakes, and even those he could only get down with the help of a special mouthwash.
One especially tough day, Jude saw the tears that came to his dad’s eyes as he painfully tried to swallow a shake. The boy fell apart, Rockett said, but after some hugs and reassurances, it was like Jude knew he had to be the man for a minute and comfort his daddy.
“It was a scary, scary time,” Rockett said.
But Rockett didn’t let the cancer define him. No matter how badly he felt, he showered and dressed his best for every chemotherapy session. He met with a trainer regularly, even if all he could do was walk around the gym. Rockett’s doctors called him a “star pupil” and said he had “aced” his treatment.
That’s why, when it came time for the big PET CT scan in February 2016 to determine how effective the treatment had been, everyone expected to see the cancer receding, if not gone.
Instead, what they saw “looked like a Christmas tree lit up,” Rockett said. “It beat me down. When I saw that scan, I just went ‘wow.’”
Despite Rockett’s chemotherapy and radiation treatment, the cancer was actually spreading. At that point, Rockett’s doctors in Los Angeles felt their only option was a glossectomy — surgical removal of his entire tongue that would render him mute and likely put him on a feeding tube for the rest of his life.
Leap of faith
Fortunately, around the same time they started talking about glossectomy, one of Rockett’s doctors mentioned colleagues at Moores Cancer Center at UC San Diego Health —
Ezra Cohen, MD, a head and neck cancer specialist, and
Sandip Patel, MD, an oncologist who runs a clinical trial site to test an experimental combination immunotherapy.
Immunotherapy boosts the body's immune system, better enabling it to attack cancer cells. This type of treatment is only available at a few specific medical centers around the country, including Moores Cancer Center, the only National Cancer Institute-Designated Comprehensive Cancer Center in San Diego.
Rockett was eager for an alternative to losing his tongue, but he said it was a leap of faith to join the trial. If it didn’t work, the cancer would likely spread even further in the meantime, making it inoperable.
“The thoughts of being there for my kids and walking Lucy down the aisle at her wedding someday motivated me to go through with the treatment,” said Rockett.
He met with Cohen, Patel and the team at Moores Cancer Center, completed the testing required to determine if he was a good candidate for the trial and left feeling hopeful for the first time in a long time.
Rockett was at Disneyland celebrating Lucy’s third birthday when he got the call from Cohen with good news — he was accepted into the immunotherapy trial. Rockett sent his family home in a separate car that night and immediately drove down to San Diego to begin the treatment.
Rockett’s clinical trial at Moores Cancer Center is testing a combination of two immunotherapy drugs that remove the defenses cancers use against the immune system. The first is Keytruda, a drug FDA-approved for some cancers — it helped get former President Jimmy Carter’s metastatic melanoma in remission — but at the time Rockett started the trial, it had not yet been approved for his type of oral cancer. The second experimental immunotherapy drug Rockett receives in the trial is called epacadostat.
Keytruda is known as a checkpoint inhibitor — it’s an antibody that inhibits the abnormal interaction between the molecule PD-1 on immune cells (T-cells) and the molecule PD-L1 on cancer cells. Normally, when PD-1 receptors bind PD-L1 proteins on the surface of other cells, it tells the T-cells that those are healthy “self” cells, so they don’t overact and cause autoimmune reactions. In this case, the T-cells are like theater ushers checking tickets — you have a ticket, you may pass. But many cancer cells take advantage of this protective mechanism by basically forging a bunch of “tickets,” displaying an overabundance of the protective PD-L1 protein on their surfaces. These PD-L1 proteins tell T-cells to leave the cancer cells alone. By disrupting the abnormal PD-1/PD-L1 interaction, Keytruda essentially reveals cancer cells’ “ticket fraud” and allows T-cells to recognize and attack tumors.
At the same time, the second drug, epacadostat, inhibits the IDO pathway, another cellular system that suppresses immune cell function and allows tumors to evade the immune system.
That first night after Rockett received his immunotherapy, he went back to his hotel room. Even though it meant being alone, he had decided to stay near Moores Cancer Center instead of driving back to Los Angeles.
“In case anything went sideways, I could just race back to the hospital,” Rockett said. “And I did end up texting Dr. Cohen at 10 o'clock at night because my tongue was inflating like a raft. I mean, it was just getting huge and Dr. Cohen just said, ‘That's great. Hang in there…this is great news. It really is, trust me. It’s those T-cells, attacking the tumor.’”
“I am cancer-free!!!”
For the first six weeks after he began immunotherapy, Rockett still needed his mouthwash to help him swallow shakes. But shortly after that, Rockett began feeling better. He could eat more solid foods and spend more time with Jude and Lucy. He even started riding his motorcycle again and easing back into Jiu Jitsu. But, still the star pupil, he continued his immunotherapy regimen.
In July 2016, Cohen was thrilled to give Rockett the best news of all: his cancer is gone.
“We are delighted that Rikki responded so well to immunotherapy. He had already been through a lot with chemotherapy and radiation treatment before he came to us, but his cancer recurred,” said Cohen, who is also professor of medicine at UC San Diego School of Medicine, and associate director for Translational Science and head of the Solid Tumor Therapeutics Program at Moores Cancer Center. “That’s the advantage of immunotherapy over traditional therapy — there are fewer side effects, we can specifically eradicate cancer cells almost anywhere in the body, and it’s effective against tumors that are resistant to chemotherapy and radiation.”
Rockett broke the good news on his Instagram account on July 13, 2016, posting a photo of himself with Cohen. The drummer wrote in the accompanying caption: "Because of this man, I am cancer free!!!"
Paying it forward
Rockett will continue therapy in the two-year trial until its completion. He receives treatment at Moores Cancer Center every three weeks and has scans to monitor his progress every nine weeks. “A small price to pay,” Rockett called it. He hopes to go back on tour with Poison again soon.
Cohen cautions that these types of immunotherapies for oral and other cancers are still in early-phase clinical trials, and although promising, are not quite at the point where they will completely replace the standard of care, which usually involves chemotherapy, radiation and surgery. These traditional approaches have saved many lives and still work well in many cases, he said.
Still, Rockett also wants to get the word out about immunotherapy — to those who have already exhausted other treatments like he did, but also to people newly diagnosed with cancer who might be able to avoid chemotherapy and radiation.
“My hope going forward is that by talking to other cancer patients, I might be able to lessen their pain and suffering,” he said. “I know from experience that chemotherapy and radiation are not fun. If I can help anyone else, it would help give reason to what I went through.”
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Head and Neck Cancer