Patient’s Journey from Incurable Larynx Cancer to Years in Remission

The First Fight

After his initial diagnosis in January of 2021, Montoya completed three rounds of high-dose chemotherapy concurrently with radiation. Assuntina Sacco, MD, medical oncologist at UC San Diego Health was involved in his care from the start, alongside Parag Sanghvi, MD, radiation oncologist. By March, the treatment was done but follow up scans in August showed the cancer persisted in the lymph nodes of his neck.

In November, he underwent a neck dissection surgery to remove the affected lymph nodes. A scan the following May showed no signs of disease and Montoya says he allowed himself to relax just a bit.

The reprieve didn't last. By July 2022, imaging and a biopsy showed the cancer had returned in his voice box.

"At that point I was really pretty scared, the cancer was coming at me really hard but I just tried to stay focused on the next step," said Montoya.

On September 1, 2022, Theresa Guo, MD, head and neck surgeon at UC San Diego Health, performed a total laryngectomy — the complete removal of his larynx. To repair the resulting defect, muscle from his chest was transplanted into his throat. The surgery removed the cancer, but Montoya would never breathe or speak the same way again.

Learning to Breathe, Eat, and Speak Again

Understanding the far reaching physical and emotional impacts of a laryngectomy, Montoya began working with a speech pathology team four months before the surgery.

"The surgery impacts so many aspects of daily life," said Liza Blumenfeld, speech-language pathologist at UC San Diego Health, who worked closely with Montoya. "A patient's communication is altered and must be relearned. Their swallowing and ability to eat and their breathing are also forever changed. These are really core parts of our lives."

For months after his surgery, Montoya relied on a chalkboard to communicate and, later, an electrolarynx — a handheld device that produces a mechanical voice, when pressed against the throat. It was a difficult period in Montoya's life as he struggled to recover and learn new skills.

Finally, five months after his laryngectomy surgery, Montoya received a tracheoesophageal prosthesis (TEP), a small valve implanted by Guo in the stoma, a permanent opening in his neck, that allowed him to produce his voice by covering the opening and directing air through the esophagus.

His rehabilitation was intensive and ongoing. His speech-language pathology team including Blumenfeld and Kristen Linnemeyer-Risser, worked with him tirelessly — teaching him the mechanics of his device, managing complications, and replacing the prosthesis when needed, typically several times a year.

"My speech therapists worked with me day and night," Montoya said. "They must have seen something in me and knew I could do it."

It took nearly a year, but Montoya learned to talk again. He still sometimes reaches for the electrolarynx as a backup when he's tired. And the stoma remains a visible, permanent reminder of what he's been through.

The Return of Incurable Disease

As the new year began in 2023, updated imaging delivered the worst news yet. Montoya's cancer had returned in his lymph nodes — a new tumor in the neck and concern that it had spread to his chest. His cancer was officially considered incurable, meaning no further surgery or radiation would be offered.

"I was really scared then," Montoya said. "I did a lot of soul searching and had to prepare to meet my maker. The hardest part for me was telling my mom."

Montoya returned to see Sacco, the medical oncologist who had been by his side through his entire journey, to discuss his options.

"I looked in her eyes, and for the first time in a long time, I had hope. My back was against the wall, but I could see she was in it with me 110%. I had accepted my fate, but she had a different plan for me," Montoya said.

Montoya's options included standard-of-care intravenous therapies or a clinical trial. The trial involved a drug called BCA101 (ficerafusp-alfa), administered in combination with Keytruda (pembrolizumab), an immunotherapy already used to treat various cancers that works by helping the immune system identify and attack cancer cells.

Montoya took a leap of faith and chose the trial.

A Drug, a Trial, and a Remarkable Response

Montoya began treatment on March 22, 2023, receiving intravenous infusions once weekly. The results came fast. His first follow-up scans on May 4, 2023 — just six weeks into treatment — already showed the tumors shrinking. Montoya's early partial response to the therapy deepened over subsequent scans into a complete response showing no detectable cancer.

"We are seeing really great results with this clinical trial treatment, but it's not common for us to see people achieve complete remission," Sacco said. "That is a huge win."

The road wasn't without challenges. The treatments triggered a significant autoimmune response in his skin — an itchy, painful rash that at times made Montoya question whether he wanted to continue. Sacco and her team worked closely with him to manage the side effects, adjusting his care plan until the rash was effectively controlled.

"It is imperative for patients to communicate with their doctor when side effects occur as we often can manage or alleviate symptoms to ensure they can stay on life-prolonging therapy," said Sacco. 

Based on the early promising results of BCA101, the drug manufacturer has already launched a Phase III trial. The trial is open to patients at Moores Cancer Center and Sacco is hopeful BCA101 will ultimately receive FDA approval.

Three Years in Remission

Montoya is now three years into complete remission. He continues to receive infusions every two weeks and sees his care team regularly.

"I have to remind myself to slow my roll sometimes," he said. "I may not be as strong as I was before, but the only thing that stops me from living a normal life these days is the hole in my neck."

He works when he can, but his priorities have shifted. "I am putting my health first," he said. "I try to work a few days a week when I can, but mostly I am focused on being healthy and staying strong."

He briefly considered stopping the clinical trial, but Sacco was clear about the risks. "She let me know the symptoms could easily come back, and if I stopped taking the drug, there was a chance it wouldn't be available to me if I needed it again." 

Sacco recalled a recent conversation in which she thanked him for putting his trust in pursuing the recommended clinical trial. His response stayed with her. "He said, 'I had trust in you, and that's why I trusted the trial,'" she said. "It does require that a patient takes a leap of faith as the treatment under study may or may not help them."

For his part, Montoya doesn't take what he's been given lightly. He's a man of faith, he says, and he's been through more than most — losses and hardships that never made the medical chart. The cancer was only part of it.

He is deeply grateful to his care team and, in particular, Sacco. "She treated me like a family member, got me enrolled in a trial and brought me back to a good place," Montoya said.