Mayor faces aggressive treatment for rare cancer
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The man who spent a decade running for mayor, and his first six months in office striving to make Pittsburgh the perfect host for the All-Star Game, will watch the contest from a hospital bed, on this, his first day of chemotherapy.
Mayor Bob O'Connor was diagnosed yesterday with primary central nervous system T-cell lymphoma, a very rare variant of an unusual cancer of the brain and spinal cord.
He has four tumors on his brain and brain stem, doctors at UPMC Shadyside said, of which none is larger than an inch.
He will start what doctors expect will be 12 weeks of intensive chemotherapy with several drugs. If he responds well, that will be followed by a year of less-frequent treatments.
"The response rates [to that treatment] appear to be very high, and the tumor shrinks rapidly," said Dr. Frank Lieberman, chief of neuro-oncology at UPMC Hillman Cancer Center.
"He should be able to fully function and to continue on as mayor," said Dr. Stanley Marks, director of clinical affairs at the center and Mr. O'Connor's attending physician.
The mayor had checked into UPMC Shadyside on Thursday night for what was described as flu-like symptoms, and he left the hospital Saturday after doctors said he had an ulcer.
The announcement of the far more serious medical condition yesterday spurred widespread surprise and concern in a region and state that was just getting accustomed to the warm, gregarious new mayor.
"Like everybody else, I'm shocked and saddened. Bob O'Connor seems like such an indestructible guy, always on the go," said Gov. Ed Rendell, who was in Pittsburgh for All-Star Game events. "I'm sure his message to the region and to the people of Pittsburgh would be, 'Be proud and enjoy the game.' "
The city's home rule charter includes provisions for the appointment of an acting mayor from among city department heads on a temporary basis and, in cases when a mayor must leave office, the ascent of the president of City Council, currently newcomer Luke Ravenstahl.
Administration spokesman Dick Skrinjar said there are no plans to name an acting mayor, as Mr. O'Connor is fully able to make decisions.
"The nuts and bolts [of governance], he's already laid out," he said. "The chief of staff [B.J. Leber] is there to keep the trains running on time."
The mayor, who lost bids for the office in 1997 and 2001 only to cruise to easy victory last year, has forged a hands-on, feet-on-the-street image since his Jan. 3 inauguration.
"He lives in those neighborhoods," said Aggie Brose, a longtime acquaintance who is deputy director of Bloomfield-Garfield Corp. "The bottom line is he wants the streets to be clean and for the streets to be safe.
"He has to understand one thing: He can't do it all," she said.
Nowhere was he more personally engaged than in the Redd Up campaign to prepare the city for today's Major League Baseball All-Star Game.
His medical team, led by Dr. Marks, Dr. Lieberman, and Mr. O'Connor's personal physician, Dr. Bernard Bernacki, said the mayor didn't want to be hospitalized yesterday and today, but they thought it was important to start treatment quickly. He can continue to make major city decisions, even from his hospital room.
The mayor's thinking "seems to be intact," said Dr. Lieberman.
"I just left his room," said Mr. Skrinjar, who had originally hoped to have the mayor in his office today, touting the city to international news media. "He's really [saying], 'Hey, what's the big deal here? This is just an inconvenience to me.' "
This morning, Mr. O'Connor is due to receive the first of bi-weekly high-dose treatments of methotrexate, an anti-cancer drug that can penetrate the barriers around the brain and spinal cord. He'll be hospitalized, likely for several days, each time he gets that treatment.
Treatment with leucovorin, a drug used to block the toxic effects of the cancer treatment, will follow within 24 hours, in an effort to keep the powerful methotrexate from wreaking havoc with other organ systems, and to reduce side effects. Powerful steroids will reduce brain swelling.
During the weeks between the methotrexate treatments, he'll get Temodar, a relatively new drug specifically for brain tumors that comes in capsule form.
The combination of methotrexate and Temodar is a treatment that's still in the clinical trial phase, said Dr. Marks. "But we're going to go ahead and treat him based on some preliminary data," he said.
After the initial 12 weeks, he'll likely only have to get the methotrexate monthly.
Surgery isn't effective against lymphoma. Dr. Marks said radiation also isn't a good option, particularly in people older than 50, because there's a high risk of memory loss and bladder incontinence.
In years past, patients with the mayor's form of cancer could only be expected to survive for around four years. Even some recent studies have shown poor survival rates.
The prognosis is better with the new treatment, Mr. O'Connor's doctors said.
"He is a man who is going to compete with this disease and he's going to fight it," said Dr. Bernacki.
The mayor started feeling fatigue, a variety of head, neck and shoulder aches, and nausea nearly two weeks ago.
He visited Dr. Bernacki on Wednesday, and had "what appeared to be simple, viral-type symptoms," that doctor said. He was told to call back if the situation worsened.
By Thursday night, the mayor felt worse, and Dr. Bernacki admitted him to UPMC Shadyside.
His blood was normal, and gastrointestinal tests revealed a duodenal ulcer -- a diagnosis that still stands, doctors said. But that did not explain some of his other symptoms, they said.
Physicians suspected meningitis, and ordered an MRI scan of his brain. That showed the intense lesions that are classic signs of central nerve system lymphoma.
They ordered a lumbar tap, which draws spinal fluid, rather than the more invasive brain biopsy. The mayor returned home Saturday, in hopes of returning to work Tuesday.
But the tap showed an extremely rare type of brain cancer, which involves T-cells rather than B-cells. Dr. Lieberman said that just 5 percent of brain tumors are primary central nervous system lymphomas, and of those just 5 percent are the T-cell type.
That type of lymphoma is usually associated with immune system problems, but Dr. Marks said the mayor didn't have any such risk factors. "It's just bad luck, if you will," he said.
The T-cell type is so rare, doctors said there aren't proven paths of treatment.
The B-cell lymphoma is more common and there is more experience with treating it, said Dr. Jane Raymond, an oncologist at Allegheny General Hospital. She said her hospital uses methotrexate for that condition.
"You let [methotrexate] get into the spinal fluid and then you give [leucovorin] to save the rest of the body," Dr. Raymond said. " That works pretty well, but it's not foolproof and some people still can have a lot of symptoms."
She said the treatment would relieve symptoms quickly, but it's unclear whether the disease can be entirely eliminated with chemotherapy. The T-cell type may be tougher to beat than B-cell.
Right now, the mayor isn't in great pain, Dr. Marks said. "He's doing well, actually. He's got a minor headache."
That pain probably is "coming from irritation of the lining of the brain," he said.
Late yesterday the mayor was in the company of his family and doctors, Mr. Skrinjar said.Post-Gazette
Mayor Bob O'Connor
Graphic: Mayor O'Connor's cancerSteve Mellon, Post-Gazette
A few of Mayor Bob O'Connor's key employees listen during yesterday's news conference. From left are Chief of Staff B.J. Leber, spokesman Dick Skrinjar and Pittsburgh Police Chief Dominic J. Costa.
Click photo for larger image.
First Published July 11, 2006 12:00 am