On July 1, Jamie Dimon, chairman and chief executive of the nation’s largest bank (by assets), J.P. Morgan Chase & Co., informed colleagues and shareholders that he had “just been diagnosed with throat cancer.”
Mr. Dimon, 58 years old and one of the nation’s best known corporate leaders, said his cancer is “curable.” He will spend eight weeks of his summer undergoing chemotherapy and radiation treatments.
The good news, he wrote in a memo, “is that the prognosis from my doctors is excellent.” The cancer was caught quickly and was confined to the “original site and the adjacent lymph nodes on the right side of my neck,” he said. “There is no evidence of cancer elsewhere in my body.” He added that he feels “very good now” and will let everyone know “if my health situation changes.”
Throat cancer is a general term for tumors of the upper airway, including the base of the tongue, tonsils, back of the throat or voice box. There are two common causes: smoking and human papilloma virus (HPV). HPV is seen most often in tumors of the tonsil or the base of the tongue.
“We have seen a rapid rise in the rate of HPV-associated tumors,” said Tanguy Seiwert, MD, associate director of the head and neck cancer program at the University of Chicago Medicine. “In some areas of the United States they are now more common than smoking-related tumors.”
Unlike cervical cancer, also caused by HPV, there is no screening tool for HPV-associated head and neck cancer.
“We expect the incidence to continue to rise,” Seiwert said.
Dimon smoked when he was younger but has stated that he quit more than 30 years ago in the 1980s, “which is a good sign,” Seiwert said.
Based on available information, “Dimon’s prognosis is likely quite favorable.
“Head and neck tumors are highly curable with modern chemoradiation treatment approaches at experienced centers,” he added. “In our experience, cure rates are in the 90 percent range for HPV-positive head and neck cancers and 75 to 80 percent for most HPV-negative head and neck cancers.
Standard therapy for this type of cancer may or may not involve surgery but typically includes chemotherapy and targeted radiation therapy for more advanced stages that involve lymph nodes, as in Dimon’s case.
The combination is highly effective but can produce significant side effects, both acute (pain and inflammation of the inside of the mouth) as well as longer-term effects, in particular dry mouth, changes in the ability to taste, and scar formation in the neck and mouth.
“With today’s treatment approaches,” Seiwert said, “functional outcomes have improved. Very few patients have lasting swallowing or speech problems.” Still, because of long-lasting side effects, there is growing interest in developing less aggressive or ‘de-intensified’ therapies, especially for better-prognosis HPV-associated head and neck cancer patients.
“A few years ago the national Radiation Therapy Oncology Group found exceptionally high cure rates for HPV-related cancers,” said Daniel Haraf, MD, professor of radiation and cellular oncology at the University. (He and colleague Ralph Weichselbaum, MD, the D.K. Ludwig professor and chairman of radiation and cellular oncology, described the first association between HPV and tonsil cancer in 1996.) “That made us suspect that for certain tumor types we could maintain high success rates but still get the job done with less collateral damage. So, instead of very high doses to a large field, we could, based on risk, deliver lower doses to a narrow field and still get comparable outcomes with high cure rates.”
One early approach to improving functional outcomes, pioneered by Everett Vokes, MD, the John E. Ultmann professor and chair of medicine at the University of Chicago, eliminated surgery from many treatment plans, focusing instead on the combination of chemotherapy and radiation leading to much improved preservation of structures essential for swallowing and speech.
This approach has since become a national standard for more advanced tumors, such as those involving several lymph nodes. The head and neck cancer team at the University of Chicago Medicine is now working to improve functional outcomes further for patients who have a more favorable prognosis.
The OPTIMA trial (OroPharyngeal Tumor Induction therapy to Minimize Adverse events—directed by Victoria Villaflor, MD, an expert in esophageal, lung, and head and neck cancers) stratifies patients with HPV-associated tumors based on multiple risk factors as well as the degree of benefit from initial chemotherapy. It then provides a significantly reduced dose of radiation under the close care of the experienced team at the University of Chicago.
Unfortunately, “it is difficult to determine in advance who will do well with de-intensified therapy and who will not,” said Elizabeth Blair, MD, a surgeon who specializes in head and neck cancer. The OPTIMA trial, which will open later this summer, bases dosing decisions on the results of two well-tolerated rounds of chemotherapy.
This year, according to the American Cancer Society, about 37,000 Americans will get oral cavity or oropharyngeal cancer and 7,300 people will die from it. So it is important, Blair added, for patients with head and neck cancer to seek “an established and highly interactive team that can provide the full complement of modalities—surgery, chemotherapy and radiation therapy—in a coordinated fashion. Those tend to be the institutions reporting the most encouraging response rates.”
One recent innovation developed by another head and neck cancer specialist at the University of Chicago may not have much bearing on how Dimon approaches his treatment.
Just last week, Jonas de Souza, MD, published a paper in the journal Cancer. It described the first tool, a short questionnaire, to measure a cancer patient’s risk for, and ability to tolerate, financial stress. “Few physicians discuss this significant side effect with their patients,” de Souza, said. “As HPV-associated patients often leave the workforce during treatment, we need tools to measure this financial burden, as well as strategies to decrease the physical side effects.
“In this particular circumstance,” he added, referring to Dimon’s condition, “I don’t expect finances to become an issue.”
Newspaper articles noted that J.P. Morgan employees reached since Tuesday’s announcement say they were surprised by the announcement but genuinely hoped that Dimon will make a full recovery.