By Sara Bondell - October 17, 2022
Vincent DiMartino takes a breath. He places his lips around his trumpet’s mouthpiece, and in an instant his fingers are quickly moving the valves up and down while his other hand gracefully pumps the slide. The chaotic notes of “Flight of the Bumblebee” fill the room before he effortlessly transitions into a slower jazz song.
Nothing feels more natural than DiMartino playing his trumpet, so it’s hard to believe the instrument wasn’t always his first choice. But throughout his life, the trumpet has always found him.
When he was young, DiMartino’s mother bought him a marimba, a percussion instrument made of wooden bars that are struck by mallets, at a garage sale. But it was too cumbersome for DiMartino to carry around. He wanted to play the drums instead, but his elementary school already had too many drummers. They suggested he try the trumpet.
DiMartino played the instrument for the next decade, but it didn’t feel like his future. It was a great hobby, but he had his sights on becoming a dentist.
Then, when DiMartino was a 17-year-old exchange student in Bogotá, Colombia, he wandered into a jazz bar on the wrong side of town and played his trumpet with a local group. He made a deal: He would continue coming back to play if he could bring his 13 friends for some free food.
That summer changed DiMartino. His passion for music was reignited.
“When I went back home, I realized I had missed music,” DiMartino said. “I told my mom I don’t think I want to be a dentist, I want to be just like my high school band director.”
This revelation led DiMartino to the Eastman School of Music in Rochester, New York. After graduating in 1970, he taught at the University of Kentucky for two decades and then at Centre College in Danville, Kentucky, until his retirement in 2012.
During that time, DiMartino built an extremely successful music career and became one of the country’s most sought-after trumpet performers. He played alongside jazz greats Lionel Hampton and Clark Terry and backed up legendary singers Tony Bennett and Ella Fitzgerald. He was the first civilian to perform with the United States Marine Band, and he has appeared as a guest soloist with the Boston Pops and many symphony orchestras.
But in June 2021, DiMartino was diagnosed with a very rare and aggressive form of skin cancer. He knew he would need to take some time off from his trumpet during treatment, but would the instrument, like the times before, find him again?
More Aggressive Than Melanoma
Knee pain brought DiMartino to his doctor. His knee was swollen and it looked like half of a golf ball was implanted under his skin. His doctor sent him for imaging, and the results confirmed DiMartino had Merkel cell carcinoma.
“I had never heard of it before. I had heard of Angela Merkel,” DiMartino joked. “But that was all.”
Merkel cells are located deep in the top layer of the skin and are connected to nerves. Merkel cell carcinoma is a rare, aggressive form of skin cancer that has a high risk of recurring and spreading within a few years of diagnosis. According to the Skin Cancer Foundation, the disease is 40 times more rare than melanoma, with about 3,000 new cases diagnosed each year in the U.S.
After his diagnosis, DiMartino went to his local hospital in Kentucky, but the prognosis and treatment options presented were not encouraging.
“Merkel cell carcinoma is one of the more aggressive types of skin cancer that we deal with,” said Andrew Brohl, MD, a medical oncologist at Moffitt Cancer Center who specializes in the disease. “People think about melanoma being the bad skin cancer, but stage for stage Merkel cell cancer is a more aggressive variety and more likely to grow quickly, progress and ultimately become a life-threatening condition for patients.”
Historically, Merkel cell carcinoma has been hard to treat. For advanced cases, where the cancer has spread or metastasized, the prognosis was usually about a six-month life expectancy.
“We used to use chemotherapy, but it was mostly only mildly effective, almost never cured the patient once the cancer got to a late stage and only really slowed it down for a short period of time before the disease became resistant to the treatment,” Brohl said.
However, things changed about five years ago when immunotherapies were introduced as a new treatment for Merkel cell carcinoma. Moffitt participated in the clinical trials that led to the U.S. Food and Drug Administration approval of Bavencio in 2017 and Keytruda in 2019 as first-line therapies for advanced or metastatic disease.
“Immunotherapies have been highly successful for Merkel cell cancer in many cases,” Brohl said. “Some patients are achieving remissions that are long lasting, and it is now rare that we would try chemotherapy first.”
In the past, the survival rate for advanced cases was almost zero. Now close to half of patients diagnosed with advanced disease are achieving remissions.
There are a few reasons Merkel cell carcinomas respond well to immunotherapy treatments. A significant percentage of them are caused by a virus that gets integrated into the genome of the cancer cell. Called Merkel cell polyomavirus, it doesn’t cause a noticeable infection, but rather sets off a series of events within cells to stimulate cancer growth.
Merkel cell carcinomas that aren’t caused by this virus are caused by ultraviolet damage to the skin. Similar to melanoma, the radiation damage upsets cell genomes and causes a lot of differences between a cancerous and normal cell. The more differences from a normal cell, the more opportunities there are for the immune system to react to it.
“Those differences sort of become targets for the immune system, and that’s why we think this cancer is more of an immuno-responsive one — because of these either viral proteins and antigens that the immune system might recognize or because of the high burden of changes from chronic UV damage to the cell of origin, which causes possible targets for therapy from your immune system,” Brohl said.
A ‘Good Thing’
The next step in Merkel cell cancer research is additional clinical trials to find possible combination therapies that can make treatments even more effective and to investigate if the treatments can be used earlier in the disease before the cancer spreads.
Moffitt is a world leader in Merkel cell carcinoma, treating a large population of patients with the disease due to its location and demographics compared with other cancer centers. Moffitt treats roughly 150 to 200 new Merkel cell patients a year, and because of this large number the cancer center can successfully run investigator-initiated clinical trials or join a network of trials.
“Right now, I believe we have more active trials in Merkel cell than anywhere else in the world,” Brohl said. “Internationally, there are less than 20 open Merkel cell carcinoma trials registered on the national clinical trials website, and at one point recently Moffitt had no less than six to seven open trials.”
Moffitt’s reputation in the field is what drew DiMartino to a cancer center more than 800 miles from his home in Kentucky. After his diagnosis, he went to teach for a week at the Interlochen Center for the Arts in Michigan while his wife began researching hospitals and treatment options. They would speak every night, and one night she told him about Moffitt’s expertise and clinical trial options.
“I hoped that I would qualify for a trial because first of all, I am a teacher and a lifetime learner,” DiMartino said. “I said, well, if I can help somebody learn more about this, no matter what happens to me, it’s a good thing.”
Deciding to get a second opinion at Moffitt turned out to be a very good thing for DiMartino. He qualified for a phase 2 trial investigating the combination treatment of two immunotherapy drugs, Opdivo and Yervoy, already approved to treat other cancers in patients with advanced disease. The trial also added radiation treatment to half of the participants, including DiMartino, chosen at random.
DiMartino and his wife relocated part time to Bradenton to be closer to the cancer center, and he is not the only trial participant to have had a robust response rate.
The trial’s results, published in The Lancet, showed that 100% of patients who had not received previous immunotherapy — regardless of whether they received radiation therapy — responded to the treatment, with 41% achieving a complete response. Out of the 26 patients who had received prior immunotherapy, eight responded to the treatment, with four having a complete response.
“Since the results are so strong, they will most likely be practice changing even without a follow-up trial. But ideally this approach will be tested in larger numbers to confirm the exciting results we have seen so far,” Brohl said. “There is a good chance this will lead to a change in the National Comprehensive Cancer Network guidelines to suggest that this would be an option to consider for patients as an alternative to single agent therapy.”
Moffitt also has opened clinical trials investigating using additional combination therapies and different therapies prior to surgery for patients with resectable disease.
The Universal Language
While DiMartino was at Moffitt for one of his appointments, someone noticed the picture of a trumpet on his face mask. They asked if he played. Word traveled fast and soon he was connected with The ReMissions, the Moffitt band led by President and CEO Patrick Hwu, MD.
“I never thought there would be a Moffitt band, let alone that I would be playing with them,” DiMartino said.
He was invited to a rehearsal and then guest played with the band at one of their performances.
“It was great,” DiMartino said. “Music is the universal language and you take people and put them together and they have this emotional connection of music.”
It’s a connection DiMartino is happy to have found again after taking some time off due to his diagnosis. His calendar is once again filled with performances and teaching opportunities, like playing at the Governor’s Ball for the Kentucky Derby and guest playing with the Sarasota Jazz Project and the Venice Symphony next season. He also volunteers to play the hymns at a church across from his Florida home and at a home for older adults in Sarasota.
“Just like all the doctors and employees at Moffitt do, you have to be an asset to your community,” DiMartino said. “This isn’t a job, it’s a life’s work. You never get good enough and there’s always more you can do where you live.”
He’s lost a little bit of breath strength during his cancer treatment, but since he had built it up during his career, it hasn’t greatly affected his trumpet playing. Looking back to his initial diagnosis, DiMartino says he never would have thought he would be where he is now: in Florida, at Moffitt, playing with The ReMissions and doing well on a clinical trial.
“It’s important for people to take things a day at a time. Don’t predict your outcome,” DiMartino said.
But the one thing he probably could have predicted is that, like always, the trumpet would find him again so he can share his gift with the world.
This article originally appeared in Moffitt's Momentum magazine.