Colorectal Cancer at Age 30
It wasn't his first bout with cancer. Spencer Laird knew he had to try something new.
His wife, CarleyAnn, immediately got to work researching alternative treatments and they agreed to come to Duke for a second opinion. Duke physicians offered him an option — a clinical trial testing a combination of immunotherapy drugs. Immunotherapy, which enhances the body’s immune system to attack cancer cells, usually has fewer strenuous side effects than chemotherapy.
“We didn’t even know what immunotherapy was,” Spencer says. “As soon as they told us about it, we made the decision right there. When you have 13 tumors, what do you have to lose?”
The Clinical Trial
The clinical trial led by Duke is funded by Gateway for Cancer Research in Chicago. Dr. Nicholas DeVito, a medical oncologist who treats colorectal, pancreatic, and esophagogastric cancers at Duke, is one of Spencer’s doctors.
This trial is testing the combination of immunotherapy drugs Botensilimab and Balstilimab (BOT/BAL). Spencer was the second patient enrolled. Today, there are 14 patients enrolled, and according to DeVito most are doing well.
“I don’t want to say I was a lab rat, but that’s basically what you are when you sign up for these trials,” Spencer says. “You just don’t know. But one thing is for sure, there was nothing to lose.”
CarleyAnn admits it was “scary” knowing he was the second person ever to be on this trial. But when you’ve been told you have stage four cancer and two years to live, she said there’s no reason not to try something new. “That’s the whole point of research: If nobody tries the new stuff, then what’s the point?” she asks.
Every two weeks, the couple makes the eight-hour round trip to Durham from Lexington, South Carolina, staying in a small camper that they haul behind their pick-up truck. Spencer gets up for early morning infusions of immunotherapy before heading back down to South Carolina.
“It’s working,” Spencer says. “And it’s become our normal.” Spencer will continue his treatments at least until February 2027, according to DeVito.
Colorectal Cancer and Younger Patients
Colorectal cancer, or cancer of the bowel or rectum, has long been associated with older adults. However, in recent years, cases among people under 50 have surged.
“The rise in colorectal cancer in younger people is certainly something that we all see in our clinics,” says DeVito. “They often present with more advanced-stage disease. That could be in part biology, but also because they’re young, busy, and their symptoms get ignored.”
Colorectal cancer remains the second leading cause of cancer death in the U.S. For metastatic cases, survival rates have remained largely the same for decades. Immunotherapy could change that.
Chemotherapy has been the backbone of colorectal cancer treatment. It works by damaging cancer cells’ DNA, but it’s a blunt instrument.
A Cancer with Little Warning
In this episode of the Beyond the Endpoint podcast from the Duke Clinical Research Institute, hosts Manesh Patel and Emily O'Brien explore the rising incidence of colorectal cancer with Duke doctors Ajay Kohli and Julius Wilder.
“With colon cancer, a lot of times there are no symptoms. That's why screening is so important,” said Wilder.
Chemotherapy vs. Immunotherapy: How Do They Work
Chemotherapy has been a cornerstone of cancer treatment since the 1940s. It uses powerful drugs to target cells that divide quickly, a hallmark of cancer. Chemotherapy prevents cancer cells from multiplying and ultimately causes them to die.
However, because many healthy cells also divide rapidly — such as those in hair follicles, the digestive tract, and bone marrow — chemotherapy often damages them too. This explains common side effects like hair loss, nausea, fatigue and lowered immunity.
Immunotherapy, on the other hand, stimulates or enhances the body’s immune system to detect and destroy cancer cells. These therapies “teach” immune cells to recognize cancer as a threat and mount a targeted attack. Because immunotherapy is more selective, it can spare healthy cells, though it may cause immune-related side effects such as inflammation or autoimmune reactions.
In short, chemotherapy is a direct chemical assault on cancer cells, while immunotherapy is an indirect biological strategy that harnesses the immune system.
“Chemotherapy acts systemically,” DeVito says. Meaning it kills tumor cells, but also healthy cells. Side effects can include neuropathy – numbness in hands and feet – which can be permanent. Other risks include bone marrow suppression, anemia and infections.
While chemotherapy can cure some early-stage patients, it rarely cures metastatic disease.
“If a tumor has spread, it’s evaded the immune system,” DeVito explains. “Chemotherapy isn’t usually durable in that setting.”
Immunotherapy can work against cancer that has spread, as in Spencer’s case, with fewer side effects than chemotherapy.
Spencer says the decision to try immunotherapy saved his life. He gave himself two days of mourning, and after that, he said, ‘We’re going to do this.’ He changed everything in his life,” said CarleyAnn.
Adds Spencer, “The first time I had cancer, I stayed in bed all day. I didn’t want to talk about it. This time, I gave my life to God, and it changed everything physically, mentally, and spiritually.”
Spencer’s story underscores why DeVito, and his team at Duke Cancer Institute are pushing boundaries.
“We are seeing a cancer we’ve never treated with immunotherapy respond without ever having chemotherapy,” DeVito says. “If we can spare patients surgery and chemo, that’s huge.”
Look at melanoma, DeVito says. Fifteen years ago, five-year survival was nine percent. With immunotherapy, the rate is more than 50 percent. “We want to do the same for colorectal cancer.”
Behind the Scenes
Making these breakthroughs possible requires more than bold ideas; it takes infrastructure.
“This trial wouldn’t have happened without Gateway,” DeVito says of the foundation that funded the study. “But it also wouldn’t have happened without Duke. We have such a spectacular gastrointestinal cancer research group that can execute complex trials, work with the FDA, make changes that need to be made so this is safe and feasible for patients, and get the study off the ground.”
That “learning loop,” often referred to as “bench to bedside and back again,” is critical, and federal research funding has helped build the infrastructure that supports innovative care centers such as those at Duke.
“Researchers use advanced imaging platforms to study tumors and identify biomarkers,” DeVito explains. “We collaborate with labs to develop mouse models that mimic human disease. And we feed insights from patients back into the lab to refine therapies.”
Spencer hopes his story will inspire others to consider clinical trials. “I don’t think cancer has to be a death sentence,” he says. “Immunotherapy and these trials really change the outlook. Without research, there’s no new stuff. So, if nobody tries the new stuff, then what’s the point?”
For CarleyAnn, the gratitude runs deep. “Duke has given us life. They’ve given us hope. And they’ve treated us like family.”
