East to East

At 16, Bogetic, who’d grown to be 6’10”, started playing professional basketball in Slovenia. For two years the academically gifted and driven athlete traveled the 500 miles back and forth between Lubljana and Podgorica to keep up with his studies. His commitment both to basketball and education would ultimately land him a new future across the ocean.

“I was an athlete nearly my whole life — being quite tall, basketball was my sport,” said Bogetic. “Some agents started picking up my playing and got in touch with universities in in the U.S. I received several offers (with scholarships), but Penn State was the only one whose coaches came to visit me back home in Montenegro and meet my family, so I went with them.”

He arrived there in June 2005 — nearly 20 years old and ready to get a head start on college classes and training for NCAA Division I basketball.

In an interview at the time with the university news office, he said, "This is a dream for me, playing college basketball. Basketball players in my country have two options. Turn pro and play in any number of leagues in Europe or come to the U.S. and get an education. For me, this is the right choice."

In 2007, he transferred to Mercyhurst University in Erie, Pennsylvania, where he played basketball there for two years. Planning for a career in international business, he would earn a BA in Finance (2009) followed by a master’s degree in Organizational Leadership (2011) and a second bachelor’s degree, this time in Computer Information Systems.

After earning his second BA, he spent the summer with his girlfriend Trish on Cape Cod. The couple had first met a year before, in 2011, in Provincetown, Rhode Island, where he was working for the summer between semesters. Trish, a flight attendant for Air Canada, was in town on a three-day layover for the Toronto-Boston-Toronto route.

The couple kept up a largely long-distance relationship and in the fall of 2012 moved south to Atlanta for a fresh start together.She took a job at a non-profit that empowers women and he was hired as a senior accountant with Emory University Research. On January 1, 2013, they got married.

Knocked Down

Happy with life in Atlanta for the next three years, the Montenegrin and Canadian transplants were decidedly rooted in the U.S. Trish, a Canadian citizen with long-time U.S. residency, had since become an American citizen. Bogetic had just applied for American citizenship. They planned to stay and start a family.

But in June 2016, Bogetic got sick.

“I started feeling acid reflux every morning. I was taking Tums, which was helping, but one morning I was eating a sandwich and a piece of bread got stuck in my throat. I had to drink water to swallow it. I knew I had to see a GI doctor,” shared Bogetic. “My doctor was very confident that I, a healthy, athletic 30-year-old, could only have acid reflux, an ulcer at worst.”

The doctor ordered an endoscopy just to be sure.

When Bogetic woke up in post-op his wife was standing next to him and a nurse was present.

“I asked, ‘How did it go?’” Bogetic recalled asking the nurse as came out of anesthesia. “And she said, ‘The doctor will be in soon.’ So that was kind of my hint that it wasn't flawless. And, you know, when the doctor came in — he was quite a young doctor, I would have guessed likely not too far from exiting his fellowship — he was pretty bummed out, you could see. He said, ‘I’m sorry to have to tell you this, especially since you’re so young, but you have cancer. Esophageal cancer.’ I found it comical that, you know, such huge life changing news was being delivered in this six-by-six room that was only giving us privacy with its curtains … all the patients in the room next to us were hearing what was being said to us.”

The median age of an esophageal cancer patient at diagnosis is 67. Bogetic was decades younger.

“It was surreal. You go in thinking they're going to send you home with ‘it's an ulcer,’ and you come home looking at 8% chance of survival. And that’s pretty bad.” [According to the National Cancer Institute, the overall five-year survival rate for esophageal cancer patients ranges from 5% to 30%.]

Esophageal cancer is a rare cancer, but rarely curable. While it accounts for only one percent of cancer diagnoses in the U.S., it causes a disproportionate percentage of cancer deaths — 2.7% of all cancer deaths and 4% of cancer deaths in men, who are three times as likely as women to develop this type of cancer.

Based on the pathology report, Bogetic’s official diagnosis was adenocarcinoma of the esophagus. A subsequent PET scan showed his cancer was already stage 3; having penetrated the walls of his esophagus and spread to at least 11 nearby lymph nodes. The biggest risk factors for getting his type of esophageal cancer are gastric reflux, Barrett’s esophagus (a condition in which the esophageal lining is visibly damaged by acid reflux), and obesity. Acid reflux issues run in his family, Bogetic said, but no one had gotten Barrett’s esophagus or cancer from it.

“Naturally, after the shock wore off, we searched for the best doctors our health insurance could buy,” said Bogetic.

After a couple of consultations with top cancer specialists in the area, he settled on Emory, where he worked. For the next three months that summer, he underwent six rounds of chemotherapy (paclitaxel and carboplatin) and 28 radiation treatments.

Concurrently, he started treatment with Herceptin (trastuzumab), which targets the HER2 protein, after genomic sequencing of his tumor tissue revealed he was HER2-positive. In normal cells the HER2 pathway is a biological pathway involved in cellular replication and growth. When a patient’s cancer cells are HER2-positive, it means that there’s too much of that protein on the surface of the cancer cells. This drives aggressive cancer cell replication. Approved first in breast cancer in 1998, and approved in 2010 in gastro-esophageal cancers, Herceptin is designed to stop this or slow it down. [An estimated 15 to 30% of breast cancer patients and 10 to 20% of gastroesophageal cancer patients are HER2-positive.]

Back Up

The tumor in his esophagus shrunk significantly — enough to greenlight an esophagectomy on Nov. 3, 2016. His surgeon removed his esophagus and performed a gastric pull, attaching his stomach to his throat, and also removed 27 nearby lymph nodes, most of which had signs of cancer. The high-risk surgery was a success.

For the next six months his scans were clear. Then, a scan in May 2017 revealed a single cancerous lymph node in his abdomen. Another surgery wasn’t advisable. Instead, his care team went after it with a much heavier chemotherapy cocktail than the first time around — 5-FU (5-fluorouracil) and capecitabine (brand: Xeloda) and cisplatin and paclitaxel again, plus four radiation treatments.

He wore a fanny pack with an infusion device, even to work, and lost all of his hair.

“That was a very, very tough treatment,” said Bogetic. “I did all six rounds, but I ended up in a hospital a couple times with a fever of 103, zero blood cells — being neutropenic (having an abnormally low count of a type of white blood cell) and it wasn't a very pleasant experience,” shared Bogetic. “But once again, my body responded greatly to the treatment and the cancer was completely eradicated from that lymph node. In August, the scans showed all clear.”

Bogetic rebounded. He got busy getting his mind off having cancer while continuing to stay on a maintenance regimen of Herceptin and capecitabine (brand: Xeloda). After more than a year cancer free, Bogetic and Trish found themselves in “calm waters.”

“Even the most pessimistic of doctors started wondering if I somehow managed to tear myself out of the grips of certain death,” he added. “Encouraged by this rare positive outlook, my wife and I decided to try again to have a family.”

Trish underwent IVF using sperm they’d banked before Bogetic’s first cancer treatment. The procedure worked the very first time. With a baby on the way, everything was falling into place.

Trish had recently gotten a new job at Cox Enterprises. Bogetic was offered a position in the international IT group at Chick-fil-A, Inc.’s corporate headquarters.

“It's a pretty exclusive company to get into. So, when I got in here was no doubt that I was going to go for it,” said Bogetic. “All of a sudden, we went from being just a couple not knowing what the future holds, to starting these new careers and expecting a baby, so much excitement that we even went on a cruise to Morocco, Spain and Portugal to celebrate New Year’s.”

Bogetic admitted he wasn’t 100 percent during the cruise due to side-effects of his ongoing cancer treatment. He was vomiting almost daily. He also contracted the painful hand-foot syndrome.

Despite this, they came back from the cruise refreshed, with Bogetic excited to start his new job at Chick-fil-A the following month.

Road Show

A week before his start date, his jaw started twitching. He immediately called an ambulance, suspecting he was having a stroke.

“They told me that it was likely nothing, just a twitch, but just to be sure, based on my history, that they would run a CT. Then they saw a shadow on the surface of my brain and I went immediately for emergency brain surgery,” recalled Bogetic.

The small cancerous lesion was removed. Following surgery, he underwent just three radiation treatments.

Fortunately, Chick-fil-A put him on the payroll immediately so he would have health insurance. He was told to take as much time as he needed to recover.

“When the cancer came back for the third time, I was devastated,” shared Bogetic. “I had given the battle my all, but it seemed as if there was no defeating the menace that refused to depart my body.”

He was 33 years old, five months away from meeting his son, seven days before starting his new job, and now facing stage 4 cancer.

According to the NCI, metastasis of esophageal adenocarcinoma to the brain or spine is rare, but increasing, and carries a poor prognosis.

“All my oncologists started approaching my case as if it were a matter of months before I no longer existed,” shared Bogetic. “I had an instinct that this wasn’t the end of the road, as bad as it seemed. Make no mistake, I never wanted anyone to sugarcoat my chances. I didn’t ask for handholding, I only wanted to feel as if I mattered. I needed to find someone experienced and knowledgeable who was interested in my case.”

He decided to seek second opinions outside Atlanta.

“I kind of went on a road show,” said Bogetic, recounting his travels to top cancer centers from the southwestern to the northeastern United States. He even arranged a video call with a specialist at the Oxford Cancer and Haematology Centre in England.

They all said that not much more could be done. At one institution, he was connected with a clinical trials team, but because his cancer was in remission, he couldn’t qualify for any of the open trials.

While discussing alternative maintenance-drug treatments with another specialist, Bogetic felt like he’d hit a brick wall.

“When I mentioned a few studies that I had read, he got visibly almost offended that I would suggest something to him instead of the other way around,” said Bogetic. “And he ended the conversation saying, ‘You know, I've seen a lot of patients make it through that five-year mark, but I don't think I've seen anyone survive this cancer.’ And he left me with that.”

"Fix the New"