How One Man Made a Game Plan When Faced with Esophageal Cancer

A few years ago Rob Riccoflexed in a mirror as he walked past it. But that particular moment ended up being one that will stay in his memory forever.

In his reflection, he noticed there was a slight difference in how one side of his neck looked compared to the other. “The next morning, I went to my doctor and asked him about it,” says Rob. “He said it was nothing, then asked if I wanted to run a test anyway. I said yes.” Rob had more doctors’ appointments and testing and ultimately heard the words he never imagined being told: You have cancer. After more tests came the official diagnosis of stage four esophageal cancer. “I had this swelling in my neck but no other symptoms at all, and it turned out to be stage four cancer,” he says.

Esophageal cancer is a type of upper gastrointestinal cancer that starts in the inner layer of the esophagus and can grow. Rob was diagnosed with a type of esophageal cancer called advanced esophageal adenocarcinoma, which typically occurs in the lower third of the esophagus. Unfortunately, most esophageal cancers do not cause symptoms until they have reached an advanced stage. This may explain why the cancer was able to reach stage four without him noticing anything. While they are harder to treat at this point, treatment options are available.

Stronger Together

For Rob and his wife Linda Ricco, who met freshman year of high school on Staten Island, New York, the diagnosis came as a huge shock. “I was a busy guy with lots of energy, I worked a full-time job, worked out in the gym every day, traveled around the world—I never had any real health issues,” Rob says. But the most difficult part was still to come. “After hearing the news of my diagnosis, the hardest thing I had to do that day was to go home and tell my wife, my rock, my oyster that I had cancer,” he says.

Linda immediately became his strongest supporter. “That moment was so devastating, we were both scared,” she says. “But I knew I needed to hold it together for Rob, not break down and cry. I couldn’t collapse into myself—he was so strong and that’s what I tried to do as best I could.”

Ever since they met, the couple has been a team—and that approach was exactly how they’d handle this new challenge. “We started getting a game plan together,” says Rob. For Linda, working on their plan was a way to feel empowered and take action. “I needed a job, and I was driven by that,” she says. “I got in touch with one of the best hospitals in our area and emailed papers over. It really gave me a purpose.”

Rob also drew from his decades of coaching youth sports, amping himself up with internal pep talks. “My mindset when I was coaching kids’ basketball was to keep the players positive so that they would believe in what they could achieve,” he says.

Deciding on a Treatment Plan

Once the shock of the diagnosis had subsided, the Riccos were eager to learn about treatment options. They learned as much as they could and discussed options in detail with Rob’s oncologist.

“We really went in blind, with no idea what was going to happen or what to expect from the treatment process. That’s one of the scary parts,” says Linda. “But Rob’s doctor was an angel … she was like his head coach, from the first day.”

Together, they decided on the treatment approach Rob ultimately took: Opdivo^® (nivolumab) in combination with chemotherapy.

Opdivo plus chemotherapy was approved by the U.S. Food and Drug Administration in April 2021 for the treatment of adults with cancer of the stomach (gastric cancer), cancer where the esophagus joins the stomach (gastroesophageal junction cancer), and in adults with esophageal adenocarcinoma. Opdivo is used in combination with chemotherapy that contains fluoropyrimidine and platinum when your gastric, gastroesophageal junction, or esophageal cancer cannot be removed with surgery or has spread to other parts of the body.

Opdivo is a type of immunotherapy, a medicine that may treat certain cancers by working with your immune system. Opdivo can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or can lead to death. These problems may happen anytime during treatment or even after treatment has ended. You may have more than one of these problems at the same time. Serious side effects may include lung problems; intestinal problems; liver problems; hormone gland problems; kidney problems; and skin problems. Call or see a healthcare provider right away for any new or worsening signs or symptoms. Please see additional Important Safety Information about side effects for Opdivo and links to the Prescribing Information and Medication Guide below.

“My doctor, actually it was her idea to do Opdivo plus chemotherapy,” says Rob. “With my doctor as my head coach and with Linda by my side, I felt confident I had a way forward.”

Passing on the Positivity

That’s not to say it has been easy. “I initially felt like I needed to hold it together for Rob and my kids and support their feelings,” Linda says. “I didn’t feel entitled to cry or be upset in front of them.” But, as a family, they learned how to lean on each other—giving support and strength, lending an ear or comfort, and offering encouragement when needed. “My family is unbelievable. I love my wife, I love my kids—we can talk to each other about anything, and it makes all the difference,” Rob says.

While Rob is no longer being treated with Opdivo, he continues to see his healthcare team for follow-up appointments. He’s also picked up a new hobby: helping others who are going through the cancer journey. Given their experience navigating Rob’s diagnosis and treatment processes, the Riccos find themselves regularly connecting with and offering encouragement to other people facing cancer—whether it’s helping them stay positive and feel supported through challenging moments or offering non-medical guidance and advice from what they’ve been through. “A lot of people reach out to me through social media, and I love helping them,” says Rob. “We need the clinical trials, the doctors, the treatments, but we also need people who can lend their positive attitude and knowledge of the cancer journey to others and that’s what I love to do.”

To learn more about Opdivo, please visit www.Opdivo.com.

Indication

OPDIVO^® (nivolumab) is a prescription medicine used in combination with chemotherapy that contains fluoropyrimidine and platinum to treat adults with cancer of the stomach (gastric), junction between the stomach and esophagus (gastroesophageal junction), and esophagus that is a type called adenocarcinoma and cannot be removed with surgery or has spread to other parts of the body.

It is not known if OPDIVO is safe and effective in children younger than 12 years of age with melanoma or MSI- H or dMMR metastatic colorectal cancer.

It is not known if OPDIVO is safe and effective in children for the treatment of any other cancers.

Important Safety Information for OPDIVO^® (nivolumab)

What is the most important information I should know about OPDIVO?

OPDIVO is a medicine that may treat certain cancers by working with your immune system. OPDIVO can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen anytime during treatment or even after your treatment has ended. You may have more than one of these problems at the same time. Some of these problems may happen more often when OPDIVO is used in combination with another therapy.

Call or see your healthcare provider right away if you develop any new or worse signs or symptoms, including:

• Lung problems: new or worsening cough; shortness of breath; chest pain
• Intestinal problems: diarrhea (loose stools) or more frequent bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; severe stomach-area (abdominal) pain or tenderness
• Liver problems: yellowing of your skin or the whites of your eyes; severe nausea or vomiting; pain on the right side of your stomach area (abdomen); dark urine (tea colored); bleeding or bruising more easily than normal
• Hormone gland problems: headaches that will not go away or unusual headaches; eye sensitivity to light; eye problems; rapid heart beat; increased sweating; extreme tiredness; weight gain or weight loss; feeling more hungry or thirsty than usual; urinating more often than usual; hair loss; feeling cold; constipation; your voice gets deeper; dizziness or fainting; changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness
• Kidney problems: decrease in your amount of urine; blood in your urine; swelling in your ankles; loss of appetite
• Skin problems: rash; itching; skin blistering or peeling; painful sores or ulcers in the mouth or nose, throat, or genital area

Problems can also happen in other organs and tissues. These are not all of the signs and symptoms of immune system problems that can happen with OPDIVO. Call or see your healthcare provider right away for any new or worsening signs or symptoms, which may include:

• Chest pain; irregular heartbeat; shortness of breath; swelling of ankles
• Confusion; sleepiness; memory problems; changes in mood or behavior; stiff neck; balance problems; tingling or numbness of the arms or legs
• Double vision; blurry vision; sensitivity to light; eye pain; changes in eye sight
• Persistent or severe muscle pain or weakness; muscle cramps
• Low red blood cells; bruising

Getting medical help right away may help keep these problems from becoming more serious. Your healthcare team will check you for these problems during treatment and may treat you with corticosteroid or hormone replacement medicines. Your healthcare team may also need to delay or completely stop your treatment if you have severe side effects.

Possible side effects of OPDIVO

OPDIVO can cause serious side effects, including:

• See “What is the most important information I should know about OPDIVO?”
• Severe infusion reactions. Tell your healthcare team right away if you get these symptoms during an infusion of OPDIVO: chills or shaking; itching or rash; flushing; shortness of breath or wheezing; dizziness; feel like passing out; fever; back or neck pain.
• Complications of bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be severe and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with OPDIVO. Your healthcare provider will monitor you for these complications.

The most common side effects of OPDIVO when used in combination with fluoropyrimidine and platinum-containing chemotherapy include: nausea; numbness, pain, tingling, or burning in your hands or feet; decreased appetite; feeling tired; constipation; mouth sores; diarrhea; vomiting; stomach-area (abdominal) pain; and pain in muscles, bones, and joints.

These are not all the possible side effects. For more information, ask your healthcare provider or pharmacist. You are encouraged to report side effects of prescription drugs to the FDA. Call 1-800-FDA-1088.

Before receiving OPDIVO, tell your healthcare provider about all of your medical conditions, including if you:

• have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus
• have received an organ transplant
• have received or plan to receive a stem cell transplant that uses donor stem cells (allogeneic)
• have received radiation treatment to your chest area in the past and have received other medicines that are like OPDIVO
• have a condition that affects your nervous system, such as myasthenia gravis or Guillain-Barré syndrome
• are pregnant or plan to become pregnant. OPDIVO can harm your unborn baby.
• are breastfeeding or plan to breastfeed. It is not known if OPDIVO passes into your breast milk. Do not breastfeed during treatment with OPDIVO and for 5 months after the last dose of OPDIVO.

Females who are able to become pregnant:

Your healthcare provider should do a pregnancy test before you start receiving OPDIVO.

• You should use an effective method of birth control during your treatment and for 5 months after the last dose of OPDIVO. Talk to your healthcare provider about birth control methods that you can use during this time.
• Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with OPDIVO.

Tell your healthcare provider about all the medicines you take, including prescription and over-the- counter medicines, vitamins, and herbal supplements.

Please see U.S. Full Prescribing Information and Medication Guide for OPDIVO.

© 2023 Bristol-Myers Squibb Company.

OPDIVO^® is a registered trademark of Bristol-Myers Squibb Company.

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