Latest News (February 2023)
After more than five years of being in total remission, an adverse follow-up scan in late 2022 brought things back to reality. Two small tumours confirmed a late re-appearance of the metastatic renal cancer. The larger tumour has been removed surgically. Prognosis is optimistic, but one can never tell with cancer, so we will wait and see what develops. Fred’s health is still very good at the moment, with no restrictions on what he does, so life goes on.
Background
Fred was diagnosed with a large tumour in one of his kidneys in 2012 and underwent surgery to remove the kidney completely. After that, his prognosis was for complete recovery, but the doctors did start a program of 6-monthly CT scans.
Unfortunately in April 2015, the CT scan detected more tumours in his abdominal cavity and subsequent testing confirmed metastatic renal carcinoma, with multiple tumours rendering his condition inoperable.
Clinical Trial
Fortunately, at that time Westmead Hospital was running a Stage 3 open-label clinical trial to assess the efficacy of a new monoclonal antibody treatment to stimulate the body’s immune system to fight cancer cells, focussing specifically on renal cell carcinoma. Fred was recruited into the trial and commenced receiving treatment in July 2015.
Such immunotherapy has been found effective for other types of cancers, especially melanoma, but had not yet been shown to be effective for renal carcinoma which, although relatively slow-growing, has usually been found to be non-responsive to chemotherapy.
CT scans at 6-week intervals from October 2015 until April 2016 showed continual reductions in the size of the target tumours, and the affected lymph nodes were now regarded as being back to normal size. From June 2016, the CT scans became three-monthly and the results were consistently excellent, with no sign of the disease spreading and the tumours eventually disappearing altogether. Side effects for Fred were minimal and did not detract from his overall well-being.
The trial (Checkmate 214 for those who may want to follow this up) has been completed and was reported in the New England Journal of Medicine in March 2018. Fred was amongst the 9.7% of people who reported complete remission which was a huge improvement over previously available treatments for metastatic renal cell carcinoma. A further 42% of trial participants experienced significant benefit in terms of reduced severity of disease and prolonged survival, with the mean not yet reached at 24 months when the trial was closed off.
In August 2018, after three years of treatment, Fred and the medical team made the decision to stop the treatment as the prevailing view was that it was no longer doing anything, there being no detectable residual tumours for it to act on. Fred then moved onto a follow-up surveillance regime, currently with six-monthly CT scans.
Scans four years after stopping treatment continued to show no signs of cancer.
The treatment Fred received, now referred to as combination immunotherapy of Ipilumimab and Nivolumab was recently added to the PBS list of approved chemotherapy treatments for advanced Renal Cell Carcinoma, based mostly on the results of the Checkmate 214 clinical trial. This makes the treatment generally available to all patients with the same condition within Australia.
