Why a cancer drug wiped out a late-stage aggressive cancer in former Victoria TV reporter Stephen Andrew while other metastatic patients on the same drug died, is a question researchers are racing to answer.
Dr. Christian Kollmannsberger, an oncologist at the sa国际传媒 Cancer Centre and clinical professor at the University of sa国际传媒, says just two years before Andrew was diagnosed, the development of new targeted drug therapies 鈥渢ook off like a rocket.鈥�
Targeted therapies and immunotherapy drugs flourished through clincial trials, and some can now be used in combination to give patients all possible options.
And yet doctors don鈥檛 know why some patients respond and others don鈥檛.
鈥淲hatever you want to call it, winning the lottery, lucky, God鈥檚 will, we don鈥檛 know at the moment what differentiates Stephen from other patients, but he definitely is an unusual patient,鈥� said Kollmannsberger.
鈥淪econd opinions can save your life,鈥� said Andrew, enjoying a coffee at a Victoria coffee shop. After his diagnosis, he went to Vancouver for a second opinion.
He had been diagnosed on Nov. 15, 2006, with Stage IV metastatic kidney cancer. He was 48.
Twelve days earlier 鈥� having run a half-marathon, exercised regularly and felt better than ever 鈥� he went to the bathroom before going on air. There was blood in his urine.
鈥淧robably every second or third patient in my practice says I really didn鈥檛 feel much, said Kollmannsberger. 鈥淭heir kidney cancer was detected because they were imaged for something else.鈥�
It turned out Andrew had a 14-centimetre tumour. It had travelled to both his lungs, and would eventually reach and wrap around his spine.
About 6,600 kidney cancers were diagnosed in 2017 in sa国际传媒, and 1,870 died from the disease or about five people per day. Of those diagnosed nationally, 700 were in sa国际传媒 and 255 died. About 40 to 50 per cent of kidney cancers are attributable to smoking.
High-profile people who have died of the disease in the capital region in recent years include developer David Butterfield and former CTV reporter Jett Basi.
Each metastatic cancer patient is different in terms of how their cancer will progress, but based on averages, Andrew had about two years.
He was given few options, but used his position as a reporter to record his journey. It was a move that would benefit him personally, but also benefit an untold number of others when he pushed for the drug Sunitinib to be funded in sa国际传媒 at a cost of $7,500 a month in 2007.
Before the availability of these drugs starting in 2004, patients just had their kidney removed. Standard chemotherapy was largely ineffective.
When Kollmannsberger came to Vancouver in 2004, kidney cancer was considered one of most boring and hopeless tumours on Earth, he said.
鈥淣obody wanted to treat kidney cancer because there was nothing to treat,鈥� said Kollmannsberger.
鈥淪eventy-five per cent of our patients didn鈥檛 get any treatment at all 鈥� they were metastatic 鈥� apart from taking the kidney out,鈥� he said. 鈥淭he remaining 25聽per cent got what we call today unspecific immunotherapy.鈥�
Andrew was given few options. He went to Vancouver for a second opinion.
Kollmannsberger upped his dose of the targeted therapy Sunitinib, designed to slow or stop the growth of cancer tumours. Andrew missed the deadline for compassionate access to the drug, which had been part of a clinical trial with Canadian participation, and paid for it through his extended health care through work.
鈥淚鈥檓 an enthusiastic clinical trialist 鈥� it offers my patients things they wouldn鈥檛 otherwise have,鈥� said Kollmannsberger.
He argues that most drugs used in clinical trials are active and it鈥檚 just a matter of determining if they meet or exceed the standard.
After just six months, some of Andrew鈥檚 tumours had vanished, but a new lump appeared.
Old therapies would have given metastatic kidney cancer patients 12 to 15 months. But on Sunitinib there was hope.
鈥淪tephen took this diagnosis and turned it around and formed it into almost a sense of being: I鈥檒l take this and fight this and try to get as much positive out of this journey as possible, and that鈥檚 what he did,鈥� said Kollmannsberger.
Andrew married his longtime partner, artist Danny Stewart, days after his diagnosis, and held a reception the next year.
For the past seven years Andrew has been disease-free, and for the past six years without any cancer-related drugs.
鈥淗e鈥檚 one of those one to two per cent who were cured by these modern therapies we have,鈥� said Kollmannsberger.
鈥淔rom a scientific point of view 鈥� a lot of groups in the world are working on why some patients are what we call exceptional responders, which Stephen absolutely falls into,鈥� he said. 鈥淲e don鈥檛 know what differentiates them, but they must have something that makes them uniquely sensitive to particular drugs.鈥�
鈥淭he ideal would be if we can actually figure out why some patients respond fantastically to a drug A and why some patients don鈥檛, and why some patients respond fantastically to a drug B and some patients don鈥檛,鈥� said Kollmannsberger.
Finding such bio-markers is going to change the way cancer is treated in the future, he said.
Such was the case when it was discovered that women who had HER2-positive breast cancer had a good chance to respond to the drug Trastuzumab.
鈥淭hat knowledge would allow us to rationally apply our treatments to that patient for personalized medicine,鈥� said Kollmannsberger. 鈥淗opefully, one day in the not-so-distant future, we will be there.鈥�
And while targeted therapies have come a long way 鈥� 10 to 11聽drugs are approved for kidney cancer now, leading to considerably longer life spans 鈥� the future is immunotherapy, he said. 鈥淚t鈥檚 a whole new chapter.鈥�
New immunotherapies, which use the body鈥檚 immune system to fight cancer, are expected to replace Sunitinib as the first treatment for a large number of kidney-cancer patients, he said.
Of immunotherapy patients, 25聽to 30 per cent have a remarkable benefit; 20 to 30 per cent a temporary benefit; and 30 to 35聽no benefit.
Bristol-Myers Squibb sa国际传媒 Co. this month announced approval of an immuno-oncology combination therapy of nivolumab plus intravenous injections of ipilimumab for treatment of adult patients with intermediate or poor-risk advanced or metastatic renal-cell carcinoma.
With Sunitinib, about one to two per cent would become disease-free, but with this new immunotherapy drug combination 鈥渨e see it in 10 to 15 per cent 鈥� so it鈥檚 quite a big step forward,鈥� said Kollmannsberger.
Better yet, it appears the two treatment groups 鈥� targeted agents and immunotherapies 鈥� don鈥檛 seem to have cross resistance, meaning they can be given one after the other.
鈥淎t the end of the day, God is on the side of the bigger battalions, so the more options you have, the higher the chance you鈥檒l respond to something,鈥� said Kollmannsberger.
Still, the question why some patients鈥� bodies respond and others don鈥檛 looms.
鈥淲e still unfortunately live in a time where in a number of patients the cancer just wins,鈥� said Kollmannsberger.
鈥淏ut what I think we can safely say is that if the cancer wins, it usually wins a lot later and the number of patients in which the cancer no longer wins is slowly but surely increasing.鈥�
After leaving TV reporting, dabbling in communications and taking an unsuccessful run at being Victoria鈥檚 mayor, Andrew found his calling as executive director of Kidney Cancer sa国际传媒, whose mandate is to educate, support and advocate for kidney-cancer patients and their caregivers.
鈥淗e is relentless in a positive way by pushing for improving the situation for kidney-cancer patients, so that鈥檚 very admirable,鈥� said Kollmannsberger.
Andrew advocates for patients to get a second opinion, try a clinical drug trial, get connected and find the care path that suits them.
鈥淚t saved my life,鈥� said Andrew.
Kidney Cancer sa国际传媒 fundraiser in September
In September, kidney-cancer patients, their supporters and advocates will be walking, running, riding or just simply moving in any way that fits their lifestyle and schedule to raise money for kidney cancer support and research.
This is the first year of Kidney Cancer sa国际传媒鈥檚 national fundraiser Move To Beat Cancer on Sept. 14-16.
The fundraiser encourages people to create a donor web page, collect sponsors, and then choose any time on that September weekend to move 鈥� walking, bowling, hiking, rowing, bicycling.
A group of riders will pedal from Montreal to Toronto and back committed to raise $20,000, while patient Paul Scott and his wife Marriane in Hespeler, Ont., will be walking trails.
Some patients will simply be walking the grounds around the hospital. Victoria鈥檚 Stephen Andrew and his partner, Danny Stewart, will be in Amsterdam that weekend, walking the canals.
Participants are encouraged to post pictures and videos to their personal pages to show examples of their activity. Bristol-Myers Squibb has pledged to match every dollar, up to $25,000, raised.
Andrew said the in-house fundraiser will put all the money donated into research and advocacy and education. Kidney Cancer sa国际传媒 is a registered charity made up of patients, caregivers and health professionals who give support, education, advocacy for patients as well as funding for research.
To sponsor Andrew and others, go to:
