Curtesy of http://adventuresinlivingterminallyoptimistic.com/2015/10/14/the-faces-of-successful-colorectal-cancer-immunotherapies-vol-1/
Leta Withers – CRC Immunotherapy Pioneer
Leta was a happy wife & mother of 3 boys, aged 9, 13 & 16 when she first experienced the symptoms of colon cancer at only 46 years old. As is often the case for patients under 50, her symptoms were mistakenly attributed to other causes until she insisted on a colonoscopy. She had been warned that due to her age, insurance probably wouldn’t cover it – but Leta insisted since she had just had two friends under 45 diagnosed with CRC. Leta doesn’t back down easily when she sees an opportunity she knows she has to take.
They found an egg sized tumor in her right colon. 11 of 23 lymph nodes were positive for cancer so she was classified Stage 3C. After 4 months of the grueling cytotoxic XELOX/CAPOX chemotherapy cocktail, her scans were clean. Unfortunately only 3 months later, tumors were found in her lung, chest lymph node, ovary, and peritoneum. She was now declared inoperable Stage IV – or as I prefer to say, she was at that point declared currently incurable…
She was terrified in private. She knew what the prognosis for inoperable Stage IV CRC was. She flew to MD Anderson for a second opinion. It was there that she first heard about the “MSI-high” biomarker and the good responses they were seeing there in PD-(L)1 inhibitor trials. Leta is in the group of 10-15% of sporadic CRC patients who are MSI-high.
While researching an offered clinical trial combining two checkpoint immunotherapies: a PD-1 inhibitor Opdivo (nivolumab) + a CTLA-4 inhibitor Yervoy (ipilimumab) Leta started the standard second line cytotoxic chemo cocktail for CRC called FOLFIRI + Avastin (bevacizumab). Her tumors were responding to the treatment but she had a lot of “down days”. The treatment was rough on her.
Looking at her current quality of life and having performed a lot of self-education on checkpoint inhibitor immunotherapies & MSI-high CRC – Leta decided to do the clinical trial instead. Slots were very limited so she had to call many times over multiple months. She finally was offered a slot – but she needed to decide without delay whether to take the “Clinical Trial plunge” or continue standard chemo. She decided to go for the trial.
Leta signed the required paperwork and started the trial within days. In her own words: “It was nothing like the chemo I had endured. I left the chemo chair feeling terrific. No nausea, no pain, no fatigue! I was hungry and felt like myself! After the first treatment, I had wine and cheese and went shopping! Just a tad different than previous chemo.” The only side effect she has endured is elevated liver enzymes. She has had 3 scans so far – they have showed shrinkage or stability in all her lesions.
To close with her own words: “I credit this drug hugely with both my favorable scans and mostly the amazing quality of life it has given me back. I feel like my old self again. I don’t feel sick, and I have no down days anymore. I feel like I drew the lucky card to be MSI-high and have the chance to be on this trial!”
Stephen Estrada – CRC Immunotherapy Pioneer
Stephen was diagnosed with Stage IV CRC at the very young age of 28. He was fresh out of school and excited to start his career. Life was fantastic until GI-symptoms became too great to ignore. Because of his young age, his symptoms were not taken seriously even during two trips to the ER. Thankfully his primary care physician took his concerns seriously and a tumor was found in his colon – but at the time of diagnosis it had already metastasized to his mesentery.
He underwent surgery followed by 6 months of the difficult FOLFOX cytotoxic chemotherapy cocktail. The chemo was very rough – his weight bottomed out at 110 lbs and he looked obviously very sick to everyone that saw him. A radiosurgery was attempted to remove a remaining tumor but it failed. Before his 30th birthday, Stephen was declared inoperable Stage IV. At that point, declared currently incurable.
He transferred his care to the University of Colorado Cancer Center. As is often the case in patients diagnosed that young, genetic testing revealed that Stephen has Lynch Syndrome – and he is also MSI-high. His new oncologist was familiar with good preliminary clinical trial results being seen with PD-1 pathway checkpoint inhibitors in MSI-high CRC patients. Based upon his new doctor’s advice, Stephen started a Phase 1 clinical trial of the PD-L1 inhibitor MPDL3280a (atezolizumab) + Avastin (bevacizumab).
In Stephen’s own words: “As I received my first infusion, I was overcome with severe back pain that lasted about two days…but after it left up, I realized that all my tumor induced pain seemed to have already faded away. The second infusion landed me in the hospital for 5 days when I started running a fever of 104. The strange thing is…I never felt very sick…just hot. A whole barrage of tests were ordered to see if there was an infection attacking me. Nothing ever came up and the fever was attributed to the MPDL3280a revving up my immune system and recognizing the cancer.”
Stephen has had 3 scans while on trial – after an initial shrinkage of his tumors, the 2 follow-up scans show stable disease. To close with his own words: “Besides my disease being held in check, the best thing is…I feel wonderful. I have gained about 40 lbs, I am able to be in the gym about 5 days a week, and I am currently in the process of returning back to work. Without this drug, I would be thin, ill, and potentially not alive.”
Pictured below are 1.) Stephen during chemo contrasted with him currently on PD-L1 immunotherapy.