Immunotherapy

We got our issue of Time magazine this week on Monday and after looking at the cover asked, “what’s immunotherapy?!” Tony read much of the article and was getting interested in finding out if immunotherapy is a possible option for his cancer treatment. The great irony came the next day, when we had an appointment with Tony’s oncologist and learned that they have a new treatment option for him (and it’s considered immunotherapy).

So let’s back up. In February, Tony started feeling some tumor-related pain. He had a scan and found a small new growth off of the original tumor. They biopsied it and sent it off for genomic testing. We had done this with the original tumor a year and a half ago, but the tests they run now are more extensive, and we were able to get better results this time. So what were the results? They looked a little something like this:

 Those scribbles in the top right corner are the name of a genetic mutation they found within the tumor cells. They think it is what caused the cancer in the first place, they just weren’t able to test for it originally. They found that this mutation causes the tumor to overproduce a MET receptor. We knew this part before, and Tony’s current treatment, Crizotinib (Xalkori), targets MET. The doctors think that maybe after a year it isn’t able to fully cover the MET production by the tumor, which is probably why there is some new growth.

The doctors also say that Tony is PDL+1, which means his tumor is using a camouflage (ligand called PDL) to hide from the killer T-cells of Tony’s immune system. There is a drug available, Nivolumab, which targets this PDL ligand and allows the killer T-cell to find and kill the cancer cells. Hence, the drug works to help the immune system work– immunotherapy.

We had thought that a surgery would be coming up, however after talking to the geneticist, oncologist and urologist, we’ve decided to try 4-6 rounds of this new treatment. We’ll then re-evaluate and see if we should continue chemo or proceed to a surgery. The side effects of this drug, Nivolumab, are generally pretty small.  However, no one has ever tried this drug in combination with Crizotinib, so they’re going to watch Tony closely to make sure his body/liver can handle it all.  One day this will all be over and maybe a distant memory, but for now we’re back at it, one treatment, one week at a time.