The reason why a cancer drug wiped out Stephen Andrew’s aggressive, late-stage cancer while other metastatic patients on the same drug died, is a question researchers are racing to answer.

Dr. Christian Kollmannsberger, a medical oncologist and Clinical Professor at the University of BC, says that just two years before Andrew was diagnosed, the development of new targeted drug therapies “took off like a rocket.”

Targeted therapies and immunotherapy drugs flourished in clinical trials and some can now be used in combination to give patients more options. Yet doctors don’t know why some patients respond and others don’t.

A medical mystery

Andrew had been diagnosed on Nov. 15, 2006, with Stage IV metastatic kidney cancer. Twelve days earlier, he went to the bathroom before going on air as a Victoria-area TV reporter and found blood in his urine. It turned out Andrew had a 14-centimetre tumour that had travelled to both his lungs and would eventually wrap around his spine.

About 6,600 kidney cancers were diagnosed in 2017 in Canada — roughly about five people die from the disease per day. Metastatic cancer patients differ in terms of how their cancer will progress, but based on averages, Andrew had about two years.

He used his position as a reporter to record his journey. It was a move that would benefit him personally, and benefit an untold number of other patients when he pushed for the drug Sunitinib to be funded in BC at a cost of $7,500 a month in 2007.

When Dr. Kollmannsberger arrived in Vancouver in 2004, kidney cancer was considered one of the most hopeless diseases on earth. “Nobody wanted to treat it because there was nothing to treat,” he says. Before the availability of new drugs, patients just had their kidneys removed as standard chemotherapy was largely ineffective. “Seventy-five percent of our patients didn’t get any treatment at all — they were metastatic — apart from taking the kidney out,” he says. “The remaining 25 percent got what we call today unspecific immunotherapy.”

With few options available, Andrew travelled to Vancouver for a second opinion provided by Dr. Kollmannsberger.

The power of a second opinion

Dr. Kollmannsberger upped Andrew’s dose of the targeted therapy Sunitinib, which is designed to slow or stop the growth of cancer tumours. “I’m an enthusiastic clinical trialist — it offers my patients things they wouldn’t otherwise have,” says Dr. Kollmannsberger. He argues that most drugs used in clinical trials are active and it’s just a matter of determining if they meet or exceed the standard. After just six months, some of Andrew’s tumours had vanished, but a new lump appeared.
“Stephen took this diagnosis and turned it around and formed it into almost a sense of being: ‘I’ll take this and fight this and try to get as much positive out of this journey as possible,’” says Dr. Kollmannsberger.

Andrew has been disease-free for the past seven years, and has been without any cancer-related drugs for the past six. “He’s one of the one to two percent who were cured by these modern therapies,” says Dr. Kollmannsberger. “We don’t know what differentiates them, but they must have something that makes them uniquely sensitive to particular drugs.”

Finding such bio-markers is going to change the way cancer is treated in the future, he notes. And while targeted therapies have come a long way — 10 or 11 drugs are approved for kidney cancer now, leading to considerably longer life spans — the future is immunotherapy, he says: “It’s a whole new chapter.”

Still, the question why some patients’ bodies respond, and others don’t, looms. “Unfortunately, we still live in a time where, in a number of patients, cancer just wins,” says Dr. Kollmannsberger.

“But what I think we can safely say is that if the cancer wins, it usually wins a lot later. The number of patients in which cancer loses is slowly but surely increasing.”

Andrew found his calling as Executive Director of Kidney Cancer Canada, whose mandate is to educate, support and advocate for kidney cancer patients and their caregivers. He advocates steadily for patients to get a second opinion, try a clinical drug trial, get connected and find the care path that suits them. “It saved my life,” says Andrew.

This article originally appeared in the Aug. 5, 2018 edition of the Times-Colonist. It has been edited for brevity.