Immunotherapy gives a young man a second chance

If you’ve ever wondered why it’s important to give money to improve medical treatment for patients then 38 year old Andrew Duke’s story is one you should read.

At age 36, Andrew spent countless hours investigating a sore hip which he thought was a sports injury from years of surfing and bike riding. After extensive physiotherapy, massages, doctor appointments and even surgery, he was eventually diagnosed with stage four metastasised renal cell carcinoma.

With no family history of cancer and being so young, a diagnosis like this was not only rare, but the last thing he expected when he received an after-hours phone call from his doctor’s office on 1 March 2017.

“I was waiting for my brothers to come over before we went to the pub to celebrate one of their birthdays and I rang them, said I’d be home in 10 minutes and the keys were in the letterbox,” Andrew said.

“Instead the doctor told me the scans I’d had that morning showed I had a very large tumour on my kidney. She called my brothers and got them to come to her rooms and passed on my diagnosis,” he said.

A cancer diagnosis is tragic for not only the patient but for their family. Andrew’s parents were travelling by boat around Australia, and while his dad was in Tasmania, his mum was in Brisbane for a few days.

“My poor mum opened the door to her three sons, surprised and so happy to see us probably thinking that we had come to celebrate dinner with her,” Andrew said.

“I walked in and asked her to sit down because there was something I had to tell her and she cottoned on that something was wrong.

“My mum was also a registered nurse so as soon as I told her she broke down in tears understanding the severity of my diagnosis,” he said.

Surprisingly that night Andrew slept well.

“Maybe my body was so exhausted from it all but I still remember waking up at 5am, the same time I do every day from my alarm and then the events from the previous day hit me and I lay there and shed a few tears,” Andrew said.

“I let myself cry for a few minutes but then told myself that crying wasn’t going to help me. Being angry wasn’t going to cure me and being worried sure wasn’t going to help me and it will only make things worse.

“Stupidly I Googled what the survival rate for my cancer was and it came back as only eight per cent survival in five years.

“That hit home pretty badly so I decided not to Google anything else after that,” he said.

Andrew’s rollercoaster ride started immediately.

He stopped working and underwent a barrage of tests including MRIs, bone scans and a biopsy of his lung tumours. A number of doctors said his kidney tumour was too large for removal however it was removed successfully three weeks after his diagnosis.

He waited three months to rescan and work out a plan. During that period the tumours had increased significantly, ruling out any further surgery options. Another option was to join an immunotherapy trial which was testing a combination of drugs which weren’t on the Pharmaceutical Benefits Scheme (PBS) which would save him $120k a year, however Andrew wasn’t convinced the trial was right for him at that time. His only other option was to use Votrient (also known as Pazotinib) which was considered the gold standard treatment for kidney cancer.

After two weeks of using Votrient Andrew began suffering extreme side effects. He began vomiting and suffering from diarrhoea up to 10 times a day, developed high blood pressure, blood-noses, mouth ulcers and deteriorating vision which required glasses.

Within a month, on top of all of the other side effects Andrew’s hair and skin was starting to turn white and his thyroid stopped working. The drug’s dosage was reduced to a more tolerable amount.

“It was so bad I couldn’t leave the house in case I needed the bathroom, I felt terrible and looked like a ghost,” Andrew said.

A consultation with a dietitian helped Andrew eliminate foods which were adding to the problem which improved his gut health significantly.

By now Andrew was having blood tests every two weeks and a scan every three months. Luckily it wasn’t all for nothing and the drug had actually slowed the progress of his cancer in his lungs. Sadly after eight months, in February 2018, the Votrient stopped working. It was devastating.

“The tumours had doubled in size and immunotherapy was my only option,” he said.

Fortunately for Andrew, the immunotherapy drugs had been added to the PBS three months before.

“I had great reservations using immunotherapy however these were my choices – do nothing and be dead by Christmas or keep taking the Votrient and be dead by Christmas,” Andrew said.

Three months after commencing immunotherapy Andrew’s Votrient side effects had disappeared apart from his thyroid condition. Instead of taking a tablet, Andrew receives a hospital based infusion every two weeks for four hours.

“I don’t mind sitting around because it gives me a chance to relax, unwind and read a book, which I rarely did before!” he laughs.

There were notable changes in Andrew’s first scan after commencing immunotherapy, with the tumours having shrunk significantly over time.

Fast forward to 2019 and Andrew is continuing his treatment with Dr Paul Kalokerinos at Mater Cancer Care Centre and quietly optimistic about his future–even committing to Mater Foundation’s Climb for Cancer event on 9 June.

“Day to day life hasn’t changed too much, I was active before my diagnosis and looked after myself pretty well so I’ve just continued to do that and enjoy my life,” Andrew said.
He’s ticked off quite a few things on his bucket list.

“I went to the US last year and watched the Superbowl and saw an ice hockey and NBA game which was pretty cool,” he said.

“Looking back over my journey I believe research into cancer treatment is so very important because what treatment works for me isn’t necessarily the same things as the next person.

“I’ve been lucky – if the immunotherapy drugs weren’t put onto the PBS I wouldn’t have been able to afford it. The more fundraising that can be done then the more options patients have in the future. You need options because I only lasted eight months on Votrient but the guy next to me lasted five years – it worked for him!

Andrew said he never knew anything about cancer before and assumed chemotherapy was just what you did.

“I want people to know that money donated to research looks for treatment alternatives.

“Let’s help researchers find out why treatment works for some people and doesn’t for others,” Andrew said.