Leonard Ganz: Maintaining a Positive Attitude with Immunotherapy
I was diagnosed with metastatic urothelial carcinoma in May 2012. Surgery was the only treatment that I needed for the metastasis until January 2019, when the tumor in my lung recurred. After chemotherapy had no effect, I was told my tumor had a high mutational burden and that made me a great candidate for a clinical trial testing an immunotherapy treatment called pembrolizumab (Keytruda). In the 11 months since I started on the trial, the tumor has shrunk dramatically. My wife and I are overwhelmed by the results, and we couldn’t be more thankful for all the research that made this possible.
My journey with urothelial cancer is complicated. In September 2010, my primary care physician suggested that I see a prostate specialist because of enlargement to my prostate and an elevated level of PSA. I was diagnosed with prostate cancer. After researching the treatment options, my wife Roberta and I decided that I would have prostate surgery. During the pre-op testing for the prostate surgery, the doctors discovered a blockage in my ureter [the tube in which urine passes from the kidney to the bladder]. Further tests showed that it was urothelial cancer.
After I had recovered from the prostate surgery, Roberta and I saw several urologists to get opinions on the best treatment for the urothelial cancer. The opinions varied widely, but we opted for laser ablation of the blockage. After three laser ablations did not eliminate the tumor, I was treated with a chemotherapy called mitomycin. The chemotherapy was administered into my kidney from which it dripped through the ureter, contacting the tumor. The treatments were long and painful.
Then, in May 2012, a CAT scan showed that the urothelial cancer had spread to the tip of my right lung. The metastasis was removed during a wedge surgery. At this point, my urologist recommended that I transfer my care to an oncologist. I needed no further treatment until January 2019, when it was discovered that the tumor in my lung had recurred.
At this point, a sample of the tumor in my lung was tested for a number of biological and genetic characteristics. I was told that the tumor was not positive for PD-L1 so I was not eligible for immunotherapy. My only treatment option was chemotherapy. I received gemcitabine and carboplatin for five months. The tumor did not grow, but it did not shrink either. As a result, the chemotherapy was deemed ineffective.
The oncologist knew from the genetic analysis that the mutational load of the tumor was very high. In fact, I was told it was the highest he had ever seen. Because of this and the fact that chemotherapy was ineffective, I was offered the chance to participate in a clinical trial testing the immunotherapy pembrolizumab.
Roberta and I are big believers in science and medicine, and we jumped at the chance for me to join the clinical trial. For the past 11 months, I have been having an infusion of pembrolizumab every three weeks and CAT scans every two months. The results have been fabulous, and I am extremely thankful to be part of this clinical trial. The tumor has shrunk dramatically, and the oncologist is extremely pleased with the results, but he has recommended that I complete the clinical trial and then we will assess what treatment I need, if any.
The incredible results I have seen with pembrolizumab have outweighed the disappointment that I felt when the chemotherapy was ineffective. I choose to keep a very positive outlook and to move forward with my life; there is a lot to be grateful for.
We need to make sure that Congress continues to fund the research that makes possible the advances like the one that I am benefiting from.