April 24, 2019

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Living longer, better

Immunotherapy has potential to extend cancer patients' lives

Simeoni Tatty, a 62-year-old Inuk man from Rankin Inlet, is currently being treated for cancer with immunotherapy. MIKAELA MACKENZIE / WINNIPEG FREE PRESS</p>

Simeoni Tatty, a 62-year-old Inuk man from Rankin Inlet, is currently being treated for cancer with immunotherapy. MIKAELA MACKENZIE / WINNIPEG FREE PRESS

Simeoni Tatty has been feeling more like himself in recent weeks. And just as importantly, he is hopeful — much more than he was a few months ago when he was told the cancer in his bladder had spread to his lungs, liver and lymph nodes.

“My doctor told me it’s usually about 12 months of life expectancy with the condition I have,” says the 62-year-old Inuk grandfather and great-grandfather, who is from Rankin Inlet, Nunavut.

Tatty had his bladder removed last spring but post-surgical complications cut his chemotherapy short. And the cancer spread. He felt awful because he had no energy and couldn’t sleep. His quality of life was severely diminished, marked by anxiety and depression. It was made more difficult because Tatty had spent months in Winnipeg, 1,400 kilometres away from home.

“I was willing to try anything to prolong life a little longer to be with my kids and grandkids,” says the carpenter who, until falling ill, had a homebuilding company that provided affordable housing in his community.

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Simeoni Tatty has been feeling more like himself in recent weeks. And just as importantly, he is hopeful — much more than he was a few months ago when he was told the cancer in his bladder had spread to his lungs, liver and lymph nodes.

"My doctor told me it’s usually about 12 months of life expectancy with the condition I have," says the 62-year-old Inuk grandfather and great-grandfather, who is from Rankin Inlet, Nunavut.

Tatty had his bladder removed last spring but post-surgical complications cut his chemotherapy short. And the cancer spread. He felt awful because he had no energy and couldn’t sleep. His quality of life was severely diminished, marked by anxiety and depression. It was made more difficult because Tatty had spent months in Winnipeg, 1,400 kilometres away from home.

"I was willing to try anything to prolong life a little longer to be with my kids and grandkids," says the carpenter who, until falling ill, had a homebuilding company that provided affordable housing in his community.

"So I asked, ‘is there was anything else short of voodoo that my doctor could give me?’"

As it turns out, a second-line treatment had recently been approved to treat bladder cancer, involving a new class of medication, often referred to as immunotherapy.

Tatty has been receiving the treatment for the last few months, and while it’s likely not a cure, it will likely extend and improve the quality of his life.

Tatty was originally given a prognosis of having about 12 months to live. His family (from left), Wendy, Minnie, Adam, Emerson, himself and Marley, are hopeful his therapy can extend that. MIKAELA MACKENZIE / WINNIPEG FREE PRESS</p>

Tatty was originally given a prognosis of having about 12 months to live. His family (from left), Wendy, Minnie, Adam, Emerson, himself and Marley, are hopeful his therapy can extend that. MIKAELA MACKENZIE / WINNIPEG FREE PRESS

This may not seem revolutionary. But this relatively new class of therapies aimed at coaxing the immune system into attacking cancer cells is providing hope in cases that otherwise would have been hopeless a few years ago.

Tatty’s story highlights the growing number of drug therapies available to patients at CancerCare Manitoba. It demonstrates the value of donations made in April, which is Cancer Awareness Month, to support research for new treatments to fight a disease that one in two Canadians will be diagnosed with in their lifetime.

"What characterizes drug treatment for cancer right now is the incredibly fast evolution of new treatments," says Dr. Piotr Czaykowski, a medical oncologist at Manitoba CancerCare who is treating Tatty.

The arsenal of new therapies is such that even experts are challenged to keep pace, he adds.

Key among the innovative treatments are drugs called immune checkpoint inhibitors, which Tatty is receiving.

"Traditional chemotherapy is a very indiscriminate treatment," Czaykowski says. "It kills anything (cells) that is actively dividing and that’s largely why you get side-effects."

Immunotherapy drugs specifically target cancer cells.

"They work on the premise that your immune system should recognize the cancer as foreign, but cancer has a way of hiding itself from the immune system," he says. "So these drugs manage to expose the cancer to the immune system."

Tatty had built a career as a homebuilder and carpeneter in his home of Rankin Inlet. MIKAELA MACKENZIE / WINNIPEG FREE PRESS</p>

Tatty had built a career as a homebuilder and carpeneter in his home of Rankin Inlet. MIKAELA MACKENZIE / WINNIPEG FREE PRESS

To date, the particular drug Tatty has received, pembrolizumab, has shown to be effective against melanoma, which is a skin cancer that’s difficult to treat with chemotherapy.

But it has also been recently approved for use in bladder cancer as a second-line treatment, meaning when other therapies fail, immunotherapy may be used.

"It’s certainly not a treatment that is effective for everybody, but for patients for whom it works, it appears to potentially control the cancer."

Czaykowski is quick to add that immunotherapy will not cure the disease. It has the potential extend the lives of some patients, but not all.

Immunotherapy has fewer side-effects than chemotherapy. That means patients generally feel better, which often improves their quality of life. And that is profoundly meaningful for individuals whose lives are measured in days and months rather than years and decades.

Yet these drugs are not without downsides.

The treatment can have severe side-effects, in which the immune system mistakenly attacks organs. Czaykowski says these negative outcomes are rare, meaning the therapy is worth trying for patients who have few options left.

"On average, it’s not like this will double people’s life expectancy and allows them to live another five years." Rather he says the treatment, on average, extends lives by about two to three months more than traditional chemotherapy.

Dr. Piotr Czaykowski</p></p>

Dr. Piotr Czaykowski

"But there are patients whose benefit is far greater than others."

Tatty appears to be among them. After a few months, the cancer is in lymph nodes is mostly invisible in diagnostic scans and the spots of disease on his liver and lungs have shrunk.

"Are we buying him time? Definitely. How much? I don’t know," Czaykowski says.

Tatty is pleased with the progress.

"I don’t really feel the side-effects that I felt with the other treatment, which really started wearing down my body," he says.

"With the other treatment there was a really depressing feeling and a sense of putting everything in order before my life comes to an end."

Tatty adds he has accepted that he will likely die from the disease. But each day he can spend among the living is a great one. That’s despite the stress associated with travelling every three weeks to Winnipeg for treatment, and economic challenge — such as potentially losing his home —from not being able to work.

"At least there is now hope," Tatty says. "If I’m going to die, I’m going to die. We’re all headed there... but I am happy I am able to spend more time with my grandkids, and watch them grow."

joelschles@gmail.com

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