It's a green light for PDL!!!

Thank God!
Paula.. WHAT EXCELLENT NEWS!!! Oh how happy I am to hear ALL OF IT! Thank you so much for sharing! I know you will do well! I wish i can get my mom on one of these trials in NY! Looking forward to good news soon! Let us know how your scans turned out as well. xxoo

GREAT NEWS!!!
And you were worried...me and fox would have done some persuasion biker style if they turned you down...glad that wasn't necessary.

I can't tell you how excited I am for you, you must be on cloud 9. I know you will have good results, I'll be talking to the big guy upstairs to make sure.

Now we just gotta find something that works for TW.

Congratulations,

Gary

garym said:

GREAT NEWS!!!
And you were worried...me and fox would have done some persuasion biker style if they turned you down...glad that wasn't necessary.

I can't tell you how excited I am for you, you must be on cloud 9. I know you will have good results, I'll be talking to the big guy upstairs to make sure.

Now we just gotta find something that works for TW.

Congratulations,

Gary

Green light
Another member of your cheering section turning up, not for duty but for the real pleasure of wishing you well and looking forward to the excellent results you deserve and that we're all confident you'll get.

Now you really are joining the ranks of the Titans, Paula and we'll have another icon like Fox to follow. Maybe that vision of the two of you skipping hand-in-hand to NEDland wasn't so fanciful!

pjune127 said:

NEDland
You know how bad I want to go there!!! I am truly excited. In the past few days I have found myself "circling the drain"...a putrid combination of despair and frustration. This is a banner day for me. The research nurse told me I am a responder and the drug company wants me to start right away. Music to my ears. Going up there on Tuesday for scans and labs and more consent forms. (Do they HAVE to list all the possible side effects???) Turns out I am not in an escalation group, nor am I one of the first 10 patients in a dose-expansion group. I feel very snug in my little group. No extra blood tests, and so it seems safer. And they are letting me leave to come home on the day I have my first treatment. Pretty comforting, I must say.

The fight has just begun...I'll try not to let anyone down. I want to be a Titan. And skipping into NEDland with Fox is my goal. The only thing that would make that better is if we could find a few more of you to join us!

Tex, waiting anxiously for your appointment on Friday. Wish you could qualify for this one with me. I'd love your company!

Love,
Paula XO

A BIG Hug and Hello
Way to go, girl.
And when I watch some of the current TV shows-"Idol","The Voice", etc., I just want to whap a few of them up side the head. Cuz,"I'll just die if I don't get to the next round." They have no idea what others go through to avoid that phrase.

Say Howdy to Tennessee. Our good friend is there this week watching his granddaughter play volleyball in Clarksville.
Good luck on all the prelim works-ups and pass your tests with flying colors.
Donna

pjune127 said:

NEDland
You know how bad I want to go there!!! I am truly excited. In the past few days I have found myself "circling the drain"...a putrid combination of despair and frustration. This is a banner day for me. The research nurse told me I am a responder and the drug company wants me to start right away. Music to my ears. Going up there on Tuesday for scans and labs and more consent forms. (Do they HAVE to list all the possible side effects???) Turns out I am not in an escalation group, nor am I one of the first 10 patients in a dose-expansion group. I feel very snug in my little group. No extra blood tests, and so it seems safer. And they are letting me leave to come home on the day I have my first treatment. Pretty comforting, I must say.

The fight has just begun...I'll try not to let anyone down. I want to be a Titan. And skipping into NEDland with Fox is my goal. The only thing that would make that better is if we could find a few more of you to join us!

Tex, waiting anxiously for your appointment on Friday. Wish you could qualify for this one with me. I'd love your company!

Love,
Paula XO

NEDland
Paula, I suppose I wouldn't qualify, would I? 70 in a few days time but very fit; however, metastatic, sarcomatoid chromophobe might rule me out? Can you point me to the number of your trial, or any others of like kind you've come across that may be recruiting?

Texas_wedge said:

NEDland
Paula, I suppose I wouldn't qualify, would I? 70 in a few days time but very fit; however, metastatic, sarcomatoid chromophobe might rule me out? Can you point me to the number of your trial, or any others of like kind you've come across that may be recruiting?

Update
I'm all too conscious of the fact that in the past few days I've neglected to reply to many friends here who have sent me kind messages and valuable information. I've been tied up in a long-running, ultra-bizarre and fascinating legal action. So, I've been in Edinburgh by day and in Discomfort by night, leaving me not enough time, in particular to do justice to the academic papers that have been sent to me. I've also just been given a boatload of further information, so it'll take me a while to respond appropriately.

Meantime, my thanks for recent messages go to at least Clara, Peg, Paula, Kathy, Ange, Alice and David for helpful messages and info.

We went to meet my oncologist yesterday. She is young but very impressive, her specialties being renal and lung cancers. She is also easy on the eye which is good news since she says she will be seeing me often, monitoring my blood pressure etc, if I go with her rather than seeking treatment that she isn't able to offer in this neck of the woods (Scotland). Staying here has a lot of appeal but I'm looking at other possibilities.

As I've said above, I've had a lot of help here and will, I'm confident, get more once I've nailed my colours to a particular mast. For the expert opinion over there, I've asked for additional help on KIDNEY-ONC, where I summarised my present position like this:

"Not many weeks ago I was considered NED, now following a further CT scan and a quick follow-up PET/CT I appear to be pT4 N2M1 with parameters that some of the 'survival' nomograms won't even accommodate as inputs, and a new tumour developing at around 100 x the typical rate of growth for RCC. I appeared to have been met-free at dx but it now looks as though I probably had undetectably small mets which, due to transition into an extremely aggressive histology, have manifested in a second renal bed recurrence and, more menacingly, compromised lymph nodes, suggesting the possibility of distant mets any day now. The team whose care I'm in (at a Hospital which is one of the top 3 cancer research centres in the World) have decided against the third op that I was hoping for in favour of passing me over to the renal oncologists, one of whom I'll be seeing in a couple of hours time.

So, with highly aggressive, metastatic, necrotic, sarcomatoid chromophobe RCC and the expert judgment that just further surgery would be fiddling while Rome burns, I'm contemplating best next moves. Thoughts, please (other than 'Get your affairs in order', which I've embarked on). I'll maybe post what the oncologist outlines in the hope of gleaning some expert comments here since there's more expertise here than probably any single doctor could dream of possessing. It would be useful to have a list of the questions that my Wife and I will inevitably have forgotten to put."

I think I put all of the main questions and got good answers from my oncologist. We're meeting again on Friday week after each gathering further data, to decide how to go forward. She has written to the UK's great IL2 expert to see whether that might be a possibility, in Manchester. Here, she could offer me either sunitinib (Sutent) or pazopanib (Votrient), to start straight away. She hopes that this would achieve some shrinkage or stability of the new tumour, which will otherwise keep growing and is probably already virtually inoperable - not a pleasant scenario to contemplate.

There are no trials that would take me in in Scotland but we are investigating possibilities in England, Europe, the USA and Canada.

It may be that at 70 and with a rare sub-type, I'll be deemed unacceptable for Il2 or I might fail the cardiac and other performance tests (though I think that unlikely). If so and I don't find a suitable trial I'll probably go with Votrient in preference to Sutent, for its usual better tolerability. Even if it's marginally less effective than Sutent, the idea would be to play to my strength and go for the one that would permit me to lead as close as possible to my existing lifestyle in the hope of maintaining my strong immune system. The same logic would count against chemo. No-one would lightly dismiss the opinion of the excellent Janice Dutcher, who favours chemo for sarcomatoid cases but I'd rather avoid the scattergun approach of cytotoxics which would undermine my best defence - my immune system.

On principle, I would favour an immunotherapy but I don't think that there's a record of IL2 showing good results for sarcomatoid chromophobe, but that's chiefly because it's so rare that there are virtually no data. The best alternative would, in theory, I believe, be a PD1 or PDL1 such as Fox and others here are on and Paula is embarking on, ideally in a combo with another agent, such as the trials John and tacyarts are on, with a PD1 + Votrient or Sutent, or even one of the chemos, like doxorubicin or gemcitabine, or possibly a newer agent like cabozantinib.

My plan now is to review IL2 data, using the experiences of members here and on ACOR to do a crude cost/benefit analysis, in case I have it on offer, and checking if it looks at all likely to help sChRCC. Also to look for any trial opportunities anywhere that could be feasible. Otherwise go with Votrient backed by mind-body medicine approach.

If anyone is able to warn me about possible pitfalls in the way of taking a path that then precludes other treatments, I'd be eternally grateful. Fox is my big hope, after his hard won experience, for educating me on possible dangers there.

Thanks everyone. What goes around comes around and I've contributed here so I'm not embarrassed to take any help now that my friends here can give me.

ClaraW said:

Paper on IL-2 and bisphosphonate
Dear Tex,
Have you read this paper?
Pilot trial of interleukin-2 and zoledronic acid to augment gammadelta T cells as treatment for patients with refractory renal cell carcinoma.
Lang JM. Kaikobad MR. Wallace M. Staab MJ. Horvath DL. Wilding G. Liu G. Eickhoff JC. McNeel DG. Malkovsky M.
Cancer Immunology, Immunotherapy. 60(10):1447-60, 2011 Oct.

Some more
2 more articles:

1. A pilot study of denileukin diftitox (DD) in combination with high-dose interleukin-2 (IL-2) for patients with metastatic renal cell carcinoma (RCC).
Atchison E. Eklund J. Martone B. Wang L. Gidron A. Macvicar G. Rademaker A. Goolsby C. Marszalek L. Kozlowski J. Smith N. Kuzel TM.
Journal of Immunotherapy. 33(7):716-22, 2010 Sep.


2. Phase III, randomised, multicentre trial of maintenance immunotherapy with low-dose interleukin-2 and interferon-alpha for metastatic renal cell cancer.
Passalacqua R. Buzio C. Buti S. Porta C. Labianca R. Pezzuolo D. Camisa R. Sabbatini R. Benecchi L. Messina C. Cengarle R. Vaglio A. Dalla Chiesa M. Tomasello G. Caminiti C.
Cancer Immunology, Immunotherapy. 59(4):553-61, 2010 Apr.



I'll email the full articles to you if like. Seems to me there are quite a lot of research on combination immunotherapeutic agents.

Texas_wedge said:

Update
I'm all too conscious of the fact that in the past few days I've neglected to reply to many friends here who have sent me kind messages and valuable information. I've been tied up in a long-running, ultra-bizarre and fascinating legal action. So, I've been in Edinburgh by day and in Discomfort by night, leaving me not enough time, in particular to do justice to the academic papers that have been sent to me. I've also just been given a boatload of further information, so it'll take me a while to respond appropriately.

Meantime, my thanks for recent messages go to at least Clara, Peg, Paula, Kathy, Ange, Alice and David for helpful messages and info.

We went to meet my oncologist yesterday. She is young but very impressive, her specialties being renal and lung cancers. She is also easy on the eye which is good news since she says she will be seeing me often, monitoring my blood pressure etc, if I go with her rather than seeking treatment that she isn't able to offer in this neck of the woods (Scotland). Staying here has a lot of appeal but I'm looking at other possibilities.

As I've said above, I've had a lot of help here and will, I'm confident, get more once I've nailed my colours to a particular mast. For the expert opinion over there, I've asked for additional help on KIDNEY-ONC, where I summarised my present position like this:

"Not many weeks ago I was considered NED, now following a further CT scan and a quick follow-up PET/CT I appear to be pT4 N2M1 with parameters that some of the 'survival' nomograms won't even accommodate as inputs, and a new tumour developing at around 100 x the typical rate of growth for RCC. I appeared to have been met-free at dx but it now looks as though I probably had undetectably small mets which, due to transition into an extremely aggressive histology, have manifested in a second renal bed recurrence and, more menacingly, compromised lymph nodes, suggesting the possibility of distant mets any day now. The team whose care I'm in (at a Hospital which is one of the top 3 cancer research centres in the World) have decided against the third op that I was hoping for in favour of passing me over to the renal oncologists, one of whom I'll be seeing in a couple of hours time.

So, with highly aggressive, metastatic, necrotic, sarcomatoid chromophobe RCC and the expert judgment that just further surgery would be fiddling while Rome burns, I'm contemplating best next moves. Thoughts, please (other than 'Get your affairs in order', which I've embarked on). I'll maybe post what the oncologist outlines in the hope of gleaning some expert comments here since there's more expertise here than probably any single doctor could dream of possessing. It would be useful to have a list of the questions that my Wife and I will inevitably have forgotten to put."

I think I put all of the main questions and got good answers from my oncologist. We're meeting again on Friday week after each gathering further data, to decide how to go forward. She has written to the UK's great IL2 expert to see whether that might be a possibility, in Manchester. Here, she could offer me either sunitinib (Sutent) or pazopanib (Votrient), to start straight away. She hopes that this would achieve some shrinkage or stability of the new tumour, which will otherwise keep growing and is probably already virtually inoperable - not a pleasant scenario to contemplate.

There are no trials that would take me in in Scotland but we are investigating possibilities in England, Europe, the USA and Canada.

It may be that at 70 and with a rare sub-type, I'll be deemed unacceptable for Il2 or I might fail the cardiac and other performance tests (though I think that unlikely). If so and I don't find a suitable trial I'll probably go with Votrient in preference to Sutent, for its usual better tolerability. Even if it's marginally less effective than Sutent, the idea would be to play to my strength and go for the one that would permit me to lead as close as possible to my existing lifestyle in the hope of maintaining my strong immune system. The same logic would count against chemo. No-one would lightly dismiss the opinion of the excellent Janice Dutcher, who favours chemo for sarcomatoid cases but I'd rather avoid the scattergun approach of cytotoxics which would undermine my best defence - my immune system.

On principle, I would favour an immunotherapy but I don't think that there's a record of IL2 showing good results for sarcomatoid chromophobe, but that's chiefly because it's so rare that there are virtually no data. The best alternative would, in theory, I believe, be a PD1 or PDL1 such as Fox and others here are on and Paula is embarking on, ideally in a combo with another agent, such as the trials John and tacyarts are on, with a PD1 + Votrient or Sutent, or even one of the chemos, like doxorubicin or gemcitabine, or possibly a newer agent like cabozantinib.

My plan now is to review IL2 data, using the experiences of members here and on ACOR to do a crude cost/benefit analysis, in case I have it on offer, and checking if it looks at all likely to help sChRCC. Also to look for any trial opportunities anywhere that could be feasible. Otherwise go with Votrient backed by mind-body medicine approach.

If anyone is able to warn me about possible pitfalls in the way of taking a path that then precludes other treatments, I'd be eternally grateful. Fox is my big hope, after his hard won experience, for educating me on possible dangers there.

Thanks everyone. What goes around comes around and I've contributed here so I'm not embarrassed to take any help now that my friends here can give me.

Article on toxicity including sunitinib, pazopanib, everolimus.
Toxicities of targeted agents in advanced renal cell carcinoma. [Review]
Patel P. Srinivas S.
Current Clinical Pharmacology. 6(3):181-8, 2011 Aug.
[Journal Article. Review]

Texas_wedge said:

Update
I'm all too conscious of the fact that in the past few days I've neglected to reply to many friends here who have sent me kind messages and valuable information. I've been tied up in a long-running, ultra-bizarre and fascinating legal action. So, I've been in Edinburgh by day and in Discomfort by night, leaving me not enough time, in particular to do justice to the academic papers that have been sent to me. I've also just been given a boatload of further information, so it'll take me a while to respond appropriately.

Meantime, my thanks for recent messages go to at least Clara, Peg, Paula, Kathy, Ange, Alice and David for helpful messages and info.

We went to meet my oncologist yesterday. She is young but very impressive, her specialties being renal and lung cancers. She is also easy on the eye which is good news since she says she will be seeing me often, monitoring my blood pressure etc, if I go with her rather than seeking treatment that she isn't able to offer in this neck of the woods (Scotland). Staying here has a lot of appeal but I'm looking at other possibilities.

As I've said above, I've had a lot of help here and will, I'm confident, get more once I've nailed my colours to a particular mast. For the expert opinion over there, I've asked for additional help on KIDNEY-ONC, where I summarised my present position like this:

"Not many weeks ago I was considered NED, now following a further CT scan and a quick follow-up PET/CT I appear to be pT4 N2M1 with parameters that some of the 'survival' nomograms won't even accommodate as inputs, and a new tumour developing at around 100 x the typical rate of growth for RCC. I appeared to have been met-free at dx but it now looks as though I probably had undetectably small mets which, due to transition into an extremely aggressive histology, have manifested in a second renal bed recurrence and, more menacingly, compromised lymph nodes, suggesting the possibility of distant mets any day now. The team whose care I'm in (at a Hospital which is one of the top 3 cancer research centres in the World) have decided against the third op that I was hoping for in favour of passing me over to the renal oncologists, one of whom I'll be seeing in a couple of hours time.

So, with highly aggressive, metastatic, necrotic, sarcomatoid chromophobe RCC and the expert judgment that just further surgery would be fiddling while Rome burns, I'm contemplating best next moves. Thoughts, please (other than 'Get your affairs in order', which I've embarked on). I'll maybe post what the oncologist outlines in the hope of gleaning some expert comments here since there's more expertise here than probably any single doctor could dream of possessing. It would be useful to have a list of the questions that my Wife and I will inevitably have forgotten to put."

I think I put all of the main questions and got good answers from my oncologist. We're meeting again on Friday week after each gathering further data, to decide how to go forward. She has written to the UK's great IL2 expert to see whether that might be a possibility, in Manchester. Here, she could offer me either sunitinib (Sutent) or pazopanib (Votrient), to start straight away. She hopes that this would achieve some shrinkage or stability of the new tumour, which will otherwise keep growing and is probably already virtually inoperable - not a pleasant scenario to contemplate.

There are no trials that would take me in in Scotland but we are investigating possibilities in England, Europe, the USA and Canada.

It may be that at 70 and with a rare sub-type, I'll be deemed unacceptable for Il2 or I might fail the cardiac and other performance tests (though I think that unlikely). If so and I don't find a suitable trial I'll probably go with Votrient in preference to Sutent, for its usual better tolerability. Even if it's marginally less effective than Sutent, the idea would be to play to my strength and go for the one that would permit me to lead as close as possible to my existing lifestyle in the hope of maintaining my strong immune system. The same logic would count against chemo. No-one would lightly dismiss the opinion of the excellent Janice Dutcher, who favours chemo for sarcomatoid cases but I'd rather avoid the scattergun approach of cytotoxics which would undermine my best defence - my immune system.

On principle, I would favour an immunotherapy but I don't think that there's a record of IL2 showing good results for sarcomatoid chromophobe, but that's chiefly because it's so rare that there are virtually no data. The best alternative would, in theory, I believe, be a PD1 or PDL1 such as Fox and others here are on and Paula is embarking on, ideally in a combo with another agent, such as the trials John and tacyarts are on, with a PD1 + Votrient or Sutent, or even one of the chemos, like doxorubicin or gemcitabine, or possibly a newer agent like cabozantinib.

My plan now is to review IL2 data, using the experiences of members here and on ACOR to do a crude cost/benefit analysis, in case I have it on offer, and checking if it looks at all likely to help sChRCC. Also to look for any trial opportunities anywhere that could be feasible. Otherwise go with Votrient backed by mind-body medicine approach.

If anyone is able to warn me about possible pitfalls in the way of taking a path that then precludes other treatments, I'd be eternally grateful. Fox is my big hope, after his hard won experience, for educating me on possible dangers there.

Thanks everyone. What goes around comes around and I've contributed here so I'm not embarrassed to take any help now that my friends here can give me.

TW... I would strongly
TW... I would strongly suggest you start on Votrient in the meantime. From what I have been reading Votrient is all that you have said it is and from what I can see, makes the best choice. I would also try the MDX and think you need to seek out a trial. .I know you have mentioned you have been tied up in court and have not checked into anything much. But remember the link with the trials that was posted by Mike I think it was? They have all the MDX trials there. You punch in your areas of interest and it comes right up. I am a bit concerned that you need to start something ASAP to hold off any growth at this point while you look for something further like MDX. I don't know how old NanaLou is but doing research on the IL2 I find it is helpful in many cases but I fear it would be too strong for you. Of course, I am not a doctor but this is the feelings I get when I do my research for mom. Is it possible that all those In trials can ask for you if they can review your case via conversation and referral for a trial of MDX? I can surely look for trails being offered and send you the links as well. Please let me know how I can help.

Here is the trials link again. Put the whole thing in when reviewing, it is one link.

http://clinicaltrials.gov/ct2/results?term=kidney+cancer&recr=Recruiting&rslt=&type=Intr&cond=&intr=drugs&outc=&spons=&lead=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&age=0&age=1&age=2&phase=0&phase=1&phase=2&rcv_s=&rcv

You can always start on a low dose of Votrient if need be. I read that 4oo mgs might work just as well as the 800 and they say maybe even 200 mgs can work. I know each case is different. With mom I am going to suggest Votrient as well, starting at the lowest possible dose of 200 or 400 to see how it does. The Doctor did say it was mom's choice to start slow since she is 80.

A lot of big decisions to make. I hope I don't come off as being senseless, but I am concerned for you, especially with your growing discomfort. I am eager to get you started on something because even when signing up for trials it doesn't happen overnight and the opinion of the " easy on the eyes" oncologist sounds spot on!

Praying for you TW....

angec said:

TW... I would strongly
TW... I would strongly suggest you start on Votrient in the meantime. From what I have been reading Votrient is all that you have said it is and from what I can see, makes the best choice. I would also try the MDX and think you need to seek out a trial. .I know you have mentioned you have been tied up in court and have not checked into anything much. But remember the link with the trials that was posted by Mike I think it was? They have all the MDX trials there. You punch in your areas of interest and it comes right up. I am a bit concerned that you need to start something ASAP to hold off any growth at this point while you look for something further like MDX. I don't know how old NanaLou is but doing research on the IL2 I find it is helpful in many cases but I fear it would be too strong for you. Of course, I am not a doctor but this is the feelings I get when I do my research for mom. Is it possible that all those In trials can ask for you if they can review your case via conversation and referral for a trial of MDX? I can surely look for trails being offered and send you the links as well. Please let me know how I can help.

Here is the trials link again. Put the whole thing in when reviewing, it is one link.

http://clinicaltrials.gov/ct2/results?term=kidney+cancer&recr=Recruiting&rslt=&type=Intr&cond=&intr=drugs&outc=&spons=&lead=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&age=0&age=1&age=2&phase=0&phase=1&phase=2&rcv_s=&rcv

You can always start on a low dose of Votrient if need be. I read that 4oo mgs might work just as well as the 800 and they say maybe even 200 mgs can work. I know each case is different. With mom I am going to suggest Votrient as well, starting at the lowest possible dose of 200 or 400 to see how it does. The Doctor did say it was mom's choice to start slow since she is 80.

A lot of big decisions to make. I hope I don't come off as being senseless, but I am concerned for you, especially with your growing discomfort. I am eager to get you started on something because even when signing up for trials it doesn't happen overnight and the opinion of the " easy on the eyes" oncologist sounds spot on!

Praying for you TW....

Hope TW is getting treatment soon
Likewise Angec, I really hope TW will be getting treatment as soon as possible to shrink the growing mass. We should all continue to do more research for TW, but I think the most important thing at the moment is for TW to be getting some treatment in the meantime.

TW, I know your oncologist is superior, but I really hope she can liase with her colleagues as a matter of urgency and sort out a plan for you asap! Maybe you could contact her office everyday prior to your appointment next Friday. I believe occasionally doctors need to be reminded, but not only that, also for her to update you on any new information/progress. That way, you can gather information from her and ponder over the information in your own time before you meet her on Friday.

Just a suggestion from a friend.

All the best,
C