Update on my son-in-law, John

As some of the longer-term members on this forum may know, my SIL was diagnosed with Stage IV, grade 4, 60% sarcomatoid RCC just about two years ago.  He had a total left nephrectomy for a 13 cm tumor.  After a nasty stint on Votrient he moved on to Opdivo which appeared to be keeping the beast away.  His last three scans showed NED after having some SBRT treatments on a paratracheal tumor near his aorta.  

We were particularly hopeful that things were looking good although he has been suffering from a bad productive cough since December.  It was thought to be simple brochitis or similar infection.  But the cough didn't go away was was getting worse coughing fits and the nagging sensation of having to "bring something up" with the coughing.  There was also a tinge of blood in the sputum.  Fast forward to the last couple of weeks.  He had another CT scan and it showed a "thickening" of the trachea wall which demanded a bronchoscopy exam.  That was done last week and the result is a large mass coming from and through the distal (back) side of the trachea which is now obstructing about 50-60% of the airway.

So, what can be done?  It's not operable due to the size of the mass and the vascular nature of RCC cells. That would be too much of a chance of massive bleeding.   Radiation is also not a possiblity due to the tenderness of the trachea and the possibility of total collapse.  Palliative possibilities include putting in a stent to help keep the airway open or more drastically, a tracheotomy or 'ostomy' or 'ectomy'.  The onc is now taking him off the Opdivo and, if his insurance approves, putting him on CABO in an attempt to shrink the mass quickly before it totally occludes the airway.  The SEs of CABO are certainly not fun from what we've surmised but chemo is the only immediate line of treatment available.

So please keep John in your prayers.  He is only 43 yo with a three year old and two year old...and my daughter is expecting #3 in about two months.  Thank you.

Penitent