Joost has had a long and stable period now with a combined treatment program:

    * high-dose Sutent (Targeted therapy specifically for Renal Cell Cancer / Grawitz),

    * painkillers,

    * regular blood transfusions,

    * a Ketogenic diet,

    * paramedical support (acupuncture, coaching etc)

Based on weekly blood samples, the leading physician (Prof Richel) has suggested to evolve the treatment program by adding an additional drug. His logic for this is

    * Joost’s body seems to be able to cope with the cancer therapy quite well. In spite of high-dose, continuous Sutent treatment, Joost has been able to keep his white and red blood (leukocytes and Hb) count up high enough. Hence, he should be able to also cope with a heavier drug regime

    * At the same time, blood markers like LDH seem to show gradually increasing tumour activity, implying that Sutent alone is not doing enough to stabilize (or reduce) the tumour’s activity. There is no absolute proof of tumour growth, and Joost feels good, but these blood markers are early warning signals that the current therapy success is not good enough.

The decision now is to try adding Certican (everolimus) to the current treatment program.

    * This drug has a mechanism of action (mTor inhibition) that should be synergistic with Sutent. Certican inhibits cell division (celdeling) of the tumout itself, whereas Sutent inhibits growth of the blood vessels that supply the tumour with blood. Logically, the combination of the two should attack the cancer from two angles, and the combined effect should be better than Sutent alone

    * Prof Richel has tried this combination a number of times before, and has generally seen a good side-effect profile (i.e. limited side-effects)

With this decision, we are now moving into new ground for the therapy. Sutent is the best proven therapy for RCC, and research into more powerful treatment such as a combination with Certican is still in very early stages. As such, unlike the initial decision to start with Sutent itself, there is now no statistical evidence that the new therapy works better than Sutent alone. That being said, there is a wide consensus in the medical community that the combination is promising. 

Next week, the new regime will be started in the hospital, with Joost under close supervision for the first few days (just in case the added drug creates unwanted side-effects).

Paul van Arkel

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