May 20, 2016, was a landmark day for many, including those devoted to treating cancer, the Las Vegas medical community and a local Navy veteran.
That Friday in May marked the first time in more than 30 years that people with a certain type of bladder cancer had access to a new Food and Drug Administration-approved drug. Comprehensive Cancer Centers of Nevada administered the very first dosage of this now commercially available treatment at their Central Valley clinic.
Tecentriq (atezolizumab) was developed specifically for people with locally advanced or metastatic urothelial carcinoma (mUC) who have disease progression during or following platinum-based chemotherapy. Tecentriq is also for those whose disease has worsened within 12 months of receiving platinum-based chemotherapy before or after surgery. In many instances, bladder cancer, which can also arise in the urethra, ureter and/or renal pelvis, can metastasize to the lungs, bones, liver or lymph nodes.
According to the American Cancer Society, approximately 76,960 Americans will be diagnosed with a form of bladder cancer this year and more than 16,000 Americans will die from the disease.
Tecentriq — which is administered intravenously — is the first and only anti-PDL1 cancer immunotherapy approved by the FDA thus far. Immunotherapy treatments — which have been a focal point of clinical research at CCCN and have been found to be incredibly effective in a number of local and national patients — equip the body’s immune system to strategically fight destructive cancerous cells. In the case of Tecentriq, the drug attacks cancerous cells specifically with the potentially devastating PDL1 protein.
Side effects from using immunotherapy treatments are typically less severe in comparison to traditional treatments. Common side effects for some patients include fatigue, nausea, diarrhea, itching or rash.
These treatments focus on specific molecules found on all metastasizing and/or cancerous cells throughout the body and not on normal cells, thus mitigating collateral damage to surrounding, otherwise healthy cells.
More and more physicians are opting for immunotherapy options for patients if they fit the specific criteria for the drugs. And for some, like northwest Las Vegas resident J. Carole Kuntz, treatments like Tecentriq not only provide optimism, but also a vital lifeline where all other options have been exhausted.
By all definitions of the word, J. Carole Kuntz is an inspiration. She served in the Navy for more than 20 years, has been happily married to her husband Kelly for more than 40 years, has a daughter who she adores and an 8 year-old granddaughter she wants to see get married one day. And now, her story is giving many battling bladder cancer in our community, country and world a renewed sense of hope.
The 74 year-old was adopted at a very young age, having lived in Colorado, Arizona and California over the years. She and her husband moved to Nevada in 2004. Kuntz had always lived a very active lifestyle with golf and running among her favorite hobbies and never had any major health complications with the exception of periodic, minor bladder infections and lung damage from years of smoking.
In August 2011 after feeling sick, Kuntz had a biopsy and she was surprised to learn that she had bladder cancer. Her urologist at the time advised that she have her bladder removed or her cancer would metastasize. So, in October 2011, she went in to a local hospital to have her bladder removed. She was told she would be in the hospital for three to five days. Due to complications, those days turned into an unrelenting five weeks, in which at one point she stopped breathing and was put on a ventilator.
Once stabilized, Kuntz finally returned home, but the effects of the extended hospital stay were noticeable. She went in to the hospital weighing 115 pounds and left weighing only 85. Going in to the surgery, she thought that would be the end of it. But, she was surprised to learn that she needed chemotherapy immediately after surgery. In January 2012, Kuntz started chemotherapy. It was at her second session that her oncologists informed her that she needed to stop this form of treatment because she was too weak to tolerate chemotherapy. So, she stopped and over the course of the next two years she would have periodic tests to see if the cancer was reappearing and/or growing.
During a check-up in 2014, her oncologist informed her that her cancer had returned, this time in her left pelvic bone and femur. She started radiation treatment followed by a different form of chemotherapy, but again experienced extreme side effects. She recalled her body temperature being so high that you could touch any part of her body and know she had a fever. She used an oxygen tank so she could try to breathe normally and regularly turned to cold rags and sacks of ice for temporary comfort.
By her side throughout the ordeal was her husband who — in addition to caring for her — worked 10 to 12 hour days with his own real estate/property management company. Without him, she says she wouldn’t have made it.
Once the side effects reached an unbearable peak for Kuntz, she was taken off chemotherapy yet again. It was at that point that she and her oncologist, Dr. Clark Jean, realized something else needed to be done.
In May 2016, Kuntz was referred to me, Nicholas Vogelzang, MD, FACP, FASCO, because CCCN had a handful of research options available for her, one of which was simply hoping that the FDA, in a matter of days or weeks, would approve Tecentriq.
And — call it divine intervention or incredibly good timing — within minutes of the end of her appointment, CCCN received word that the FDA had indeed approved Tecentriq for patients worldwide. Kuntz was ecstatic to hear the news. Where certain lines of treatment had simply not worked for her and she was at a point of feeling completely lost, she now had another chance.
Thanks in part to quick coordination by CCCN and Genentech — the manufacturer of the drug — Kuntz would receive the drug less than 48 hours after her initial appointment. She was all set to become the first in the world to receive commercial Tecentriq.
On May 20, she received her first dosage of Tecentriq. It was hard not to be moved by Kuntz’ energy leading up to and during the appointment, especially knowing that just weeks prior that there was such little spark left. Within a matter of 60 minutes, the treatment was complete.
Since that day in May, the team at CCCN continues to see Kuntz every two weeks for a lab draw and 24 hours later an injection of Tecentriq. Her only side effect to-date has been nauseousness from time to time, for which she takes a supplemental medication. The nurses, doctors, pharmacists and staff at CCCN are hoping for the same results with Kuntz as they’ve seen with those 20–30 patients who took Tecentriq in its trial phases — more than 15 percent of patients experienced significant tumor shrinkage.
Kuntz has advice for patients who may be in a similar situation as she is: “I was given another chance. As long as there is a slight chance, don’t ever give up hope and believing. What’s your choice?”
And, for many patients, there is now a new choice.