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​The power of immunotherapy

Wednesday 30 June 2021

You are a healthy 27-year-old with the prime of your life ahead of you, you see the doctor about what you believed to be lingering effects of the flu and receive the news everyone fears. You have cancer.

Then you find out it is not just cancer, but stage 4 bowel cancer. You are rushed from your home in Emerald to Mackay for emergency surgery to remove large sections of tumour from your bowel and large parts of your bowel itself.

Surgery is then followed by six months of gruelling chemotherapy which you are told has not worked, and your cancer has spread to several other areas of your body. You are told your options are palliative care, chemotherapy or hopefully being eligible for a trial.

You are accepted into a trial under the care of oncologist Dr Rahul Ladwa, and that trial essentially saves your life.

This is Taylor Kirkwood's story and without the PA Hospital, Dr Ladwa, and the immunotherapy trial she was placed on, she would not be here to tell it.

15 months on from beginning the trial, and still receiving treatment at the PA, Taylor has been told her cancer has regressed 65 per cent and is now considered stable, and possibly, hopefully, no longer a threat to her life.

The now 28-year-old said being told she had a stage 4 malignant adenocarcinoma came as quite a shock to both her and her now husband Joe, whom she married in August 2020.

"I saw my GP on the Monday morning and I was diagnosed on Saturday afternoon; the process was quite quick. I didn't really think – well, I didn't think it was going to be cancer," she said.

"I didn't have any indication I suppose that anything was really wrong, until they sent me for a second CT scan.

"Unbeknown to me, the results had come back. They'd been shown to the doctor on duty who was actually a surgeon. He suspected cancer and wanted me to go for a second CT scan to be sure. It was when they came back and said, "We need you to have a second CT scan," that I thought, you know, that is a little bit odd they need a second scan.

"About three o'clock he came in. My partner and I were just sitting there, and we could just tell by his face that he wasn't going to give us good news. He just said, "You know, we don't normally say this straight away, but it's very obvious from your CT scans that you have cancer. You have a tumour in your bowel and it's quite advanced.

"To be honest, I kind of tuned out after then. I suppose I went into shock thinking about it. Because I didn't really react. I didn't feel sad or angry or anything like that. Everything just shut down and I just started asking the obvious questions, like what happens from here, do I have to have surgery and that sort of thing.

"It was quite devastating for my partner because his mother had stage 4 inflammatory breast cancer about 12 years prior. She is in remission now, thank goodness. But he had already been through that before, so, it was quite upsetting for him."

Taylor during her stay in hospital

Immunotherapy is the next tier of cancer therapeutics which use the body's own immune system to target and attack cancer cells, and upon learning of Taylor's case, Dr Ladwa believed she was a candidate for an immunotherapy trial he was running.

"The trial's up to stage 3B. The reason it is a trial is because the drugs they're trialling are traditionally used to treat advanced stage metastatic melanoma. Skin cancer. But they have been doing some research into the way that skin cancer and bowel cancer metastasises," she said.

"I started the trial in September 2020. I started out having treatment once every three weeks and having CT scans once every six weeks. I am now having treatment once every four weeks and having CT scans once every eight weeks.

"I got the results of my last CT scan in mid-April. Based on the five spots they are keeping an eye on as part of the trial. My cancer has shrunk over 65 percent."

Taylor said having been through chemotherapy and now being treated by immunotherapy she knows first-hand the virtues of immunotherapy when compared to chemotherapy.

"I count myself lucky compared to other people I've spoken to who've had the same chemotherapy regime as me. It is quite an intense chemotherapy. It's considered one of the strongest chemotherapies that people have to go through," she said.

Taylor and her husband Joe

"It does leave you with a lot of permanent side effects like nerve damage and all sorts of stuff like that. But even though I was very sick, I think I got off OK.

"The difference between chemotherapy and immunotherapy for me personally is like night and day. I mean with the chemotherapy you are just always sick; you always feel nauseous. You are always just exhausted and drained.

"With that particular type of chemotherapy, you get cold sensitivity, so you can't drink or eat anything that's colder than room temperature. You can't touch cold water. You can't touch the fridge or anything like that, you are basically just existing, I suppose.

"Other than the very first round of immunotherapy, where I had some quite bad body pain, I just get fatigued.

"I spoke to Dr Ladwa about the pain after the first round, and he said it was a good thing because it's basically the tumours swelling. Which is what they start to do before they start shrinking. They swell then they start pressing on nerves and organs and stuff. So, you feel a little bit of pain.

"Other than that, which I had for maybe two days after the first round. I feel obviously still not yet myself as I was before I was diagnosed, but I feel much better. At this point, I would say I feel about 80 percent of my old self. The only side effect I get is fatigue which is only really bad on treatment days."

With Dr Ladwa funded by the PA Research Foundation for a trial exploring why 50 per cent of squamous cell carcinomas of the skin patients respond to immunotherapy in the hope more cancer patients can potentially benefit, Taylor said she was eternally grateful to the Foundation's donors who make research like Dr Ladwa's possible.

"I remember when I had my very first appointment with Dr Ladwa before I had my first treatment, he gave me the results of my CT scan, they were really bad, I had cancer everywhere and in multiple organs and all through my lymph nodes.

"I asked him, "Do I need to start worrying?" Because I couldn't think of any other way to put it, he said, "Ask me again in six months"."

"I asked him in April, I said to him, "Did you ever think we would get to this point?" And in his own way, he did say to me that no he didn't expect that we would get past that six-month mark.

"He was quite concerned when he first met me, things were looking quite dire. I guess I could say that the PA funding and supporting Dr Ladwa's research has quite literally saved my life."

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