Lior Dangoor, 33y, diagnosed 06/07, RCC, clear cell, Stage IV, grade 3.
Mets to opposite (right) adrenal, spine, ribs, pelvis, lungs.
 
6.8
2014
 

History

28.6.07

CT performed due to broken rib of unknown origin and spinal pain. Findings are: mass in left kidney (7.3×8.5×8.5cm), a mass in right adrenal (12×7×9cm), multiple bone metastases (posterior right 9th rib – with soft tissue – anterior right 5th rib, D7, D10, D11, L4, L5, sacrum, left iliac bone) and several lung nodules. Significant cord compression at the level of D10 was diagnosed. Biopsy from the kidney demonstrates Fuhrman’s nuclear grade 3, clear cell carcinoma, with positive staining for Vimentin, CD10, EMA. Areas of necrosis.

4.7.07

Irradiation of spine at 3Gy (10 days). Begins treatment of Zometa monthly.

19.7.07

First cycle of Sutent (50mg/28 days). CT at end of cycle shows significant shrinkage of renal and adrenal masses (30% and 40%). Shrinkage in lung lesions. Stability in bones.

28.8.07

Sutent cycle 2. Additional slight shrinkage in soft tissue, stability in bones.

5.10.07

Sutent cycle 3. Stability.

8.11.07

Irradiation to both rib metastases at 3Gy (10 days).

14.11.07

Sutent cycle 4. Stability.

20.12.07

Surgery: Partial left nephrectomy and right adrenalectomy. Primary tissue culture cells grown and frozen.

7.1.08

Sutent cycle 5. Only one lung nodule left. Bones stable, shrinkage in soft tissue near 9th rib.

13.1.08

HLA typing reveals that one of Lior’s sisters has similar HLA type (and can be a donor if stem cell transplant becomes an option).

15.2.08

Sutent cycle 6. Near total disappearance of lung nodules.

26.2.08

Pathology staining at UCLA demonstrates tumor cells positive for Carbonic Anhydrase IX (CA IX) in over 95% of the cells and Furhman grade 2 – not 3.

27.3-18.4.08

High Dose Interleukin-2. Two rounds. 8 and 9 doses.

4.5.08

Sutent cycle 7.

30.5.08

MRI demonstrates bone metastases are still active and suggests – in addition to increase in ESR and platelet levels seen only in 07.07 and reappearance of sever thoracic back pain immediately after HD IL-2 – that IL-2 did not have a significant anti-tumoral effect.

12.6.08

Sutent cycle 8.

20.7.08

Sutent cycle 9.

18.8.08

CT scan shows no new findings and sclerotic process (early bone formation) in a number of bone sites.

28.8.08

Sutent cycle 10.

28.9.08

MRI shows that all bone metastases are still active though perhaps less. This scan covers the femur for the first time and demonstrates a “new” finding in right femur. A look back at older CT scans confirms that this met was there since the beginning.

11.10.08

Sutent cycle 11. CT shows stability in all sites.

20.11.08

Sutent cycle 12.

28.12.08

Sutent cycle 13. CT shows stability in all sites.

25.01.09

First dose of DNP-modified autologous vaccine.

02.02.09

Sutent cycle 14.

19.02.09

Second dose of DNP-modified autologous vaccine.

12.03.09

Third dose of DNP-modified autologous vaccine.

13.03.09

Sutent cycle 15. CT shows stability in all sites.

02.04.09

Fourth dose of DNP-modified autologous vaccine.

21.04.09

Fifth dose of DNP-modified autologous vaccine. A skin test to evaluate delayed-type hypersensitivity (DTH) to the autologous cancer cells was performed by injecting unmodified irradiated cancer cells. A weak response (1+) was attained.

22.04.09

Sutent cycle 16.

21.05.09

Sixth dose of DNP-modified autologous vaccine.

31.05.09

Sutent cycle 17. CT shows stability in all sites.

18.06.09

Seventh dose of DNP-modified autologous vaccine.

06.07.09

Pre-operative embolization of vertebrae T10 and T11 at Tel Hashomer hospital. In this procedure the blood vessels that fed both vertebrae were blocked off in order to prevent excessive bleeding during the kyphoplasty procedure that would proceed it. The long procedure (almost 6 hours) was a success, and the good news was that the tumors did not appear to be very vascular, i.e. are partially dead.

07.07.09

Kyphoplasty – cement injection – to vertebrae T11, T10 and T9 (originally planned only for T11 and 10) at Hadassah Ein Karem. The kyphoplasty procedure works by inserting a balloon into the affected vertebra, inflating the balloon to restore the vertebra to its original height (prior to the fracture caused by the tumor) and then filling it with orthopedic cement. When successful this procedure strengthens and stabilizes the vertebra, kills the tumor, restores height and relieves pain. Before the kyphoplasty, three biopsy samples were taken from each one of the vertebrae. Pathology results show that all of the samples are non-malignant (not cancerous)!

14.07.09

Sutent cycle 18.

15.07.09

Eighth dose of DNP-modified autologous vaccine. Another skin test to evaluate delayed-type hypersensitivity (DTH) to the autologous cancer cells was performed by injecting unmodified irradiated cancer cells. A stronger response was attained than last time, at fifth dose.

22.08.09 18.09.09

Sutent cycle 19.

09.09.09

CT shows several new lesions in the left lung: two spots on the interlobar fissure. One which grew to 15mm over the past several months and one which remained small, and a lymph node in the hilum which also grew to 15mm during this time. Looking over past CTs, it seems the two spots had been there since diagnosis and began to grow in January. The oncologist believes this does not represent an outburst of the disease or general progression, but rather a local occurrence that may be taken care of locally while continuing Sutent.

17.09.09

Ninth dose of DNP-modified autologous vaccine (booster).

29.09.09 26.10.09

Sutent cycle 20.

04.10.09 18.10.09

Five sessions of stereotactic radiosurgery to the left lung tumor and the left hilar tumor at 50 Gy (10 Gy x 3) RapidArc.

03.11.09

MRI of all bone lesions. Some areas show less uptake. No lesions show more uptake and no new lesions seen.

07.11.09 04.12.09

Sutent cycle 21.

07.12.09

CT scan shows an excellent response to the radiation treatment. All three lung spots are practically gone, radiation oncologist reports CR (complete response) – two letters we had not seen until today! All bone lesions show stability. No new lesions.

20.12.09 15.01.10

Sutent cycle 22.

02.02.10 02.03.10

Sutent Cycle 23.

15.03.10 25.04.10

Sutent Cycle 24.
 
 

 
26.10.09
   
WBC2.2
Hemoglobin11.6
Platelets187
Creatinine0.8
CRP1.7
ESR90
CA 15.331.3
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