First time we heard "The Cure"

We can't count our chickens and the chances are still not great, but it was very exciting to be sitting in a meeting, talking about the possibility of a cure for a disease we had been told was incurable.

Prof Hawkins was very pleasant and full of facts and figures for us, including:

1. Christie's Hospital, Manchester, is a big cancer centre and they see 120 renal cancer patients a year. They treat approx 20 - 30 with high dose interleuken 2 (IL2) and have been doing so for 3 to 4 years.
2. Although the definition of complete response is just 4 weeks with an absence of tumour, in fact in 75% of complete response cases, the tumour never relapses.
3. In general, 10% of IL2 patients treated get a complete remission (based on a small number of patients). However, many renal cancer patients aren't even accepted for this treatment.
4. When they randomised high dose interleuken 2 against low dose intrevenous and low dose sub-cutaneous, the chance of long lasting, complete response is approx 7x as high with high dose intravenous.
5. IL2 doesn't have much success as a second line of treatment (eg. after other types of immunotherapy)
6. Their experience (again, small base) is that approx 30% of their patients have had some response, with half of those getting a complete response. None have relapsed yet (but early days for some). Even those with partial response get a slower tumour growth rate than on other treatments.
7. They then looked at the histology of the primary tumour, to see if certain groups get better results. There are three groups:

* In the top group, 75% responded with half of those getting a complete response

* In the average group, there is about a 20% response rate

* In the worst group, there is only a 3% response rate (so they no longer treat these people).

8. The treatment involves 5 days of treatment every 8 hours or so for as long as your body will bear it (max 14 doses, average about 8 - 9). Then 5 days recovering, then 5 days feeling OK and then they start again. After these 2 goes, they give you two months off and then re-scan. If there seems to be a response, they start the cycle again, up to 5 times plus an extra one (ie. treatment can take 18 months). If there is no response, they stop. (I will post more details on treatment & side effects if we go ahead, to minimise confusion).

Quentin

They need to analyse his tumour to see if he is top or middle set. (Let's hope this is more like Physics than French.) They seem to know already that he isn't in the worst group.

The three options for Quent are therefore:

* Suitable for treatment, get on with it quickly

* Suitable for treatment, but there's no rush (if the spots aren't growing)

* Surgery. Dr Hawkins said that if (BIG IF!) there are only one or two spots left (given some had disappeared with Quent's spontaneous remission), they could make a case for cutting out the remaining one(s). If there are only 1 or 2 metastases and they remove them, there is a 40% chance they will never come back (and if they do, we still have IL2 up our sleeve).

Conclusion

A very positive meeting and Quent is very keen to go down this route, in Manchester rather than the USA. Probably the most important fact is that with IL2, the objective is to cure the patient, whereas with interferon / combination, it is basically palliative care.