ImmunoAdvocates Gordon Levine Colorectal Cancer Gordon ‘s Story In November 2014, Gordon learned that he had a malignant tumor in his colon. Over the next four years, Gordon underwent several surgeries and chemotherapy regimens, which put him in two brief remission periods. In early 2018, the cancer once again recurred in the colon, this time having also spread to the abdomen, liver, lung, and bone. Gordon’s oncologist was able to place Gordon in a clinical trial where he received pembrolizumab (Keytruda). While the treatment showed some early promise, CT scans ultimately indicated tumor growth and his participation in the trial was terminated. Having essentially exhausted his available treatment options in Montreal, Gordon was fortunate to have been introduced to Dr. Aaron Miller at UCSD Moores Cancer Center in San Diego. Although Gordon’s tumor did not have the MSI-high mutations for which immunotherapy has shown the best success, new genetic sequencing, conducted in the fall of 2018, revealed other mutations that, in Dr. Miller’s opinion, opened the door to another attempt at immunotherapy: a combination of nivolumab (Opdivo) and ipilimumab (Yervoy). After three rounds of treatment, Gordon’s tumour markers had plummeted and a CT scan showed substantial reduction in the cancer. A subsequent CT scan indicated further disease reduction. Questions and Answers How and when did you first learn you had cancer? In November 2014, I was in the hospital for an angiogram due to suspected arterial blockage. The angiogram revealed a double-blockage which required bypass surgery. At the same time, a blood test indicated extremely low hemoglobin. Follow-up tests, including a colonoscopy, discovered the tumor in the colon. How did you learn about immunotherapy and why did you decide to do it? I had initially heard about immunotherapy from a friend who was in a clinical study. After my second recurrence, it was clear that chemotherapy had not worked. In order to find a systemic treatment, I enrolled in a clinical trial and received Keytruda. Although this treatment was ultimately not fully successful, and given the lack of other alternatives, I decided to try combination immunotherapy (Yervoy and Opdivo). What was treatment like? Did you have any side effects? Immunotherapy is very different from chemotherapy even though both are administered by way of infusions. Side effects from chemo are immediate and intense and then fade away. Side effects from immunotherapy do not present for several days, and for me, were much less severe than chemo. They included itching, light rash, digestive irritation, and fatigue. Are there things that surprise you about the cancer experience? The biggest revelation is that we are living in a period of tremendous innovation and advancement, and as a result, there are treatments that did not exist even a few years ago that can significantly extend your life and provide quality of life despite a stage 4 diagnosis. I have also learned that we, as cancer patients, need to actively advocate for ourselves to ensure that we receive the best treatment. Do not accept doctors telling you that there is nothing more that they can do. What would you want another patient to know about immunotherapy or about participating in a clinical trial? The most important piece of information you can receive is the genetic sequencing of your cancer. This information will open the door to the most relevant treatment for you. If that treatment includes immunotherapy, find a way to get the treatment—look for a clinical trial, or a precision immunotherapy clinic, or an immunotherapy oncologist.