KC (E87) is a 50-year-old male. In late January 2013, he had breathing difficulties and had to be hospitalized. There was fluid in his lung. Pleural tapping was done. KC’s health was restored after 10 days in the hospital where 4 litres of pleural fluid was tapped out.
A CT scan done on 21 February 2013 indicated the following:
- Multiple pulmonary nodules in both lower lobes. Right pleural effusion and enhancing right pleural nodules.
- Bilaateral heterogeneously enhancing renal masses in upper pole measuring 7.3 x 6.6 cm (right) and 7.0 x 8.1 cm (left).
- Right lobe liver with ill defined lesion in segment IV of liver suggestive of local infiltration.
- Multiple enhancing peritoneal nodules in right subhepatic space.
- Enlarge retrocrural lymphadenopathy and multiple subcentimeter paraaortic and aortocaval nodes. Mild to moderate ascites.
Impression: Bilateral renal masses likely renal cell carcinoma with local infiltration and lung pleural and peritoneal metastases.
After the CT scan KC was asked to go home and nothing was done. There was no medication either. No satisfied, KC went to consult an oncologist at a private hospital. Another CT scan was done on 26 March 2013. The results indicated:
- Multiple mildly enlarged mediastinal nodes.
- There is a small-to-moderate right pneumothorax (a collapsed lung – a collection of air in the space around the lungs. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when taking a breath).
- Pleural mass at the right anterior costophenic sulcus measuring 8 x 5.6 x 3.8 cm.
- Another large right pleural based mass noted anteriorly underlying the right third rib and it measures 6 x 2.7 x 2 cm.
- There is also a fairly large pleural based mass medially abutting the left atrium. It measures 5 x 4 x 3 cm.
- Bilateral multiple slightly lobulated pulmonary nodules with two nodules at the left lung apex demonstrating cavitation.
- There are bilateral large heterogenous masses occupying the upper half of both kidneys. The right renal mass measures 9 x7.4 x 6.7 cm. The left renal mass measures 8.7 x 8 x 6.6 cm.
- There is a peritoneal heterogenous lesion invading segment 6 of the liver, measuring 5.6 x 5 x 5 cm.
- There are multiple mildly enlarged retroperitoneal nodes measuring up to 17 mm.
- There is biconcave appearance of T3 vertebral body due to compression fracture.
- There is deformity at the left iliac crest, due to previous bone grafting.
KC was told by the oncologist that since both his kidneys are infected with cancer, surgery is not indicated. The cancer has also spread to his lungs and liver. The oncologist prescribed Sutent. The total cost of his first visit to the oncologist was RM 7,000. Sutent itself cost RM 5,000 for 9 days consumption. The remaining RM 2,000 was for the CT and RM 300 for consulting the oncologist.
KC came to seek our help on 5 April 2013. The following are excerpts of our conversation.
Chris: Did they remove your kidneys?
KC: No, both my kidneys were infected. They could not remove them.
C: Then you saw the oncologist, what did he do?
KC: He prescribed me this drug (showing Sutent box).
C: How much did this cost you?
KC: RM 5,000 for 9 days of consumption.
C: Did you ask if the drug is going to cure you?
KC: Only to control the spread of the cancer.
C: How long do you need to take this drug?
KC: He cannot tell me. I told the doctor. This drug is expensive, I cannot afford it. He said: How much is your life worth? And when I talked too much he got angry at me. I told him I cannot afford to take this medication. I only earn RM 1,000 plus per month – how to afford it.
C: Did he tell you the adverse side effects of his drug?
KC: ?? No, I told him I cannot afford to take the medication. He asked me: How much is your life worth? And why do you come and see me then?
Comments: This is indeed a sad and tragic story. Just reflect on this: How long do you expect a patient who earns RM 1,000 plus per month afford to take drug that cost him RM 15,000 per month? What is the rationale of asking this patient to take the drug? To cure him or is this for any other purpose? Patient was to take Sutent so as to stop the cancer from spreading. This unfortunately is the line very often sold to patients to make things attractive. But is that an honest answer based on scientific fact? Read below and you will be shocked!
This is something you need to know that oncologists or those with vested interests, will not tell you!
- Cancer drugs that shrink tumours by cutting off their blood supply may end up helping them to spread, a study suggests.
- Tests on mice showed that both Glivec and Sutent depleted pericytes by 70 per cent while metastasis rates tripled.
- Glivec, the brand name of the drug imatinib, and Sutent (sunitinib) have both been shown in trials to increase patient survival by a significant degree.
- Drugs such as Glivec and Sutent reduce the size of tumours but could also make them more aggressive and mobile.
- As a result tumours find it easier to ‘metastasise’, or spread around the body.
If you just looked at tumour growth, the results were good,‘said lead researcher Professor Raghu Kalluri, from Harvard Medical School in Boston. But when you looked at the whole picture, inhibiting tumour vessels was not controlling cancer progression. The cancer was, in fact, spreading.
Seventy to 80 percent of cells in breast tumour are non-cancer cells. Are they all bad? Some of them are there to protect us and they’re not all bad.
Indeed Sutent has been approved by the US FDA for treatment of advanced renal cancer, but the reality is it does not cure advanced or metastatic renal cancer or any cancer at all for that matter. Know that!
Below is the Information obtained from the drug company’s website: http://www.sutent.com/rcc.aspx
The website said, Sutent has been proven effective in the treatment of advanced RCC (renal cell carcinoma).
A clinical study has proven that Sutent is more effective than interferon alfa (IFNα), another approved treatment option for advanced RCC.
- SUTENT More Than Doubled Median Progression-Free Survival (PFS) vs IFNα – 11 months vs 5 months with IFNα.
- SUTENT Achieved More Than 2 Years’ Median Overall Survival (OS): 26.4 months vs 21.8 months with IFNα.
- FIVE TIMES more people saw their tumors shrink. 103 patients taking Sutent compared to 20 taking IFNα.
Of course, when you read this information it is very impressive (but don’t fall into the trap of sweetened or massage research data!). Why do I say the message is a sweet camouflage? Let’s look at the data critically.
- If you take Sutent, you have TWO TIMES longer progression-free survival. Progression-free survival means the length of time from the start of treatment that patients remain alive and their disease does not worsen. The question you want to ask is:, what if you don’t take Sutent – can you also have progression free survival? Of course, but it is shorter a bit. According to the Drug Company, with Sutent the progress-free survival was 11 months compared to 5 months without Sutent. So Sutent gave an advantage of 6 months.Progression-free does not mean cure at all. It is just the disease does not worsen and you are still alive.
- Those who take Sutent remained alive. The median overall survival was 26.4 months and then they die. But what if you don’t take Sutent? Patients were still alive but died at 21.8 months. That means by taking Sutent you live longer by 4.6 months.
Take note: you live longer by only 4.6 months. Is that what you want? Let us look at the economics. To live 4.6 months longer you need to take Sutent for at least 27 months, according to this study. This would cost you about RM 15,000 x 27 = RM 405,000. I am sorry, is my calculator playing tricks on me? Is that not a lot of money to you and me? And spending that kind of money to chase after 4.6 months of extended life? Let us hope that the extra 4.6 months of life is blissful, worth every minute of it. Or is it? There is no free lunch – you may have to suffer severe side effects as listed below.Nowhere in medical literature do I ever come across data showing that Sutent cures your cancer.
3. Five times as many people on Sutent saw their tumors shrink – is this a great achievement? Shrinkage of tumour has NO meaning. It is just a lure or camouflage! And what do you make out of the research led by Professor Raghu Kalluri of Harvard Medical School in Boston which said that Sutent may shrink the tumour but ultimately Sutent may end up helping cancer spread more aggressively and widely.
The following are warnings given by the Drug Company.
SUTENT may cause serious side effects, including:
- Serious liver problems, including death
- Heart problems—include heart failure and heart muscle problems (cardiomyopathy) that can lead to death.
- Abnormal heart rhythm changes— you feel dizzy, faint, or have abnormal heartbeats
- High blood pressure.
- Bleeding sometimes leading to death— these symptoms may include:
- Painful, swollen stomach (abdomen)
- Bloody urine
- Vomiting blood
- Headache or change in your mental status
- Black, sticky stools
- Jaw-bone problems (osteonecrosis)—severe jaw bone problems may happen.
- Tumor lysis syndrome (TLS)— caused by the fast breakdown of cancer cells and may lead to death. TLS may cause nausea, shortness of breath, irregular heartbeat, clouding of urine and tiredness associated with abnormal laboratory test results (high potassium, uric acid and phosphorous levels and low calcium levels in the blood) that can lead to changes in kidney function and acute kidney failure.
- Hormone problems, including thyroid and adrenal gland problems— as in the following signs and symptoms:
- Tiredness that worsens and does not go away
- Heat intolerance
- Loss of appetite
- Feeling nervous or agitated, tremors
- Nausea or vomiting
- Irregular menstrual periods or no menstrual periods
- Fast heart rate
- Weight gain or weight loss
- Hair loss
- Feeling depressed
Common side effects of SUTENT include:
- It may make your skin look yellow. Your skin and hair may get lighter in color
- Gastrointestinal symptoms, including diarrhea, nausea, vomiting, mouth sores, upset stomach, abdominal pain, and constipation.
- Rash or other skin changes, including drier, thicker, or cracking skin
- Blisters or a rash on the palms of hands and soles of feet
- Taste changes
- Loss of appetite
- Pain or swelling in arms or legs
- Shortness of breath
- Bleeding, such as nosebleeds or bleeding from cuts
How much is your life worth?
Let me ask you to ponder what Rabbi Harold Kushner said:
Perhaps we all should read the article below presented by Drs Tito Fojo and Christine Grady. The first author is from the Medical Oncology Branch of the National Cancer Institute, Bethesda, USA, while Dr. Grady is from the Clinical Center, National Institutes of Health, Bethesda, USA.
In their paper, Dr. Fojo & Grady wrote:
- The all too common practice of administrating a new, marginally beneficial drug to a patient with advanced cancer should be strongly discouraged.
- In cases where there are no further treatment options, emphasis should be first on quality of life and then cost.
- For therapies with marginal benefits, toxic effects should receive greater scrutiny.
- We must deal with escalating price of cancer therapy now.
- The current condition cannot continue … the time to start is now.
- As oncologists, we cannot go without answering these questions. The moral character of our specialty depends on the answers.
You may wish to read the following related stories:
- Kidney-Lung-Brain Cancer: Sutent = Heart Damage http://cancercaremalaysia.com/2011/09/19/kidney-lung-brain-cancer-sutent-heart-damage/
- Sutent for Advanced Kidney Cancer http://cancercaremalaysia.com/2011/09/18/sutent-for-advanced-kidney-cancer/
- Kidney Cancer Part 2: Two Oncologists Two Different Opinions – Is Sutent indicated in this case? http://cancercaremalaysia.com/2011/09/19/kidney-cancer-part-2-two-oncologists-two-different-opinions-%E2%80%93-is-sutent-indicated-in-this-case/
- Die of Cancer But Don’t Die A Bankrupt! http://cancercaremalaysia.com/category/kidney-cancer/
Perilous Approach: Avastin and Sutent Promote Growth of Breast Cancer Stem Cells
(Note: Many patients in Malaysia have been treated with this very expensive drug)