Issels: The Next Generation

© Copyright 2003 by Gar Hildebrand and Christian Issels, USA
(Explore Issue: Volume 12, Number 6)

The breakthrough was completely unexpected, frightening, and wonderful. The patient who benefited dramatically is Steve Keller (not his real name), a British sports hero whose far-advanced, high-grade leiomyosarcoma had been steadfastly refractory to multiple combination and high-dose chemotherapy treatments since his diagnosis in May 2002. The list of failed chemotherapies was long, including Adriamycin/ifosfamide, gemcitabine/Taxotere, high-dose ifosfamide, and DTIC.

During the early months of treatment, his disease was slowly but relentlessly progressive, with growth of most of the lesions imaged in his liver, lungs, spleen, and bones. There was transient improvement in his bone pain, but there was no regression of bone or other lesions. Two months before we first saw him, he had learned that a new lesion had developed in his paraspinal muscles at L4-L5, adding to known extensive metastases in his lumbar and sacral vertebrae.

During the months prior to admission for Issels Comprehensive Immunotherapy, he had received palliative radiotherapy to several ribs, his right scapular region, and his right hip. There may have been a slight reduction of tumor bulk in the right scapular region, but this was a subjective observation on physical exam, without radiological confirmation.

Only about three weeks prior to admission to the Issels Treatment Center, he had received very bad news: despite dacarbazine and all the drugs before it, his disease was active, growing, and disseminating. There was CT evidence of an increase in the size of his rib metastases with the largest one literally bulging into the upper right lung; there was growth in several of his diffuse pulmonary metastases; and there was extension of his multiple hepatic implants, the largest of which was 5 x 5 cm. A persistent left-sided hydronephrosis was unchanged in comparison with scans taken three months earlier, and the responsible ureter-compressing gigantic lower-pelvic mass (10 x 9 x 8.5 cm) remained ominously the same. A mass posturomedial to the left acetabulum had also grown to 3.5 cm. A new 1.5-cm nodule had appeared in his left adrenal gland. His spleen had been removed at the suggestion of his oncologist, who was optimistic that pathological examination of the organ would demonstrate a chemotherapy response; sadly, the splenic parenchyma was 30% replaced by intermediate-grade leiomyosarcoma with absolutely no signs of tumor necrosis.

The most recent impression and recommendations of the home medical team centered on pain control with morphine and other opiates, phase II clinical trials, and palliative (hospice) care.