Interleukin-2 patient: "I Thought I was Bulletproof"
In his 23 years with the Air Force David Valenta saw danger up close. He was involved in the Iranian hostage rescue attempt, where 52 Americans were held hostage for 444 days. He was there for the invasion of Granada in 1983.
"I thought I was pretty well bulletproof," he said.
Thirteen months after retiring, Valenta was enjoying a glass of wine one night when he started passing blood and blood clots in his urine. Doctors at the military base ordered an x-ray, then a CAT scan after the test showed a mass in one of his kidneys.
Valenta had cancer in his right kidney. His grandfather had died from it; his father died from lung cancer but also had been diagnosed with kidney cancer. Valenta underwent surgery and doctors told him it was successful. He didn't think about the cancer again for years.
Thirteen years later, he experienced incapacitating pain in his right side and started passing gallstones. A biopsy showed the long-ago kidney cancer had metastasized into two spots on his pancreas.
"The 'why me?' lasted about a day," the former airman said. "Then it was gear up, flaps up."
Valenta said he was fortunate because his family physician referred him to Alegent Creighton Health Bergan Mercy Medical Center and Ralph Hauke, M.D., a medical oncologist with Nebraska Cancer Specialists. Dr. Hauke suggested he try Interleukin-2 (IL-2), an FDA-approved immunotherapy that boosts the body's natural immune defenses against cancer. One advantage to the immunotherapy is that the doctor and patient know in about four weeks whether the treatment helps. Valenta knew if it didn't work for him, he could turn to chemotherapy and medication as another option. Because his kidney cancer was slow growing, he agreed to try IL-2.
"I was ready to fight this," he said. He began the first cycle, which requires hospitalization, in April of 2009.He had chills, lost his appetite and felt tired but good.
After a week off, Valenta began the second cycle, again at Bergan Mercy. It was a lot rougher: he was sick right away, felt bloated and gained 30 pounds even though he had no appetite.
He got through the tough regimen: "I was wishing it was over but I never thought, "Why did I start this?' I told myself, 'Your life is longer than your therapy.'"
A CAT scan a few months later showed a 10 to 12 percent shrinkage in the pancreatic tumors. Another test in March of 2013 showed no change at all in the size.
"No growth is happy growth," he said. "I was elated."
Valenta is considered a "partial responder" because he is not cancer-free, said Ralph Hauke, M.D., an oncologist with Nebraska Cancer Specialists, who's aligned with Alegent Creighton Health. He's worked with IL-2 for 12 years.
He said some patients have no evidence of the disease long-term and are considered "complete responders." For metastatic kidney cancer patients, IL-2 is the only therapy that's been proven to offer some patients the chance to have no evidence of the disease long-term.
A study conducted by the National Cancer Institute in the 1990s showed the success rate of IL-2 patients to be 20 percent with renal cancer patients and 15 percent with melanoma patients. Dr. Hauke says since then, physicians have been better able to screen patients for IL-2 and that's raised the response rate to about 40 percent. Doctors have also been better able to adjust the dose according to what the patient can tolerate.
Why don't more physicians turn to IL-2 for treatment of patients? Dr. Hauke said it carries "a stigma" because treatment has to be inpatient and the response rate is low. Patients must be screened for a healthy heart, brain, lungs, kidney and liver to qualify. It's also a "fairly toxic" alternative with a number of potential side effects. But Dr. Hauke added: "For some it's their only shot to be disease-free without being on medications for the rest of their lives." After a successful IL-2 treatment, the patient doesn't have the side-effects, like constant fatigue, that come with taking drugs.
Valenta said he and his wife of 39 years are thrilled that the immunotherapy gave him more time and a "quality of life" he wouldn't have had with chemotherapy and pills. "If it were to become necessary, I would do it (IL-2) again," he said.
He spends his hours with family, doing woodwork and riding his motorcycle. He's a ride captain with the Patriot Guard Riders. "There are a lot of things I don't get excited about anymore," he said. "I don't think about whether I'll be here next year or about the guy who's cutting me off in traffic."
"I'm going to die with the cancer," he said. "Not from it."