The Promising Immunotherapy Treatment Giving Utah Grandmother, 79, a Fighting Chance After Advanced Bile Duct Cancer Diagnosis

Immunotherapy Treatment Offering Hope for Stage 4 Cancer Patient

• A Utah grandmother diagnosed with stage 4 bile duct cancer is undergoing an immunotherapy treatment that has shown great promise during clinical trials, notably improving the survival rate among patients.
• Liver and bile duct cancers occur in the liver region but differ in origin; liver cancer starts in liver cells, while bile duct cancer affects the bile-carrying ducts.
• Durvalumab (brand name IMFINZI), in combination with traditionally used medications, has been shown in two important clinical trials to reduce the risk of death by 26% versus chemotherapy alone.
• Durvalumab is a human monoclonal antibody, a small molecule that binds to certain proteins — PD-1, PD-L1, and CD80 proteins — on the surface of cancer cells. PD-1, PD-L1, and CD80 proteins help cancer cells evade the immune system, making them seemingly invisible, but durvalumab makes these proteins visible again to the immune system, which targets the cells with precision.

Eden Thompson, 79, is a retired university professor living in Utah. She was diagnosed with a rare type of cancer last year called biliary tract or bile duct cancer (BTC). Liver and bile duct cancers occur in the liver region but differ in origin; liver cancer starts in liver cells, while bile duct cancer affects the bile-carrying ducts. Thompson is currently taking an immunotherapy drug called durvalumab (brand name Imfinzi) for treatment, which has had promising results during clinical trials. Patients experienced improved survival rates compared to patients who received chemotherapy alone. This is really exciting news as these cancers are known to be difficult to treat.

Liver cancer and bile duct cancer are both cancers that affect the upper digestive system, but they originate in different locations and have some key distinctions:

• Liver cancer : This cancer starts in the liver itself, the large organ responsible for filtering blood, producing bile, and other vital functions. HCC is the most common type, arising from the main type of liver cell, the hepatocyte.
• Bile duct cancer: This cancer originates in the bile ducts, a network of tubes that carry bile, a digestive fluid produced by the liver that helps break down fats in the intestines. There are two main types of bile duct cancer: i ntrahepatic bile duct cancer , which starts within the smaller bile ducts located inside the liver, and extrahepatic bile duct cancer , which develops in the larger bile ducts outside the liver, closer to the small intestine.

Thompson was relishing retirement with her husband in Orem, Utah, a serene city situated approximately 45 miles south of Salt Lake City. Nestled between Utah Lake to the west and the Cascade Mountains to the east, it provided the perfect backdrop for their golden years. WATCH: Understanding Liver Cancer and Bile Duct Cancer Although she occasionally visits her daughter and grandson in Vermont, her tranquil life as a former university professor was abruptly disrupted last year when she discovered an unsuspecting lump in her neck, sparking growing concern. “I thought that was kind of strange,” Thompson told SurvivorNet. She reached out to her doctor and underwent tests to get answers. Her doctors decided to remove the mass from her neck. It was then biopsied, revealing it was cancer. “I was told that it was not at the primary site of cancer, and the cancer originated someplace else,” Thompson said. Follow-up tests, which included CT scans and an MRI, helped pinpoint the cancer’s origins. “In June of last year, I was officially diagnosed with stage 4 intrahepatic cholangiocarcinoma (bile duct cancer),” Thompson said. Although being diagnosed with advanced cancer was concerning for the 79-year-old grandmother, she soon became determined to fight the disease head-on. “I settled down, and I am just going to tell myself that cancer is just a word. It is not a sentence. It means that I’m not a prisoner of this disease and that I still can do whatever I’ve been doing,” Thompson said staunchly. As she and her care team were digesting the diagnosis and possible treatment options, Thompson chose to get multiple expert opinions. Dr. Steven Rosenberg , chief of surgery at the National Cancer Institute and one of America's most renowned cancer doctors, strongly believes in seeking out multiple opinions. WATCH: The value of getting a second opinion. "If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care because finding a doctor who is up to the latest information is important," Rosenberg previously told SurvivorNet. "It's always important to get other opinions so that you can make the best decisions for yourself in consultation with your care providers," Dr. Rosenberg continued. In Thompson's case, seeking multiple opinions made it clear which treatment route she had to take. “I found out that there was only one standard of care for this type of disease, and that is chemotherapy plus immunotherapy,” Thompson said. Chemotherapy stops cancerous cells from growing, dividing, and spreading to other organs. It works by traveling through the bloodstream, killing cancerous cells. However, the process also impacts healthy cells, leading to side effects. Notable side effects may include nausea, vomiting, fatigue, and hair loss. WATCH: Managing chemo side effects. “I’ve heard a lot of horror stories about chemotherapy, so I didn’t want to go that path. So, I did my research and tried to see if I could get into a clinical trial or even undergo radiation,” Thompson explained. Despite her wishes, Thompson still landed on the standard of care, which included chemotherapy. She managed to complete her chemo regimen last December after undergoing eight cycles. Thompson started taking an immunotherapy drug called durvalumab (brand name Imfinzi). This drug treatment uses the body’s immune system to fight cancer. It can be combined with standard-of-care therapies, ideally to prevent the cancer from worsening and prolong patient survival. “I do (durvalumab) every four weeks,” Thompson said. WATCH: How Immunotherapy Works to Treat Cancer. Durvalumab is a human monoclonal antibody, a small molecule that binds to certain proteins on the surface of cancer cells. These include PD-1, PD-L1, and CD80 proteins that help cancer cells evade destruction by a patient’s native immune system. PD-1 and CD80 are proteins expressed on several immune cells. These proteins can interact with PD-L1, a conjugate protein expressed by tumor cells, essentially rendering tumors invisible to the immune system, which would otherwise try to target and kill cancer cells stemming from the tumors. Durvalumab helps make tumors visible to the immune system by binding to PD-L1 and preventing it from interacting with PD-1 and CD80 proteins. Durvalumab's versatile action makes it useful in many cancers, such as HCCs, BTCs, and lung cancers.

Expert Resources on Liver Cancer

• Advanced Liver Cancer Diagnosis, Treatment, and Symptom Management
• Alcohol Can Increase Your Liver Cancer Risk in Multiple Ways — Here’s What We Know
• Bile Duct Cancer and Liver Cancer — Same Organ But Different Diseases
• Cabometyx: A Promising New Targeted Drug Therapy for Liver Cancer
• Liver Cancer: Risk Factors, Screening, and How it’s Diagnosed
• Liver Cancer: Treatment for Early Stage
• For Some Patients With Liver Cancer, Surgery Is A Good Option And May Even Offer A Cure
• How The Immunotherapy Drug Combination of Imfinzi and Imjudo is Changing the Game for Advanced Liver Cancer Patients
• Durvalumab to the Rescue, Once Again: The Immunotherapy Drug Improves Survival in Liver and Biliary Tract Cancers
• Recovery, Pain Management and More — What to Expect After Surgery for Liver Cancer

Dr. Farshid Dayyani, a UCI Health medical oncologist specializing in gastrointestinal and hepatobiliary cancers, explains to SurvivorNet that durvalumab showed great promise during clinical trials, giving patients hope. Dr. Dayyani says the three-year overall survival results of the Topaz 1 trial showed that adding Imfinzi to the chemotherapy (standard-of-care) backbone significantly improved overall survival in patients. “The risk of death in those patients [in the Topaz 1 clinical trial] went down by 20%,” Dr. Dayyani said. “The three-year follow-up maintained the benefit in terms of patients living longer at three years… meaning the risk of death was actually reduced by 24% in the patients who received Imfinzi versus placebo,” Dr. Dayyani added. Patients diagnosed with BTC or another cancer type wishing for the latest treatment options should talk to their doctor and ask what the latest U.S. Food and Drug Administration (FDA) drug approvals are. Patients are also encouraged to seek multiple opinions from board-certified medical oncologists on the latest treatment options.

Understanding Bile Duct Cancer

Bile duct cancer, or cholangiocarcinoma , is a rare but aggressive form of cancer that quietly develops in the bile ducts, the vital pathways that transport bile (a digestive fluid) from the liver to the small intestine. The biliary system, also known as the bile duct system, includes your liver, gallbladder, and bile ducts, which work together to make and transport bile, a digestive fluid. Its purpose is to help your body efficiently use the food you eat and manage waste products.

“When we consider bile duct cancer, it usually gets kind of swept under the same shingle as liver cancer, but it is not the same thing, and treatment approaches can be very different,” Dr. Mariam F. Eskander , a surgical oncologist and assistant professor of surgery at the Rutgers Cancer Institute of New Jersey, tells SurvivorNet. “Bile duct cancers can also affect the bile duct system that runs from within the liver to outside the liver. So we have what are called intrahepatic cholangiocarcinomas, which is bile duct cancer within the liver, and extrahepatic bile duct cancers, which are cholangiocarcinomas outside of the liver,” Dr. Elliot Newman , the chief of surgical oncology at the Northwell Health Cancer Institute at Lenox Hill Hospital in Manhattan, tells SurvivorNet. Bile duct cancer often first shows up in the later stages with subtle symptoms that can be mistaken for less serious conditions. “Unfortunately, bile duct cancers often don’t have symptoms. Patients usually seek medical assistance once symptoms appear. That usually means that the cancer has grown bigger and more advanced,” Dr. Eskander notes. Some common symptoms for bile duct cancer may include:

• Abdominal pain
• Unexplained weight loss
• Jaundice (yellowing of skin and eyes)
• Dark urine
• White stool

The Power of Support

Although Thompson has a go-getter attitude towards her cancer journey, she believes her strong support system fuels her fire to fight. “Having a community around me and the support that I get is so important. The support that one gets when one is going through a phase in life like this. My number one support, of course, needless to say, is my husband,” Thompson said. WATCH: Seeking support after a diagnosis. A support system can be made up of close family members and friends. Your support group can also be filled with people outside your inner circle. "Some people don't need to go outside of their family and friends circle. They feel like they have enough support there," New York-based psychiatrist Dr. Lori Plutchik tells SurvivorNet. "But for people who feel like they need a little bit more, it is important to reach out to a mental health professional," she added. One of the benefits of having supporters includes helping alleviate stress and anxiety following your diagnosis. Supporters can also help advocate for you during treatment.

After Diagnosis, 'Do Your Homework'

After her own diagnosis, Thompson has some advice for others dealing with cancer: “do your homework.” “I was a former professor, so I know the importance of information and being knowledgeable about everything that you’re going through. Do your homework, find out everything you can about what’s going on with you, and do not be afraid to ask and seek second or even third opinions,” Thompson said.