Rambam Uses Immunotherapy to Treat Rare Case of Pediatric Colon Cancer
Zakaria was diagnosed with metastatic colon cancer at age 16. When chemotherapy and surgery proved ineffectual, Rambam’s doctors discovered a gene mutation and switched to immunotherapy. Two years later, Zakaria no longer has cancer symptoms. September 18, 2019 – Three years ago, after eating a meal with his family, Zakaria started having stomach pains and began to vomit. His doctor thought he had a virus and sent him home. His situation worsened, and when tests eventually revealed that the problem was more serious, his parents brought him to Ruth Rappaport Children’s Hospital at Rambam Health Care Campus, where he was diagnosed with colon cancer that had metastasized to his liver – a disease rarely seen in children. Over the course of several months, Zakaria, who was 16 years old at the time, was treated with chemotherapy and surgery. While he initially responded well and was briefly in remission, the cancer returned fairly quickly. Doctors performed genetic testing in order to determine whether there might be a genetic component to his illness. The results showed a mutation on a mismatch repair (MMR) gene. This gene’s role is to correct damaged DNA, but when it doesn’t work properly, it creates a susceptibility to contracting colon cancer. Once the damaged MMR gene was discovered, Zakaria’s doctors believed that he might benefit from immunotherapy using Nivolumab, a medication that has proven efficacy in treating metastatic melanoma in adults. Within four months, he was in total remission despite having had multiple metastases in his liver. “If we didn’t have the immunotherapy, Zakaria would no longer be with us,” notes Professor Myriam Ben-Arush, Director of the Pediatric Hematology-Oncology and Bone Marrow Transplantation Division and Director of the Pediatric Division in the Ruth Rappaport Children's Hospital at Rambam. Today, Zakaria is 19 years old. He has been receiving immunotherapy for approximately two years, and has shown no signs of illness. He comes to Rambam every two weeks for relatively easy treatment, which has none of the side effects usually associated with more conventional cancer therapies. “There’s no hair loss or destruction of the immune system. We don’t even need to see him between treatments,” says Ben-Arush. Zakaria’s father shares that his son is in good shape. “He is home and feels good, and has even started playing soccer again.” There are no plans to stop the treatments, and Zakaria will continue to receive them for the foreseeable future. “We don’t know what the implications of discontinuing the treatment might be,” emphasizes Ben-Arush. While the use of this type of immunotherapy is not unusual, due to the uniqueness of Zakaria’s illness, Ben-Arush’s team has presented his case at various international medical conferences. “This is a special situation, especially given that colon cancer—while more common in adults—is extremely rare in children, even without factoring in the genetic component,” explains Ben-Arush, adding, “there are very few cases throughout the world.” In the photo: Zakaria, Professor Myriam Ben-Arush, and Zakaria’s father. Photography: Pioter Fliter.
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