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Both Terry Wartman and Larry Holden consider themselves very fortunate.
Nearly three years after being diagnosed with Stage 3 melanoma, each man is feeling healthy. Each has a supportive wife with him every step of their cancer journey and the backing of family and friends.
And, they have each other, a fast and firm friendship formed by the impact of a life-altering diagnosis and participation in a clinical trial, which is now in its third year at Princess Margaret Cancer Centre.
"It's a tremendous benefit," Larry, 70, says of the friendship, which began in the fall of 2015 with a conversation as the two men sat in a waiting room at the cancer centre during the early stages of the Princess Margaret arm of an international study on two drugs used to treat advanced melanoma.
"It's definitely a different kind of support with someone who has complete understanding of what you're going through. We compare how we're feeling. We bounce around ideas.
"I consider him a good friend."
Terry, 61, says having a buddy throughout the study has offered a level of comfort.
"A lot of people are pretty afraid to ask you how things are going, there's that wall," he says. "You can't get down to the nitty gritty and talk about what's really going on but that's what Larry and I do.
"It's a little more candid and a little more real.
"We've become the best of friends within the year for all the right reasons. We not only have the same diagnosis but we also share the same stupid sense of humour."
The two men are among 906 advanced melanoma patients from 130 cancer centres in 25 countries participating in the randomized, double-blind trial. The Princess Margaret arm, which is one of two in Canada along with the Cross Cancer Institute in Edmonton, is led by Dr. Marcus Butler, the Clinical Head of the Immune Monitoring Team, and includes 16 patients from the Princess Margaret.
Study's early findings positive
The patients in the trial, whose cancer had been surgically removed, received one of two immunotherapy drugs – nivolumab or ipilimumab – for up to one year. All were tested for recurrence of their melanoma every 12 weeks for the first two years. Now, in year three, tests are every six months.
According to early results published in
The New England Journal of Medicine last month, nivolumab offered patients "significantly improved recurrence-free survival" versus ipilimumab. At one year, 10 per cent fewer people in the study who were on nivolumab had a relapse compared with the other drug.
The early findings of this trial, which is closed to new patients, are part of a number of ongoing studies of adjuvant cancer therapy, which is additional treatment aimed at reducing the risk of the melanoma returning. More information on these and others can be found at
Health Canada's Clinical Trials Database and at
clinicaltrials.gov, a database of privately and publicly funded clinical studies conducted around the world.
Dr. Butler advises any patient to have their doctor find out if they may be eligible for new trials.
One of the concerns at the outset of the trial, Dr. Butler says, was that patients needed to have an amount of cancer in their body that could be seento realize benefit of the drugs. But the initial findings show "even when the residual disease is microscopic" the impact can be positive, he says.
"This suggests that as we develop better and more targeted therapies and immunotherapies, using these agents earlier may be a way to avoid patients developing far-advanced Stage 4 disease," Dr. Butler says. "That hopefully means we can cure more patients."
Now, well into the third year of the trial, Terry and Larry have pretty much returned to their lives.
They've also remained friends despite the fact Terry is a Boston Bruins fan while Larry loves the Leafs.
Trial participation 'a win-win'
Terry, who got his melanoma diagnosis just as he was beginning to build his own new home in Peterborough, 140 kilometres east of Toronto, is hoping to move into it by next spring. The side effects he had while receiving the drug – a minor rash, joint pain and muscle soreness – have disappeared.
"I consider myself extremely fortunate in that I really didn't have side effects," Terry says.
Larry, who has recently moved from Haliburton to Bobcaygeon, about 170 kilometres northeast of Toronto, suffered from a rash. And, late in the first year, his pituitary gland "shut down," disrupting the function of his thyroid and adrenal glands, a condition that now requires him to use a steroid, but says otherwise "I'm back to normal."
Both men talk about how accommodating Dr. Butler and his clinical staff were during the first year of the trial – fitting their blood work, physician visit and drug infusion into one day rather than two – to help ease their long commute and avoid having to stay overnight in downtown Toronto.
The two men are thankful to be part of the trial, not just because they each saw it as the best chance to help themselves, but also as a chance to further the scientific research into their condition.
"To me, it was a win-win," Terry says.
In addition to regular visits with their wives to each other's home, Terry and Larry have also adopted a little more urgency into their day-to-day lives, reluctant to put things off as they once might have.
Each has also made a pact to tell the other if they get word that the melanoma has returned.
"I feel really good. I hope it continues," Larry says. "But I don't know where the future lies."
Perhaps not surprisingly given their firm and fast bond, his friend shares a similar philosophy.
"I don't think you ever get confident," Terry says. "But I do feel a lot better about things than I did three years ago."