What began as some aches and pains in his shoulders quickly turned into much more for 47-year-old Paul Calnan. An avid gym-goer and volunteer firefighter, Paul thought his shoulder pain was just a product of his lifestyle. When the pain persisted and his weight began to drop, he turned to the medical experts at St. Elizabeth’s Medical Center.
After several unsuccessful attempts to address what he thought was a musculoskeletal issue, lab work from a rheumatologist revealed that his liver levels were off. Paul was immediately referred to Claudius Conrad, M.D., chief of General Surgery and Surgical Oncology and director of The Boston Liver, Pancreas and Biliary Center at St. Elizabeth’s Medical Center.
An MRI confirmed the worst: Paul had a large tumor on his liver, an unusual condition for someone his age. The tumor was so large that it had radiated pain up to his shoulders. The biopsy showed that Paul’s tumor was stage 4 intrahepatic cholangiocarcinoma, a rare form of bile duct cancer that presented on his liver.
Despite having his gall bladder removed and multiple treatments for stones throughout the past 20 years, Dr. Conrad was the first doctor to identify the root cause of Paul’s problems and tumor as oriental cholangiohepatitis, a disease endemic to Southeast Asia and the Middle East that is extremely rare for a U.S. patient. The disease causes thicker bile, which leads to stones to form in the liver and chronic inflammation. In Paul’s case, it resulted in a large malignant tumor.
When Paul received the news, it was “like a punch in the stomach” – his immediate thought was that his life was over. With a wife and 10-year-old son, Paul had a lot of living left to do. Luckily, both he and his multidisciplinary medical team weren’t willing to give up.
At the time of diagnosis, Paul’s tumor was 10 cm long: between the size and the placement, it was inoperable. That’s where Olga Kozyreva, M.D. came in.
Dr. Kozyreva, an oncologist with Dana-Farber Cancer Institute at St. Elizabeth’s Medical Center, immediately started Paul on chemotherapy. The tumor began to regress – but not enough for surgical removal. Paul was feeling the symptoms of chemo, including hair and weight loss, and Dr. Kozyreva knew she had to do more to help treat him.
While Paul’s tumor in itself was rare, the chances of qualifying for immunotherapy are even lower – only 3% – yet a test of Paul’s tumor showed that he had a unique set of genetic markers that qualified him. While chemotherapy was not failing, Dr. Kozyreva wanted to try the immunotherapy to give him a better chance to respond to the medication; Paul was willing to do anything to fight the cancer.
Paul’s outcome drastically changed for the better after starting his treatments with the immunotherapy drug, Keytruda. A mere three weeks after starting, Paul had recovered from the side effects of chemo and even was able to return to work part time. Even more incredibly, regular CT scans showed the tumor was continuously shrinking.
The tumor eventually shrank enough for Dr. Conrad to perform surgery to remove it completely. Surgery would still be intensive: a surgery of this capacity had only been done a few times worldwide. The 8-hour operation included resection of all the veins draining the liver, the large vein connecting the liver to the heart (inferior vena cava) and all inflow blood vessels and bile duct to the right liver. Despite the challenging operation, the tumor was completely removed. The team eagerly awaited results from pathology and celebrated the second they got the call back: the tumor was completely dead from the immunotherapy.
Paul is now fully recovered from surgery and was able to return back home to be with his family and carry on with a second chance at life.
As told March 2021.
About Our Patient Stories
This story includes descriptions of actual medical results. St. Elizabeth’s Medical Center and Dana-Farber provide personalized care for each patient based on their unique needs; their experiences and results will vary.