Pill that freezes cancer cells gives Kenyans hope

One morning, Innocent Wangila, a security guard, walked into the bathroom to take a shower then blacked out.

When he regained consciousness, he says: "I saw people dressing me. They all looked strange. They were upside down."

Wangila thought he was going blind but he was not.

After many tests and misdiagnoses, including being told he had malaria, then ulcers, he was finally diagnosed with severe anaemia.

The severe anaemia was chronic myeloid leukaemia (CML), he later learnt, a type of blood cancer.

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THERAPY DRUGS
A few days later, he started cancer treatment; not the normal chemotherapy combined with radiotherapy, but taking tablets daily. 

"I asked the haematologist how long his patients had taken the pills. I wanted to know how long I had to live," the 45-year-old says. That was 11 years ago.

In Kenya, longevity is not a word normally used in the context of cancer, especially if a drug that would keep a patient alive costs between Sh350,000 and Sh1 million a month.

But Wangila and hundreds of other patients with leukaemia, gastrointestinal stromal tumour (gist) - a rare type of stomach cancer - lung, bladder, colon, skin and breast cancers are surviving, thanks to targeted therapy drugs that have become game-changers in treatment of the disease.  

RESEARCH
The father of three, who has lived to get a son after the diagnosis, who is six years old now, says most Kenyans rush for chemotherapy and radiotherapy because they know little about targeted therapy. 

Unlike chemotherapy or radiotherapy, targeted therapies precisely attack the tumours, keeping the abnormal cancer cells to "sleep" for years or kill them.

But the costs of detecting and treating these cancers that respond well to targeted therapy are high, even for the wealthy. 

Cancer affects thousands of Kenyans, but many, including doctors, are only beginning to understand it. 

As it burrows deep in the body, there are little or varied symptoms similar to many illnesses.

SYMPTOMS

Wangila, who works with G4S, says his cancer started with severe backaches and dizziness eight years before diagnosis.

For Alice Muthoni, 55, another leukaemia survivor, her woes began with loss of appetite, a symptom of any common disease.

"I never felt hungry. I could eat a bowl of fruits and feel full the whole day. One day, everything turned pitch black, I got dizzy and fell. Then I started falling more often, everywhere," she says.

She decided to see a doctor.

"I knew it was just a minor thing. So I told the doctor that I had come in because I couldn’t eat and had never-ending headaches," the mother of two says.

BLOOD TEST

A random blood test was done. The white blood cells were abnormally high while the red blood cells were low.

The doctor asked her to do a bone marrow test. When the results came back, she had CML. The diagnosis traumatised her.

"I was devastated. I had known that I was sick but nothing can prepare you to being told that you have a terminal illness.

"After crying for almost 30 minutes, I asked the doctor, "when I am dying?", she says.

"The doctor told me, ‘you are not dying because your cancer is manageable.’ I was so sure he was lying. We all know that cancer kills, so why was this one different?" she says.

SURVIVAL
Today, nine years later, Ms Muthoni has survived on targeted therapy drugs.

Dr Andrew Odhiambo, a consultant oncologist, says the most successful targeted therapy today is a drug called Imatinib used to treat leukaemia and a rare stomach cancer.

"Patients on this drug have survived close to 20 years. Previously, leukaemia patients died within five years of diagnosis no matter what doctors did.

"Chemotherapy would work initially but after five years, the leukaemia would spread and the patient died," he says.

In Kenya, Sudan, Tanzania and Rwanda, poor patients get Imatinib medicine, also known as Gleevec, for free.

The drug maker, Novartis and Max Foundation, a charity firm, donate to thousands of patients in 172 countries.

DOSAGE
When patients start the treatment, they take eight drugs a day whose market retail price would be Sh20,000. 

As the body fights the cancer, the dosage reduces to two tablets daily. 

Ms Muthoni says over the years, she has regained the 16 kilogrammes she had lost and feels normal.

"I have gone through pain, fear of death but now I can encourage someone else. Cancer is no longer a killer disease," she says.

The breakthrough cancer treatment drugs have manageable side-effects that include loss of appetite, blood clotting, body swelling, thinning skin and colour change.

But they are not as harsh and varied as chemotherapy or radiotherapy side-effects.

SIDE-EFFECTS

Miriam Wachera, 30, was diagnosed with leukaemia last year.

Since she started taking the drugs, she says, she has become three shades lighter to the extent that villagers in Gatundu village in Kiambu mock her.

It is the catcalling and teasing that sends her to bed crying.

"People think I bleached my skin. Men in the village mock me that I am a white woman.

"The women demand that I tell them what I use to lighten my skin. Other villagers say my mother wants to offer me as a sacrifice.

"They believe she is a devil worshipper. Yet we go to church. The reverend had to explain to them that my mother is not a devil worshipper, that anybody can be get cancer," she says, choking up.

CHEST PAINS
Save for a dark mole near her chin, Ms Wachera’s skin is admirably smooth.

She adds that she would not care much about her changing skin colour as long as the drugs keep her alive to see her nine-year-old daughter grow up and for people to understand that she is sick, even though she looks healthy.

Her cancer started with an enlarged spleen. She went to Gatundu Hospital and was told she had chronic malaria.

A few days after taking malaria drugs, her feet started swelling.

"I thought I had strained after carrying heavy loads and standing for long hours," she says.

It was followed by chest pains, which a doctor diagnosed as pneumonia.

"I kept getting worse despite taking a mix of drugs. One night, I travelled over 80 kilometres to another hospital and I was told that my heart was not functioning well," she says.

MONITOR
But after doing more tests, she was finally diagnosed with CML.

A doctor enrolled her in the Max Foundation programme and she picks her free dosage every month.

But the programme is not without costs. The patients under the Max Foundation programme have to go for routine blood tests to show if the drugs are working before they pick more. 

If the Novartis drug stops working, a doctor recommends other medicines from Pfizer, Bristol-Myers Squibb or Takeda Pharmaceutical, companies that also offer donations but in small volumes. 

Some patients, however, lack the money for the tests and abandon treatment. 

Lucy Mwangi, who represents Max Foundation in Kenya, says some patients also lack fare to travel to Nairobi to pick the drugs.

"We have patients travelling from Kwale, Garissa and Busia. They all pick drugs from Nairobi.

"Others abscond treatment because they feel better after six months. They think they’re healed," she says.

RECURRENCE
Dr Odhiambo says targeted therapies may not entirely eliminate the disease and if a patient stops medication, the cancer will recur.

Most of the drugs freeze the cancer cells similar to how diabetes or high blood pressure drugs work.

Another challenge is that many poor patients may never get to know the sub-type of cancer they have to benefit from targeted therapy, which may work better than chemotherapy and radiotherapy or a mix of the three treatments. 

Many doctors also have little knowledge on these new treatments.

TREATMENT
A lung cancer test to detect a gene mutation known as EGFR costs more than Sh40,000.

"Many people cannot afford. But if the test is positive, then a doctor has no business starting a patient on chemotherapy. He should directly opt for targeted therapy," Dr Odhiambo says.

Globally, cancer treatment is becoming more accurate in taming the disease with focus shifting to immunotherapy. 

These new treatments are putting the sick out of misery. Some patients previously told to go home and wait to die are being thrown a lifeline.

"We have patients being alive five or more years later and their cancer was Stage Four, which had even spread to the brain. 

"Now they drive themselves to the clinic, pick drugs and come back after a month," Dr Odhiambo says.

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