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A Patient’s Story: How Immunotherapy Fought Stage 4 Skin Cancer, and Won

Air Force Captain Trent Krajaefski received a devastating diagnosis of Stage 4 melanoma after an episode of sudden near blindness. He turned to the Princess Margaret’s Dr. David Hogg, who led a clinical trial to test a new treatment that uses the body’s own immune system to fight cancer. Today, the tumours have been reduced by 80%. Krajaefski tells his remarkable story to the Catalyst.

Looking at Trent Krajaefski today, you’d never guess the challenges that this 36-year-old Air Force Captain has faced over the past four years. Back in 2011, following a jog near his then home in Borden, Ontario, he experienced sudden and dramatic vision loss. Within two weeks of this first episode, he was told that he had Stage 4 melanoma of unknown origin that had metastasized from his abdomen to his optic nerve, lungs and brain.

Knowing that about 10% of patients with metastatic skin cancer survive more than five years, largely because this cancer is resistant to chemotherapy, Krajaefski opted for an experimental treatment: immunotherapy, which uses the body’s own immune system to combat disease. This new therapy was being undertaken by a team of researchers led by Dr. David Hogg, Medical Oncologist and Senior Scientist at The Princess Margaret Cancer Centre (PM), one of the top five cancer research centres in the world.

Having qualified to participate in Hogg’s clinical trial, Krajaefski he jumped at the opportunity, and never looked back. Today, his most recent scan shows that 80% of the tumours in his lungs and abdomen have disappeared.

He shares his extraordinary story with the Catalyst. 

Trent in 2013
Trent Krajaefski

Let’s go back to the beginning of your story. You went for a run in 2011. Can you tell us what happened that day; how the disease first presented itself?

Yes, at the time I was posted to CFB Borden, just outside of Barrie. I was out for a jog. Afterward, when I was getting into the shower, I experienced what appeared to be a mirror- or disco-ball effect to my vision. I was getting this sparkling effect in the lower left-hand visual field in my left eye. This spread throughout my vision. Then after about two minutes, it became a complete loss of vision. I couldn’t make things out any more. All I could see was a battle-ship grey colour. Then after about 20 more minutes, I started to see the outlines of objects again. I could see colours again, although I was having a really hard time focusing on anything.

I went down to the hospital in Alliston, where they did a series of ocular checks. At first, the doctors believed this may be a migraine aura, but I didn’t have a headache. So they said to themselves, let’s take a look inside the old noggin [paraphrased].

It was midnight, a cold winter night in March, in Alliston where they put me through a CT machine, and found there was a one-by-one inch tumour in the back of my brain.

You qualified to participate in Dr. Hogg’s clinical trial using immunotherapy to treat melanoma, and in participating, you travelled to Toronto from Ottawa (where you are now living) every three weeks and underwent intravenous treatment for two years. Can you describe your treatment in more depth? And were there any side effects?

This treatment was really simple from a patient’s perspective. The other two chemotherapies that I did previously were a little more painful. This one was unbelievable. It was painless, effortless, fast and easy. The opposite of what you think of when you think of the horrors of chemotherapy – pain, losing your hair, red-eyed and miserable.

Trent - early rounds of immunotherapy
Early rounds of immunotherapy

You sit down in the chair and they put an IV into you, after doing a general blood test to see how things are going… There’s a tiny bag of [the treatment] that takes 15 minutes to feed through the IV. The side effects were minimal. Fatigue was probably the most common. Then I’d just get on a train and head home to Ottawa. I think the fatigue was based on the travel, to be honest.

It only took two or three injections, a month and a half, for me to realize that this wasn’t going to slow me down. And it didn’t. Not even for the military’s rigorous annual physical fitness test.

I had over 40 treatments in two years. But the treatment was so easy and painless that when I was on it, a lot of people never even knew that I had cancer.

How soon did you start to realize that the tumours were shrinking? Tell us about this revelation.

Dr. Hogg took the first set of CTs after several months of starting the treatment. He noticed immediately that there was a significant shrinkage. If you look at the CT scan [below], you can see this.

I remember it being kind of funny because I heard Dr. Hogg was showing the scans around like a proud parent showing pictures of a brand new baby. He was showing me, saying: “Look at this! Look at this!”

Immunotherapy
The left side of this scan shows patient Trent Krajaefski’s chest prior to treatment; the right side illustrates how immunotherapy shrunk the tumour. Photograph courtesy of The Princess Margaret Cancer Centre.

How would you describe the difference that immunotherapy has made to your life?

Once I got on this drug, the immunotherapy, I got my life back, really.

I think it’s hard for anyone to imagine how profoundly this affected your life and that of your family and friends in the Air Force. Can you tell us a little about the impact of this disease on your life and your support system?

My whole family lives here in Ottawa – my parents, my sister, my wife’s family – which was a big deal. My wife, Sarah, a public servant, got a job in Ottawa and I was posted to Ottawa, so that in case things went backwards , in that usually the military member gets posted and the spouse follows, we had the family support right here.

Trent and Sarah before cancer   Trent and Sarah in Scotland
Trent Krajaefski and his wife Sarah. Left: Before cancer; right: on vacation in Scotland.

I am in the military and I can’t say enough good things about the military’s support. They’ve been fantastic. The military has provided me with the money to go to and from the treatments. The drugs were covered by the pharmaceutical company, but they provided the support if I needed to see a social worker, a psychiatrist, or anything like that. Everything was readily available. The support from my employer has been fantastic.

What are your impressions of Dr. Hogg and his team?

I couldn’t ask for a better team at the Princess Margaret. Dr. Hogg, for starters, is a very serious, extremely professional and knowledgeable man. He is everything you could ask for in a doctor.

Hogg120x150
Dr. David Hogg, Medical Oncologist and Senior Scientist at The Princess Margaret Cancer Centre

After five months of visits, I thought: I wonder if I could make him really laugh? I can’t remember how or why, but it wasn’t a problem after all. He has an incredible sense of humour. When I mentioned I was traveling to Scotland, and checked in with him about my medical safety when over there, his advice was: “When you drink, don’t drink too much.” He knew that I was going on vacation and I’d probably do some stupid things… He’s an excellent judge of character.

The primary care nurse, Mary Anne Chappell was proactive right at the get-go. She contacted me regularly, by email or text, to just ask: How are things going today? It was really comforting to know that they’re still thinking of you.

It was a great team at the Princess Margaret.

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Today, Krajaefski goes to follow-up appointments every twelve weeks. In the event that there is a reoccurrence, he says that he will be offered different types of immunotherapy at PM.

To read the sister article on Dr. Hogg’s work, go here.