What started as a nagging ache in David Snyder’s left arm was getting worse.
Not only was his pain becoming more severe, but his range of motion was shrinking. Massage therapy wasn’t helping, and neither were regular visits to his trusted chiropractor.
A broken arm led UTMC physicians to discover David Snyder had metastatic kidney cancer. After intensive treatment, he’s now 14 months in remission.
Snyder didn’t know it at the time, but his arm was broken — and he was about to become a very complex medical case.
“I thought I was in pretty good health,” Snyder said. “My arm was sore, but I never considered it could be broken. I certainly didn’t think it could be cancer.”
Imaging performed at a regional hospital near his Michigan home in 2021, however, showed a mass on the bone. Snyder, now 72, was told he needed to see an orthopaedic specialist.
He turned to The University of Toledo Medical Center, which was able to get him an appointment within days. After a battery of tests, UTMC determined Snyder was suffering from kidney cancer that had metastasized to his arm and snapped his humerus in two.
Snyder underwent multiple surgeries to remove the cancer and repair his arm. He also received radiation therapy followed by a state-of-the-art immunotherapy regimen to ensure his cancer was in remission.
It was a dizzying carousel of specialists, but through it all, Snyder felt supported by the entire team at UTMC.
“From the people who took my temperature at the door all the way through to the top physicians that I dealt with, they were engaged with me all the way. I think where healthcare has missed the mark is when they forgot what their product was. They put more emphasis on the numbers than the product, which is customer care,” he said. “I did not experience that even one time in the two-and-a-half years that I was affiliated with UTMC. They have a different culture than anything I’ve ever seen before.”
On more than one occasion UTMC staff proactively called him to reschedule appointments to days he would already be on campus for other appointments with different clinics. He said he deeply appreciated the effort, which reduced the number of times he had to make the hour-and-a-half trip from home.
Dr. Danae Hamouda, a medical oncologist who treated Snyder, said a high level of coordination among specialists is vital — both for planning specific treatments and for easing the patient’s burden while they are receiving care.
“We talk about the medication side effects and the possible side effects after surgery, but we also need to consider the patient’s time commitments and the time they’re spending in the hospital system,” Hamouda said. “We really try hard to minimize that. When we talk about personalized care, it’s not just the treatments we select but it’s also considering any socioeconomic factors that may be a barrier to good treatment. I think that’s something that makes UTMC special.”
The first step in Snyder’s treatment was removing the cancerous tumor from his arm, which was performed by Dr. Michael Mott, an orthopaedic surgeon who specializes in bone and musculoskeletal cancer.
In addition to removing the tumor, Mott inserted a plate to help reconnect the bone and rebuild Snyder’s humerus.
His case was then referred to Dr. Firas Petros, an expert in treating urologic cancers, including kidney cancer.
Snyder was beyond impressed upon their first meeting. Though his latest imaging had been done late the previous day and his appointment with Petros was first thing the next morning, he said the doctor could not have been more prepared.
“My wife and I walked in there and felt like this guy must have been studying my case for years. He knew my case inside and out,” Snyder said. “He didn’t talk to us like I was a 5th grader. He didn’t talk over my head; he didn’t talk at me. He did a very nice job of explaining he situation. He said you have a serious problem, but we have all the capability to address it.”
Kidney cancer, Petros said, is unpredictable. Like any cancer, it’s most treatable when it hasn’t spread. Lung metastases are most common, but kidney cancer also can spread to the liver, brain, lymph nodes and — as was the case for Snyder — bones.
The distant metastasis classified Snyder’s cancer as stage four, but doctors found no additional cancer outside the kidney, including in nearby lymph nodes. Petros determined the best course of action was to remove Snyder’s right kidney, where the cancer had originated.
“His overall health was good. He didn’t have any significant medical comorbidity. His cancer just had spread to his left arm, but he didn’t have pulmonary metastasis,” Petros said. “In patients with favorable or intermediate risk, by taking out the kidney you can prolong their lives.”
After his kidney was successfully removed, Snyder began several weeks of radiation therapy followed by an immunotherapy called Keytruda paired with a targeted cancer-blocking drug called Lenvima.
Though now a first-line treatment for advanced kidney cancer, it was a novel strategy when Snyder was treated. The data supporting the two drugs’ use, Hamouda said, was only a few months old. And while both drugs had individual approval from the U.S. Food and Drug Administration, the agency had not yet issued an indication for their paired use in the treatment of advanced renal cell carcinoma.
“Cancer care is rapidly advancing and at UTMC we want to be on the forefront of that progress,” Hamouda said. “Being up to date on the latest clinical data, even ahead of FDA approval, made an impact on his care. There are patients like David who are having exceptional outcomes that we would not have seen just a few years ago.”
Snyder also was given a medication called Zometa to help regrow and strengthen the bone that had been broken by the cancer.
Today, Snyder is cancer free and has regained 90% mobility in his left arm.
“He has an exceptional outcome,” Petros said. “A patient with such a complex case requires a multidisciplinary approach. There was great coordination among urology, orthopedics, radiation oncology, medical oncology and our nursing staff. Every single person in the hospital is important because everyone contributes a little bit to patient success. Mr. Snyder also was a good patient. He was engaged and active in his own care. I’m glad that he’s doing very well.”
Snyder also enrolled in UTMC’s molecular target registry clinical trial, which follows patients in remission and helps clinicians better understand how specific treatment regimens have worked over time with a goal of identifying specific signals that may help improve therapy for future cancer patients.
He sees it as his way of paying it forward and advancing cancer treatment, recognizing the therapies he received were unavailable just a few short years ago.
“I never felt like I was given a death sentence. I was stage 4, but the people at UTMC gave me the sense of confidence and my faith in God gave me the sense of confidence that this thing is going to be alright eventually,” he said. “I’m sure my outcome has a lot to do with my outlook, but I saw that same level of care with everyone. Those fears are diminished and that makes you be able to recover better.”
