A Change in Direction

I was at Sloan Kettering this past Tuesday.  Regretfully, a CT scan showed that the two tiny tumors in my abdomen have grown in the past three months.  The verdict was that the growth is statistically significant, and that the Ibrance is no longer working.  I'd been on Ibrance for six months, and it has a median progression free survival period of 18 weeks.  So, I got about that much time out of the medication before the tumors resumed their growth.

I did complain to the doctors that my pain level has increased in the past few weeks.  They believe it's because one of the tumors, which is sitting against my rear rib-cage, is probably pushing on a nerve.  They suggested two options to deal with the pain, and left it up to my primary care provider and I to decide.

I sent an email to my PCP and she immediately agreed with my preferred option.  The change has worked well and the pain is not bothering me as much as it had the few previous weeks.

The doctors at Sloan Kettering described this entire ordeal as a marathon.  They said that I am literally not sick right now.  I'm in good health, I feel good, I'm training reasonably well, and the disease is not impeding my life at all.  At the same time, it's important to prevent those two tumors from growing further.

The tumors are so small that surgery was not the recommended option.  Instead, they want to try a 12 week run of chemotherapy.  This time, it will be a combo of Doxorubicin (the first chemo agent I had, and I responded very well to it) combined with Lartruvo.  Lartruvo is in a category of drugs known as biologics, and when paired with Doxorubicin, it seems to amplify the effects of that drug.  Patients who take the combination of the two drugs statistically lived twice as long after treatment as though who got Doxorubicin without the Lartruvo.

The doctors described the current state of my disease as being in the early stages of a marathon.  Yes, we've used up one magic bullet with Ibrance.  After four more rounds of Doxorubicin, I will be at my lifetime limit for that drug.  But, there are still many more options out there, plus I'm sure we will do surgery again in the future.

I am hopeful that the combo of the two drugs will substantially shrink, or perhaps kill, the two small tumors that I have.  Doxorubicin worked very well last time, and if Lartruvo makes it work even better, I should experience significant shrinkage in two tumors that are already small.  If that happens, I will hopefully enter a period of time where I won't have any treatments at all.  Also, shrinking the tumor in the back will hopefully reduce my pain level.

So, while this was a setback, it's not a huge issue.  Yes, it would have been nice to be one of the lucky few for whom Ibrance works a long time.  But, that didn't happen.   At the same time, my tumor load is small and I'm fairly healthy.

On the downside, Doxorubicin is a nasty true cytotoxic chemo.  My hair will fall out.  I will be nauseous and tired.

On top of this, I started a new job in February, and I had to tell my employers about the cancer because of the chemo.  So far, I've been overwhelmed by the support I've gotten at work, the response to my plan to minimize the impact on work (I'm going to do chemo on Fridays so that I can rest on the weekends, maybe work from home on Mondays, and otherwise hopefully feel pretty good throughout the process), and just the good will I've felt from the senior management in the company.

I was very concerned about telling people here, considering that I'm still the new guy, but I think that things are going to be OK.  My biggest concern is that I'll be be too tired on the weekends to do much fly fishing.  Our season is off to a terrible start, with a cold April, rivers running high, and I haven't fished even once yet.  The forecast for this coming Saturday is looking dismal and I might not get out again this weekend.  But, I'll get out pretty soon.

So, on to a new chapter.  I'm not thrilled at taking this drug again, but it's what I need to do.  So, I'll muddle through.  Life goes on.

On the fun side of life, concert season is starting.  I saw They Might Be Giants three weeks ago.  I saw Peter Hook and the Light two weekends ago.  And, next week, I'll be seeing The Editors, a band I've wanted to see for a long time.

After that, I still have tickets for five other shows through the summer and the fall.  Unlike last summer, when I was recovering from surgery, I'm hoping to feel better at the shows this summer.  I'll be tired, but I won't be recovering from surgery.

And, I'll be saving money on haircuts over the next six or more months.