Back on April 22, my wife and I went to Sloan-Kettering for my latest CT scan. We got the results a few days later (and my apologies to any readers who’ve been waiting for an update) – and they were good. The tumors have continued to shrink, and by as much as another third since the scan in February.
This, of course, is really good news. When I began chemotherapy, the doctors at Sloan-Kettering told us that one-third of patients see a reduction in their tumors’ size as a result of this treatment; for another third, the tumors don’t contract but also don’t continue to expand; and for the final third, the tumors keep expanding despite the treatment. I’ve now had two stretches of this treatment, from December through January, and from February through April, and in both stretches I’ve been in the first, most fortunate third of patients. I am truly grateful.
There are evidently people who continue on the chemotherapy I’m currently on (the so-called “gold standard” combination of two drugs, gemcitabine and cisplatin) indefinitely. The problem, however, is that for many patients any one treatment eventually loses its efficacy – apparently because the cancer, already in some important degree the result of genetic mutations, tends to continue mutating and to eventually hit on a mutation that gives it resistance to whatever treatment has so far been used against it. Or, in Gareth Cook’s words in this past weekend’s Sunday New York Times Magazine, “Darwin’s survival of the fittest governs inside a tumor, selecting for a crueler version of the disease.”
So this raises the question of what other treatments can be brought to bear, and when they should be employed. This is a very promising moment in cancer treatment – there are all kinds of new drugs and new approaches. Unfortunately that doesn’t make the task of deciding what to try easier! Among the most promising possibilities are immunotherapy trials – for example with a drug called Keytruda, recently used as part of a very successful course of treatment for Jimmy Carter’s brain cancer. Another intriguing one is a drug not yet in clinical trials, called 3-bromopyruvate, which another article in the Sunday Magazine, by Sam Apple, reports has “wipe[d] out advanced liver cancer” in rats and rabbits.
The most promising trial, however, may be a more conventional one, in which a pump is implanted in the abdomen and then connected via a tube to the artery leading to the liver; once this is in place, chemotherapy can be delivered straight to the liver. My current chemotherapy is “systemic,” meaning it goes through my blood stream to my whole body; it’s good to have systemic treatment, to ward off any spread of the tumors from the liver elsewhere, but at the same time treatment of the whole body probably has less intense impact on the liver by itself than treatment targeted right to the liver. One of the best features of this clinical trial, moreover, is that the systemic treatment can continue along with the directly-targeted treatment.
So that’s where matters stand right now: we’re assessing what treatment option to take up. No one says that we have to decide overnight – but obviously we do want to decide as soon as we feasibly can. A tricky problem, but one that I’m fortunate to have.