Truck Cancer

Another drug, another scan, another progression. This is not the post I wanted to write or be living with (ha). The good news is I don't feel too bad, and for that I am grateful.

It's still a bit early on in the process of scans --> radiology report --> doc consults --> biopsy (?) --> decisions --> treatment. Also, looking at that I'm trying to run some more of this parallel to speed up the process, but more on that in a bit. Right now I'm in the doc consults phase. I've met with Dr. Stover at OSU and am meeting with Dr. Chung at Christ tomorrow. I'm hoping to have a meeting with an oncologist at UC next week and Dr. Stover is consulting with my former oncologist Dr. Heather Parsons at Dana Farber. I was going to go out, but I think this will be sufficient (still have that option though).

So scans. I've not felt worse in the lung department and scans bore that out according to my favorite pulmonologist (Dr. Christopher Schmitt at Christ if you're in the market and I hope you're not). Yay! On the down sides, my vertebrae lit up on the bone scan and showed cancerous lesions on the CT scan. On the even bigger down side my liver has more and bigger lesions. Some of these are infiltrating the hepatic portal veins. I haven't seen images yet, but Dr. Stover wants me started on treatment soon and so do I. Luckily as of 4 weeks ago my liver enzymes weren't high, I told the doc it was because I challenged it regularly (I did get a chuckle for that). When I was sharing with family, Shell said she wished Dr. Stover had a cancer death ray, then sent me this, which cracked me up. Should I pass this on to the doc lol?

Image put together by my creative sister :-)

Ok, treatment options. I've been searching through clinical trials basically since this last progression and saving some that looks good. Right now my top choice is part of the TAPUR study. This study matches already FDA approved drugs for other cancers or other biomarkers (these can be mutations or receptor status or other things that help us characterize the disease). My last genomic (DNA) testing on a liver tumor came back with high LOH, which stands for loss of heterozygosity. Usually your cells have two copies or versions of every gene, but cancer cells get all kinds of crazy and can lose chunks of DNA leading to a loss of one of these genes. Mine is a little on the high range, which makes me eleigible for this arm of the study that utilizes two drugs - an immunotherapy drug called Tecentriq/atezolizumab plus a targeted drug of the PARP inhibitor variety called Talzenna/talazoparib. This trial is at UC (close!) and I wouldn't have access to these drugs otherwise. UC has not been the quickest or most communicative, but the ball is rollling and based on a conversation with a coordinator, I hope to get in with a doc this week.

At the same time, we will pursue insurance approval for a standard of care drug called Trodelvy/sacituzamab govitecan. This is a newer class of drugs called antibody drug conjugates. These link up a chemotherapy drug with an antibody that targets molecules more common on cancer cells, in this case TROP2. 

The weirder option (I say weirder because I'd never heard of it) is TACE, or trans arterial chemoembolization. Bascally they run a tube into the liver and target the tumors with chemotherapy and cut off blood flow so the tumor(s) die. I love dying cancer cells. Anyways, as I understand it I could do this, then wait to recover and start the Trodelvy or the clinical trial (however, there's a risk that the clinical trial may not be enrolling anymore).  

The decisions get harder and the stakes feel higher. 

And! I'm grateful to have options and smart docs on the case. And for time away with some of the family at the beach- relaxing, reading (we should have calculated the books read!), swimming, sleeping, and eating good food. Plus I played a new game that's just my speed - "Taco, Goat, Cheese, Pizza". Hilarious.