Back in Black

Pro Tip: If your oncologist enters the examination room and announces, "So, Plan B" odds are the news you'll be getting isn't going to be the sort of stuff you'll want to highlight on your Christmas card newsletter.

Google "back in black"and you'll find this non-cancer related gem.

We met with Karen's doctor this morning to review the results of her latest PET scan. While we had hoped for continued good reports we were expecting pretty much what we got: she has stopped responding to the crizotinib and her cancer is back and progressing. Where previous PET scans were nice and clear the scan from Monday was dotted with black pools of tumors. Right now the spots are largely confined to the lymph nodes in the center of her chest with one adventurous little outlier homesteading in her neck.

The good-ish news is that Karen can immediately stop taking the crizotinib. She's really been battling nausea from the drug so this is welcome. The flip side of this is that she is now looking at chemo.

Our timetable looks like this. At the unholy hour of 8AM this coming Monday, we will meet our nurse practitioner to go over the chemo regimen in detail. She will likely start chemo soon thereafter. While Karen wants to wait until after the Festival of Pies (Dec 14) we will see if that's really feasible or not. If the doctor is urging her to start, then she'll be starting. This will be traditional intravenous chemo and she'll be imbibing a delightful cocktail of three drugs: Carboplatin, Avastin, and Alimta. These will be administered three times at 21 day intervals. After these three rounds of treatment, she'll have another PET scan to see if she is responding to the treatment. If it works, great. There will be more chemo and (ideally) she'll eventually move into "maintenance chemo" where she will take just the Alimta and Avastin. She can potentially do this for an extended period of time so that's what we're hoping for. We're talking about a period in excess of a year.

If the initial chemo is not successful in beating the cancer back into submission, we will try another suite of different chemicals to see how that goes. We're kinda hoping not to get to that.

So we are essentially right back where we were literally a year ago at this time, staring down the triple barreled shotgun of chemo. We were incredibly fortunate that 1) crizotinib was even an option and 2) the crizotinib was an option that totally kicked ass and gave us a year we likely would not have had. Median life expectancy at this stage is 12-14 months and since Karen was basically here 12 months ago she has more than beat the odds. We are hopeful that she can continue to do so.

STATUS UPDATE

• Karen' latest PET scans show that her tumors have returned and are growing once again.
• At the moment, growth is centered in her chest, primarily in the lymph nodes.
• This means the crizotinib is no longer an effective treatment and Karen can stop taking it immediately.
• Karen will now move to traditional IV chemotherapy. She will take a cocktail of three different drugs.
• Chemo will be administered three times, every 21 days. This will take two months and will be followed by a PET scan to determine if it is having a positive effect.
• If the chemo works, Karen will have a few additional rounds of treatment and will move into "maintenance chemo" for an indeterminate period of time.
• If the initial chemo does not prove effective, Karen will try a different blend of chemo drugs.