Friday, February 25, 2011

Reflections, Infections and Inflections

Cancer isn't an infection the way a virus is, although it feels the same. For so many ills and diseases the protocol for cure is well known, even though it can be a hard road. I remain impressed by the women we see each day at the cancer center, getting their blood draws, doctor visits, and then chemotherapy or radiation treatments. Their spirit and determination is admirable. I suspect part of what keeps them going is that they have a pretty good idea that the probability of success is quite high. Yes, they may have to live for 5 years not knowing if the cancer will reoccur. But given the treatments and the continuing medications (Tamoxifen) if you were in Vegas you'd bet on their success at becoming disease free.

Our road is different, and more challenging. We are now heading down a road of possible treatments which are clinical trials. The work and research being done in this area is quite fascinating. So many bright minds trying to figure out how to unlock the various keys - how to get the right medication through the right pathway to the right spot - based on each person's unique DNA. So in some ways we have more options now than we thought - our next logical step would be (and still could be) the in-hospital treatment with Interleukin-2. But we are going to use the failure of the Ipilimumab as an inflection point - to go explore some of these promising options. 

Adoptive Cell Therapy is one of the most promising options, because it uses a combination of Interleukin 2 with a "special sauce". They remove a tumor or piece of a tumor to extract some natural t-killer cells from it. Then in a lab they see if they can harvest the cells. Usually they can, sometimes they can't. If they see they're growing, they continue to harvest, possibly for many weeks, until they have about 6 billion of them. Then there's a three week procedure where they give them back to you. This involves a week of chemotherapy, the infusion of your T cells, then a week of Interleukin 2. And then you wait, and hope that these t-cells are abundant enough, strong enough and smart enough to recognize the bad stuff and go to town on it.

The first step is to figure out if Meagan qualifies - based on her particular characteristics and mutations (we already know she qualifies for a similar trial here in Seattle). That will happen when we head to Bethesda for the initial exams, tests, and scans. It would be great if she does qualify. But then it means if we agree to do it, that the path is different. Logistics become more of a challenge. I'm sure they are quite supportive at their end, but still we have a lot on the home front. 

So it's a time for reflection on what to do, how to go about it, who to trust, and assessing the potential outcomes and impact. We will prevail. You pick a path and don't look back. You just hope you've got all the right data and perspectives before you make that choice. I'm confident that when we have the opportunity to choose we will be ready.


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