Thursday, March 10, 2011

Conventional Treatment, Clinical Trials, Alternative Medicine, and Attitude

These four components make up the legs of the chair on which we are sitting to get Meagan disease free. Given we have been fortunate to dodge the vicious blow of melanoma that strikes fast and hard and leaves little time, we are engaged in all of these areas.

In terms of conventional treatment (and we'll include Ipilimumab, now known as Yervoy in that category) we have just about hit all the logical ones. The one remaining treatment, Interleukin 2 is on the horizon. But it may be that we undergo a clinical trial which incorporates Interleukin 2 within the protocol, instead of a stand alone treatment. Because that treatment is really nasty, involving a multi-week hospitalization. We'd rather do it in Seattle, with our support network in place. But that would be for the stand alone treatment only, or possibly a clinical trail. More likely we'd do it at the National Cancer Institute in Bethesda.

Conventional treatment does not just include systemic treatments to try to rid you of the disease. A systemic treatment is like chemotherapy and radiation for breast cancer that eradicates all evidence of it, at even the cell level. Even if the systemic, conventional treatments don't work, there is the continuing option of tumor removal, until there is a breakthrough and a systemic cure is discovered. Many melanoma patients live this way, and some who have done so are now experiencing the benefits of those breakthroughs (such as with Yervoy / Ipilimumab).

Given the unfortunate failure of Ipilimumab / Yervoy to work for Meagan, we are heading to the clinical trial route. There is still a lot of reason for optimism in this path. The latest direction is Adoptive Cell Therapy, extracting your own bodies T-cells (those cancer fighting cells) and multiply them by the billions and then re-infusing them into your body, along with a dose of conventional drugs like Interleukin 2. There are all sorts of variations on the theme, depending on your particular DNA makeup, and there continues to be new drug development. So as long as we can buy time, through tumor removal or partial success with the various therapies or simply slow growth, we have a great shot at beating this. Most long term survivors of melanoma, and I'm talking LONG  TIME, have participated in some way in clinical trials. It doesn't mean you are a lab rat or that you are in randomized trials (where you might not get a drug they think works). There are many Phase 1 or 2 trials (not ready for submission to the FDA for approval and not ready for broad testing) available. Sorting out which ones make sense and which ones keep you eligible for future ones in the event of lack of success is what we rely on our team for.

Because melanoma is an immune system cancer, it just seems to make sense to get your body in tip top immune system shape. Meagan has already plunged into that with her change in food sources and exercise and certain supplements. Next week we visit a naturopath who is working at the intersection of conventional and alternative medicine in oncology to get her perspectives on what else we should be doing. It's pretty clear most oncologists, even those specializing in melanoma, take a somewhat dim view of the power of foods and natural herbs and supplements to support disease control or eradication. Yet, there is plenty of evidence that certain foods and herbs exert powerful influences on your immune system. Up until now we have really lacked that integrated view of the conventional and alternative avenues, and we'd like there to be some coherence and someone looking at her holistically. But we are not so beyond the fence that we will go to the clinics Tijuana for the bizarre.

Lastly, is the power of attitude. I've written about this before. Quality of life is really important. You don't have to be in denial about the severity of the disease to hold positive thoughts in your head and a belief in an optimistic outcome. We say to each other (or maybe I say it more to her when she wavers), "we will prevail". Meagan is living her life right now the way she wants, surrounded by friends and family and drawing on the strength and energy of those around her. Every person faces their own mortality in different ways; after all, life is a terminal disease, it's not a question of "if" but a question of "when". Some people, when faced with more imminent signs of possible early demise, opt for knocking off a bucket list of activities. That's fine, but not who Meagan is or we are as a couple. For us, life is about being who we are, living where we are, surrounded by people we love and care about. Couple that with a positive attitude, and we think that will be the magic ingredient that works with all the other aspects to see us through to becoming disease free.

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