Monday, June 8, 2015

Excitement at ASCO

     Each year, around this time, the American Society of Clinical Oncology, (aka ASCO,) holds their annual meeting.  It is at this conference that great minds in clinical oncology bring the latest data and information they have gathered from their research and present it to other oncology care providers, and the rest of the world.  I don't know if it's always held in Chicago, but last year, this year and next year, have been, and will be, in our Windy City. The 2015 conference was May 29th-June 2nd.

      Although I knew about the 2014 ASCO meeting last year, I didn't know that non-providers or non-clinical researchers could attend.  A few lung cancer ninjas that I know went last year and reported back to us on medications that were either newly available or in the pipeline, and other breaking news.  

      I wanted to attend this year, but Wynn and I were invited to a wedding, so we were out-of-town that weekend.  I knew that I could learn the information presented at this year's ASCO meeting from others who attended, and that I would regret missing the nuptials of the daughter of a dear childhood friend. 


     Following this year's meeting, on June 4th, Nathan A. Pennell, MD, PhD wrote an article for the ASCO networking website called Connection.  Dr. Pennell is an oncologist and director of the lung cancer medical oncology program at the Cleveland Clinic.  He did his fellowship at the Dana-Farber Cancer Institute - Harvard Medical School, and his PhD is in neuroscience.  I mention a few highlights from Dr. Pennell's bio to make the point that the guy probably knows what he's talking about.  His article is entitled:  View from the Podium:  Lung Cancer Finally Gets Its Moment at ASCO2015.  Here's the link if you're interested in reading it:

https://connection.asco.org/commentary/view-podium-lung-cancer-finally-gets-its-moment-asco15

"Immunotherapies, whoa-ooo-whoa."

      This article is seven paragraphs long, not too technical and made my heart SING....LaaaaaaaaaH!  Pennell described the buzz and excitement among the ASCO attendees about new immunotherapies showing great promise for lung cancer patients.  (Immunotherapies are medications used to boost the patient's own immune system to combat the cancer.) The response rates are good and overall survival (OS) rates are much improved over previously used chemotherapies. He wrote the sentence, "It was magical," to describe the excitement he felt knowing that he could bring this good great news of a new treatment option back to his patients.  

      I figure if Dr. Pennell is excited and optimistic about the future of immunotherapies in lung cancer, then...SO AM I!

Sunday, May 24, 2015

Glancing Back While Moving Forward

     


     A year ago I wrote a blog entitled, "Decreasing Urgency."  At that time, it had been about a year and half from when I was diagnosed with advanced cancer, and because my medication was controlling my disease well, I was able to feel some relief, and hope.  I realized that I was moving away from my initial sense of panic, that was driving me to try to get things done quickly...before I lost my chance.  I wanted my children, both in their twenties, to "ripen" before I died.  I was secure that I had mothered them as best as I could, but there were a few things I still needed to tweak.  I needed to get my house in order - organizing my belongings and getting rid of unused "stuff" that had quietly, and insidiously, accumulated in our basement. My last quest was to create as many memories for Wynn, unrelated to my illness, as I could.

     The priorities I had a year ago are still very important to me.  Nathan and Nina are moving forward in their lives and I am so very happy for them both.  I see that they are continuing to surround themselves with support systems that will, without a doubt, help them negotiate life's ups, and downs.  It is incredibly comforting to me...as I am sure it would be for all mothers.  I continue to want to have as many shared experiences with Wynn so that he can look back and know how happy I was to be his wife.  Over the past year I have come to appreciate that Wynn, too, wants to have  shared experiences with me.  He goes to great effort to make sure I know that I am loved.   

     Along with making sure Nathan and Nina are headed in the right direction and that Wynn knows how much he means to me, the third priority was dealing with the junk in my house.  So last weekend, together with my next door neighbor and dear friend, Brigid, we had a garage sale.  Although I've been told that garage sales can be money makers, our goal was to make sure we brought nothing back into our houses.  Therefore, everything was priced to sell.  Most items were less than $5.00, many items were less than $1.00, and we ran 2-for-one specials, as needed.  We made sure each visitor knew to "Make an Offer" on anything they were interested in. 

     The weekend was a success.  Brigid and I unloaded most all of what we brought out to sell.  That old adage, "One man's trash is another man's treasure," is so true.  We could not believe what people bought.  And...in getting rid of a lot of old and unused stuff, we both profited beyond our expectations.  At the end of Sunday, there were a few things that did not sell.  We loaded them into our cars and drove straight to the Goodwill Donation Center.  It was beautiful.

     Preparing for a garage sale required a fair amount of planning and work.  In
lieu of Mother's Day gifts, I asked my family to help me clean the garage and drag tables and crap out of the basement.  (I'm pretty sure they would have all preferred to buy me flowers and a card.) Sorting through nearly 30 years of accumulated crap is definitely not for sentimental types. There were items that I clearly wanted to hold onto to, however, when I came across something I wasn't sure about, I reminded myself that I will likely have a shortened life...and since that's the case, I wanted to be responsible to my family so as to not add the burden of cleaning out my crap on top of my absence.  



     As you can imagine, going through our things brought back many, many memories.  I came across something that gave me pause and I sat down, for over an hour, as I was drawn back nearly two and half years.  I have a basket of get well cards and notes I received in the first few months after I was diagnosed. I opened and re-read each word that was sent to me.  I cried, not because I was reliving the fear and difficulty of those
first few months, but because I was so touched by the the outpouring of support that flooded into my mailbox. I re-read over a hundred cards, letters and notes from all over the U.S., Europe and Japan.  Some family members and friends sent more than one card and my friend, Claudia, was on a campaign to send me an uplifting card, per week, for months. 

     So...while it feels great to purge my house of junk in an effort to move forward more freely, I was reminded how these notes gave me strength back then...I didn't want to let anyone down who was sending me encouragement.   




Thursday, April 30, 2015

My Appointment with Dr. Camidge, and Josh

     Monday, after work, Wynn and I hustled to O'Hare to catch a plane to Denver because the next morning we had an appointment with Ross Camidge, MD, PhD - a lung cancer specialist at the University of Colorado.  This is the appointment I scheduled after I had a tumor marker scare, which I blogged about back in January:


     Dr. Camidge is a medical oncologist, clinical pharmacologist, and researcher with extensive experience in lung cancers that are caused by DNA mutations, such as the kind I have. There are a few clinical researchers in the U.S. that specialize in patients with ROS1 mutations, and I chose to make an appointment with Dr. Camidge because I had read that he had experience with patients who also have cMet mutations.  I have both, (or so I thought), so he seemed like the guy for me. The Anschutz Cancer Pavilion at the University of Colorado Medical Center is a large academic comprehensive cancer center, with some sort of affiliation with the National Cancer Institute.  There are two "famous" ROS1 mutation specialists there, Dr. Camidge and Dr. Robert Doebele. 


     On Tuesday morning, before seeing Dr. Camidge, we met with his fellow, Sinead Noonan, MD.  She spent nearly an hour with us reviewing my history and answering my questions.  She, methodically, responded to all of my questions and in the style I like best, explaining each of her answers in language Wynn and I could understand and digest.   

     Dr. Camidge came in later and spent another 30-40 minutes with us.  He, obviously, is incredibly knowledgeable about ROS1 and cMet and is very skilled at explaining what he knows.  He must be really good at reading facial expressions because when I became lost in his answer to one of my questions, he tried again using an analogy.  (Thanks, Dr. Camidge.)  Here's what I learned:

  1. I probably don't have a cMet mutation, in addition to my ROS1 mutation.  Having two tumor mutations is rare and initial testing results made me, and my local oncologist, think that I had both.  However, more recently, researchers have devised a better and more accurate way of testing for cMet mutations and with the newer method, it looks like I don't have cMet.  I kinda liked the idea of having a cMet mutation because, initially, it was thought that cMet mutation driven cancers responded better to targeted chemotherapies.  The data is still coming in, but it's moot for me.
  2. Per Dr. Camidge, if one is going to have a tumor mutation, ROS1 is the one to have.  As far as mutations go, it's a relatively "simple" DNA alteration that responds to Xalkori better and longer than another similar mutation called ALK.  Additionally, ROS1 driven cancers don't seem to metastasize to the brain as commonly, which is really good since Xalkori doesn't cross the blood-brain barrier, it seems.  
  3. Regarding what to do when Xalkori stops working, he said the following:
    • Still, no one knows how long it will work for me.
    • When it stops working, it won't stop working suddenly in all my suppressed tumors.  It gradually stops working in some cells in different areas and overtime, will stop working in more and more cells.  When that time comes, I'll know because my blood tumor markers will start rising and I will then get scanned more frequently, either by CT or PET, to find the "hot spots."  As long as there are five or fewer hot spots, I can have targeted radiation to "zap" those tumors.  I will do this for as long as possible.  
    • When the time comes that there are more than five hot spots on a scan, that will be the time to start a new medication.
    • Since there is no cure for my disease, the goal is to get as much time from each of my treatment medications as possible, thereby extending my life as long as possible.  
    • Right now there are two medications in Phase I/II clinical trials that are being used by other patients who have ROS1 and acquired resistance to Xalkori.  Hopefully by the time I need them, there will be much more known about these medications so I can try the best option.
  4. I asked him about the frequency of needing CT scans, because I've always felt uneasy about being exposed to such radiation every 3 months.  He and his team have been studying the accuracy of tumor markers in blood with cancer growth and they will soon publish data confirming that when cancer is actively growing, certain tumor markers in blood will rise.  Conversely, when tumor markers are low, cancer cells are not actively growing.  For me, since I've been doing well on Xalkori and ROS1 driven cancers grow relatively slowly, he is comfortable testing for blood tumor markers every 2-3 months and getting CT scans every 6 months.  Certainly, if my tumor markers start to rise, I'll get scanned more frequently. 
  5. The red hot topic in cancer treatment is immunotherapy.  Although great advances have been made in the science of cancer immunotherapies, including in some lung cancers, it's not ready for me yet.  Dr. Camidge, however, was optimistic that it's not too far away.
  6. Dr. Camidge made a few miscellaneous comments that I made note of:
  • Lung cancer patients with ROS1 mutations are rare, therefore, the data about us "dribbles in."  It may take many years to gather needed information and data.
  • He feels reasonably certain that I will have years a head of me, probably not decades, but years.  (That sure beats the matter of months I thought I had in the beginning.)
  • He has several patients with ROS1 mutations, who have been on Xalkori since the beginning of the phase I/II clinical trial, (over 3 years.)
  • If there is ever a time when I should enter into a clinical trial that he recommends, I can always see if there is a trial site at one of the big medical centers in Chicago. 
  • When I asked him how often I should make the trip to see him, he said, "When you need me. You can email me anytime, too."
  • I mentioned that I'm taking a break from my book club because I have no time to read books for pleasure.  I spend nearly all my time reading about cancer.  He looked disappointed and then told us about a great book he's enjoying by Jack Finney called Time and Again.   
      Wynn and I feel this was such an important and valuable meeting.  We learned new information from the researcher himself...and he and Dr. Noonan were so kind.  
_________________________________________________



      It was a beautiful day in Denver and we were lucky enough to meet our nephew, Josh, for lunch.  A great day all around!  



 

Tuesday, April 21, 2015

A Quick Knee Update

       It has been four weeks since I was skiing at Solitude in Utah, fell, and injured my right knee.  Getting insurance preauthorization for a brain MRI to check for metastatic disease took a day.  Who knows why, but it took nearly two weeks to secure insurance preauthorization for an MRI of my knee. There's good news and bad news. I always like to give the bad news first...

     I did some real damage.  Per the MRI, I completely tore my medial collateral ligament (MCL), partially tore my anterior cruciate ligament (ACL), have a segond fracture, and contusions on my femur and tibia.  

     The good news:  By the time I saw my orthopedist after the MRI, things had started to calm down and heal.  The swelling and pain had reduced significantly and I was able to bear weight well.  The MCL and segond fracture will heal on their own and I'll probably be able to get by in life with a partially intact ACL.  For now, my orthopedist doesn't think surgery is needed, as long as things continue to move in the right direction...and since I'm not an elite athlete.  He's optimistic that I may be able to rehab myself back to the point of being able to ski again.  I graduated from the crutches by week 3 and next week, will get a smaller brace.  I go to physical therapy twice a week and am slowly on my way to recovery.  

     The key to full recovery?  PATIENCE, PERSISTENCE and CONSISTENCE. I'm pretty sure I can be persistent and consistent, but I'm pretty terrible at being patient.  

(P.S.  Ohhhh...if only I could rehab my way out of stage 4 lung cancer.)   

    

Tuesday, March 31, 2015

100th Blog...A Week of Firsts

Solitude
     Almost every year I take a week off from work to attend an educational genetics conference.  I go to get continuing education units to keep my board certification current and to spend a few days with old friends.  This year our conference was in Salt Lake City.  If you've never been to Utah, consider putting it on your bucket list.  The mountains are so beautiful and there are interesting sites to see...the Mormon Temple and Tabernacle, as well as, the Family History Library.

       The mountains in the surrounding area have great ski resorts.  Earlier this season, Wynn and I went to Lake Tahoe hoping to get in a few days of downhill skiing, but when we got there, there was no snow.  None.  Nada.  Instead we hiked, worked out at a local rec center and took in a yoga class.  So...when I had the opportunity to get a couple days of skiing in before my conference, I
Vicki
couldn't pass it up.  My long-time friend, Vicki, and I made our way to Solitude, a scenic resort nestled in the Big Cottonwood Canyon about 40 minutes from downtown Salt Lake City.  When we got there the mid-mountain snow base was 56", but they hadn't had any new snow for a couple of weeks.  The next morning we awoke to a snowstorm which was expected to bring 4-6" of new snow.  It was beautiful coming down, but it wasn't cold enough so rather than powder, it was heavy slush.


     Although Wynn and I try to get in a week of downhill skiing a year, I've only improved to an intermediate skier.  I feel comfortable describing myself as a strong blue-run skier, when snow conditions are optimal.  I struggled at Solitude in the heavy, wet snow.
    
     On the second run of our first day, I took a fall.  It was an ordinary fall; nothing really spectacular.  I would tell you the details, but I got hurt and it's painful to relive, so I'm only going to give you the short version.  The snow
Bionic leg
conditions were harder than my ability to ski them and in my wipe-out, I twisted my knee.  Since then, I've had a long series of new experiences: 

  • First time to ride down in a sled pulled by a ski patrol.
  • First time getting evaluated in a slope-side medical clinic.
  • First time in a brace that makes my leg look bionic.
  • First time on crutches.
  • First time riding in a wheelchair at the airport.
  • First time boarding with passengers taking extra time or needing assistance.
      I'm home now and saw my orthopedist yesterday.  He thinks I have an ACL tear, injured or torn MCL, and a fracture of the segond, which is often seen with ACL tears.  I did a number on my poor knee.

     We will know exactly what my injuries are after an MRI, which is scheduled for next week, pending insurance approval.  After that, I'll learn what my options are, but I'm told, likely surgery.  I'll keep you posted. 

My pals, Laurie, Andrea, Vicki, Margie, Stef

Tuesday, March 10, 2015

CT Scans #9, Update and Dr. Paul Kalanithi

     This morning I had an appointment for CT scans of my chest, abdomen and pelvis.  Unexpectedly, I slept pretty well last night.  In the past, the night before my CT scans is usually sleepless.  I suppose I didn't chase sleep because I've been feeling more confident about my cancer status lately.  

A patient's perspective...I'm going in...
     Unlike my previous CT scans, which were ordered with IV contrast only, this time my oncologist added oral contract.  CT scans with IV contrast illuminate vessels and organs, within the abdominal cavity and pelvis region, with greater detail.  Since I have a PowerPort implanted in my chest, I don't need to do anything special prior to getting scanned because the contrast dye is injected directly into my port by the CT tech.  IV contrast is a fairly benign event, except that when it goes in, there's a distinct warming sensation that travels through my body.  The tech always warns me that, "it will feel like you've wet yourself, but you haven't. It's just the contrast."  They are correct.  It's a weird feeling.  

     Oral contrast uses a barium sulfate suspension to allow more detailed imaging of the stomach and intestinal tract.  My oncologist wants me to have CT scans with an oral contrast every-once-in-a-while to get a better look.  Every-once-in-a-while is good because the prep for this isn't fun.  Two hours before the scan, I had to drink, what felt like, a gallon of thick, white, chalky-ish barium sulfate suspension.  Mine was supposed to be berry-flavored.  In actuality, it was probably the amount of a Starbucks Grande drink.  It was really filling and I had trouble downing it all at one time.  Then, an hour later, I had to try to down another one.  



     My oncologist called me tonight to let me know that my CT scans continue to indicate that my cancer is stable, which means that Xalkori is still working for me.  So for now, I stay the course on my miracle medication. 






On another note...

     My relief today was tempered by the sad news that Dr. Paul Kalanithi passed away yesterday of metastatic lung cancer.  He was a neurosurgeon at Stanford University Medical Center.  He was 37 years old.  He had what I have.  He, too, never smoked.  He was well known among my lung cancer community because last year, a few months after he was diagnosed in 2013, he wrote a poignant NY Times article entitled "How Long Have I Got Left?  

http://www.nytimes.com/2014/01/25/opinion/sunday/how-long-have-i-got-left.html?_r=0 

       Each time I learn of another lung cancer patient's death, two thoughts race through my mind.  I am instantly reminded that I, too, will die of lung cancer.  Then I wobble through a wave of survivor's guilt.  Today I wondered why Dr. Kalanithi died less than two years from the time he was diagnosed and I'm still here 27 months later.  My heart breaks for his young wife and infant daughter. I got to live nearly 20 years longer before being strapped with lung cancer.  Dr. Kalanithi did not get to see his daughter grow to adulthood as I have with my children.  I cannot escape the reality of my diagnosis, even though my scans were good today.


Rest in Peace, Dr. Kalanithi. 

   

Sunday, March 8, 2015

Life Goes On...again





 

     


     I've posted this photo before.  This sapling is growing out of an old stump and is my metaphor for the continuation of life.  I see a delicate young sapling with it's roots safely protected by the wood and deep roots of an old tree.  As corny as it is...I think the symbolism is beautiful. 


     This past week, our niece, Jayme, and her husband, Andy, had their first baby.   Meet Asher Reid! 


 Isn't he BEAUTIFUL!

     
     Well done, Jayme and Andy!  Mazel tov to Asher's grandparents, Bob, Eudice, Dick and Nancy.  Hearty congratulations to uncles and aunts, Larry, Leslie, Harold, Caitlin, Jenny and Jon.