My Illness prior to Sept 7 2014

Summary of my case history

I was diagnosed with cancer in my lower left and upper right lungs in January 2012 by a broncoscopic biopsy. A PET scan then showed it had metastasized (spread) to my bone, and I was at stage 4, advanced cancer, inoperable. A subsequent biopsy to determine the kind of lung cancer showed I had adenocarcinoma, specifically non-small cell lung cancer (NSCLC) - typically non-smoker and Asian, with the EGFR+ mutation. The standard treatment for this kind is a daily oral tablet of Iressa commenced in early February. Iressa inhibits the enzyme used by the EGFR+ mutation to grow.
The first symptoms I experienced were back in October 2011 after two colds, followed by coughing spasms with occasional mucus tinged with blood. X-rays and CT scans, initial misdiagnoses of pneumonia, TB, etc. eventually sent me to a chest physician who ordered the broncoscopy above.

Reactions

Many, if not most, of you will want to pray for me. I am comforted by that because it shows you care for me. But you should also know that I am agnostic, and do not believe in an afterlife. I have no fear of the nothingness after death but fear the pain before that. While I appreciate the trouble that many have taken to apprise me of alternative therapies and special diets, my preference is for evidence-based medicine, complemented with good commonsense nutrition and exercise. Yokelin and I work out in the gym regularly. While there is no evidence that a "positive attitude" prolongs life, as long as my cancer is in remission I will enjoy learned discussion, Rabelaisian humor, good food and wine, travel, music, reading, and vigorous but friendly political argument. I have achieved all that I wanted in life. Foremost are my independent minded wife Yokelin, our two talented sons Kerwyn and Lyndon, who married two equally talented women, respectively Amanda (Stephens) and Petahn (McKenna) and each presenting us with our three granddaughters respectively Lisa and Josie (parents Kerwyn and Amanda), and Noelle (parents Lyndon and Petahn). (Lisa, Josie and Noelle provide me with the best motivation to survive as long as possible without my cancer progressing.) Then there are my numerous past doctoral students and the post-doctoral fellows I have mentored - all of them now holding national and international leadership positions in industry and academia. Their career success is my joy and reward. You can see an album of happenings related to my and their careers. On Green and left wing politics I need not say much as my Facebook activities speak for me. I have made ample provision for the love of my life, Yokelin, to enjoy her many future years with her CBN classmates, her sister, and some of our mutual friends. And of course I have your comradeship, which I have treasured all these years.

Living from Scan to Scan

Cancer takes an emotional and physical toll on its victims. I am sure that my emotions will be like a roller coaster - ebullient at times but sad at other times when I reflect that I will likely not see my granddaughters grow up. At most times however I do not let the extremes occupy my thoughts, keeping myself busy with the company of friends, discussing all manners of things - science, mathematics, cosmology, cognition, game theory, religion, politics, economics, green energy among them. I read books, plan social engagements around meals and coffee as if I do not know when I will say my final goodbye. Essentially I live from scan to scan, hoping for each new scan to announce cancer control, or to signal new treatment if available. You may be curious however about how I am affected physically by the illness and the treatments. Therefore on the right hand column I have placed a link to recent photos of me and family, sometimes with friends and relatives. I will update this page whenever I have new CT scans, or if my health changes. Meanwhile, thanks for reading. Do not feel obliged to comment as I take it for granted that all of you wish me the best. All comments here will be visible to anyone who visits this page. To say something personal to me, you can email me or send me a message in Facebook.

Added mid February 2014

 Who gets lung cancer? 

In fact anyone with a lung can get it. 

This article tells a story about a lady who was unfortunate like me.

Let me explain why in the larger scheme of things cancer is really an evolutionary mechanism. The way evolution works is by random mutations in our DNA, leading to changes in our biology. These mutations are rare but may happen in cell division. Most mutations that are "bad" are eliminated by our immune system but the ones that "escape" can become cancerous. A good number are just harmless.
What has this got to do with evolution? Well, new species arise from existing ones by evolution. The vast majority of mutations are in fact "bad" and eliminated, or become cancerous and kills the host.
Once in a very very blue moon a mutation confers an advantage, e.g. our walking gait, our larger cerebral cortex - and natural selection reifies that advantage.

We may not like cancer but if it had miraculously disappeared when our ancestors were homo erectus we would still be homo erectus ("Peking man"). There is a mathematical reason why if we live a long time we will get cancer. This is because our cells have to divide (reproduce) for us to live, and each division can result in a "bad" error that may not be caught by our immune system. We have a huge number of cells - so each division that only has a very very small probability of an uncontrollable error will become in the limit almost a certainty by virtue of the enormous number of divisions, the extremely large number of cells, over time. This is called the Poisson Limit Theorem. 

So in a very deep sense I am a victim of a limit theorem and evolution. I take solace from this understanding.

End of February addition

Survival Statistics

Cancer survival durations are often given in medians - how long before an event when the median (half) of the patients get there? How many months before the cancer shows signs of "progression" (become active again)? What is the median survival time? Links on three informative essays on the meaning of the statistics are these:

Stephen Jay Gould on Medians

New entry since Jan 2014.
Cancer survival graphs
How long have I got left?

Periodic Reports 

Update Friday 18 May 2012

I had a CT scan done last Friday 18 May 2012 of the regions where the PET scan showed the primary lung node had metastasized to my bone - right hip, two lumbar and some ribs.
On 20 May 2012 Sunday, I saw my oncologist Mark Wong at Westmead Hospital. Mark looked at the CT scans and agreed with the radiologist's report. The Iressa is working as it reduced the primary node in my lower left lung a little and the ramified nodes in the bone are stable. These nodes would otherwise have doubled in size in the past 4 months. Some lucky patients have dramatic node shrinkage but I do not, just holding them to the same size. If that continues I am fine, But in time the Iressa fails for most when the cancer mutates again. Other options then come into play; I will cross the bridge when I come to it.
In the meantime Iressa has given me a normal life, and I am very grateful for that. The average stage 4 patient like me has a remission of 18 months, so we are talking about July next year. If I am a lucky patient the Iressa will continue to work much longer. My oncologist son Kerwyn has a patient matching my stage 4 case history for whom Iressa is still working after 3 years. Yokelin's (my wife) oncologist brother Tan Meng Kuan in the Tung Shin Hospital in KL has a stage 4 patient still ok under Iresaa for 4 years. It is highly individual.
Up to now I feel well, so nobody who does not know would suspect I am terminally ill. It is terminal as stage 4 lung cancer is incurable, but the longer I live the better the chance that it can be managed. Those who have recently met me or engaged me in Facebook or email forums will see that I have not - and will not - let the bad prognosis attenuate my passions and love of the good life.

Update Tuesday 19 June 2012

I saw my oncologist Dr Mark Wong today for a monthly checkup. Between the last one and this I suffered two colds in succession, the ones doing the rounds in Sydney. A lingering cough, with blood tinged mucus sometimes, got me worried that Iressa had stopped working. However, Mark was not concerned as I had no other complaints. In any case my cough has lessened quite a bit now and the blood tinge has mostly gone. Yokelin and I have resumed gym workouts - the hiatus was due to our bad colds. At our age we will build up to our previous level over 2 weeks. I see Mark again next month just after a CT scan to check if the tumor is under control. Well, so far so good. If the July CT scan is ok, I expect Mark to allow us to go to the VI Reunion in Cambridge in late August to early September, and thence to join VIOS Ivy Ang Humphreys and her husband Hugh in a Birmingham canal trip for a week, followed by a tour of Croatia organized by VIOS Pheng (Khoo) Beh. Of course my old VI buddies are already urging me on to much mischief at the Reunion, but if they do not desist I will plan surprises for them, ha ha!

Update Tuesday 17 July 2012

After a CT scan last Friday I saw Mark today. This is the result of the scan. The primary lung tumor, the one in my left lung has shrunk by 30% since the initial diagnosis. The secondary tumor in my right lung has possible evidence of further growth - it was cup shaped in May but the hollow is now filled in. There are two possibilities. The first is that Iressa is beginning to lose its effect. The second is that the filling in is actually fluid and not cancer. The metastases to my hip, spine and ribs are stable. The upshot is that Mark wants me to get another CT scan on 10 August and he will see me on 14 August. A PET scan is also being considered as it provides a more accurate picture of what is going on. If the tumors are stable Mark will allow me to travel, otherwise he will begin intravenous chemotherapy that usually has unpleasant side effects and of course travel is out. At the moment I have a cold and a bad spasmodic cough from it. Prior to it I had a cough too, but the kind from post-nasal allergy drip, and I have been informed that many, if not most, lung cancer patients have some cough anyway. Other than this minor complaint I do my usual things. If worse comes to worst I will have to cancel my attendance at the VI Reunion in Cambridge and the Birmingham canal trip too. The Croatia trip is probably already out. How much time does intravenous chemotherapy buy me? Again the data is statistical. At least 6 months of good quality is expected, much longer in many cases. Iressa treatment sometimes becomes effective again after it! It is very individual.

Update 14 August 2012

Today I saw my oncologist Mark Wong. He said that my PET and CT scans on 7 August showed that the secondary suspect node in my right lung is indeed growing and not fluid. However they also showed that the primary in my left lung had reduced and a secondary in my hip bone has vanished. This kind of mixed result is not uncommon in EGFR+ mutation patients, with the majority of nodes responding to Iressa while a few (one in in my case) resistant to it. Mark assessed the progression (that's how an increasing node is described) as not aggressive enough to require immediate intravenous chemotherapy, so the good news is that I can travel to the VI Reunion, Croatia and Greece, returning home for the chemo to begin on 3 October. The other good news is that Iressa will continue to be administered to control the other nodes. The intravenous drug side effects are mainly some fatigue, possible nausea leading to appetite loss - a total cycle of treatment lasting 6 weeks. En route to the UK we will be in Malaysia for 10 days, but on the way home it will be merely an overnight stopover. The intravenous infusion has a schedule like this: 1 day of many hours with two drugs, then a week later a shorter session because only one drug is administered, and then a week off before another infusion. Well, my Kindle will be in full use while I am being infused. The upshot comrades is that other than a spasmodic cough that can be alleviated with off-the-shelf palliatives I am actually fit, and perhaps even more important, I remain socially, politically, philosophically and mathematically engaged.

Update October 5 2012

Yesterday I had my first chemotherapy additional to the oral tablet Irresa. This was after we returned from our tour of Croatia, the VI Reunion in Cambridge, and a canal boat trip. As I will be adding a few more photos please re-visit this page a few times later. First the chemo. The schedule will be like this. First session (I just had this yesterday) is an IV combination of gemcitabine and carboplatin, two cytotoxic drugs. A week later I just get the gemcitabine. Then a week of rest with no drug. The cycle then repeats, 2 cycles for me. Side effects are theoretically wide ranging but their reputation exceeds the reality. The worst for me was the fatigue because I did not sleep a wink that first night - it's the initial chemo effect. When I cannot sleep I do not count sheep. I simply try to figure out novel solutions to things like Ramsification - you know, the attempt to internalise theoretical terms by clever, exhaustive property predicates. Imagine trying to Ramsify our chemistry teacher Mr Sim! Anyway the next 4 days my body exacted its revenge and I slept for hours at all times of the day and night. On the 6th day I recovered, got around hesitantly but was ravenous.
What is the prospect of a good remission for me? Well, here is the rub. THEY do not know! Who are THEY? My oncologist, and even my elder son Kerwyn the radiation oncologist is unable to help. Why? Heterogenous adenmocarcinoma where some tumors have the EGFR+ mutation that responds to Iressa while others "learn" to defy it, have little data to support effective treatment. So I am a bit of a guinea pig. Whatever, I will continue with Iressa while the IV treatment is on. How good is the gem + carbo mix. I do not know - THEY like it, but it is almost always a matter of time before the tumor sneaks past any cytotoxic gateway. While I will avail myself of all reasonable treatment options to stay healthy I am prepared for the worst.
I am currently (18 Oct) in my rest week with no chemo. A partial update will appear soon, when my second cycle of chemo begins on 25 October. Tiredness is not really an issue but gym is out of the question, and I am still in semi-quarantine.

Update Thursday 25 Oct

On 23 Oct I saw Mark Wong my oncologist. He showed me the CT scan taken just after I got back from the 6 weeks away. Not good. The misbehaving node in my right lung is not only now bigger but it has metastasized small ground-glass like cancer speckles around it. Well, the gem + carbo chemo over the last 3 weeks was intended to fix that, and I went for the second cycle today. What has the first cycle achieved? Indirect evidence is that something may have happened as the nasty cough I had is now less severe and not as often. Moreover the blood that tinged the mucus coughed out is mostly gone. I feel a lot more "normal" and have sneaked out to shop when there are no crowds. If the second cycle reinforces this improvement the subsequent CT scan in about a month may be encouraging. The infusion today was uneventful. Mood wise I am fine, just as outraged by right wing idiocies as ever, and wanting to eat yummy foods. Not all is bad news. The metastases to my bones are virtually gone - Iressa fixed that. The primary tumor in my left lung is stable, probably Iressa's guard too. It now depends on how the gem + carbo works on the right lung tumor.
I just ordered a Kindle Whitepaper, so I plan to make good use of it for a few months - a good sign I am not ready to "shuffle off this mortal coil" yet :-).

Update Tuesday 4 Dec 2012

I had a CT scan last Friday to see how my tumors have responded to the 3 cycles of chemo so far. You may recall that the chemo was to treat the right lung node that became resistant to Iressa. I saw Mark's colleague today, the oncologist Dr Oliver Klein since it was a very busy day for all the oncologists. Oliver pulled out my scan - it was sent electronically to him - and he was very pleased with the result. I had reported earlier that my cough is now very much reduced and the blood tinged mucus is gone. Well, the CT scan verified objectively these improvements. The right lung node has reduced considerably, at least 50%. Oliver said that I am responding as well as hoped, and more improvements may come with the 3 more cycles of chemo I am due to receive. The primary in the left lung continues to shrink too but slowly. No new tumors were evident. All told the results are as good as a stage 4 one year patient like me can expect - half of the patients with my history are already dead. I am of course not out of the woods. Cancers are "smart". Most of them "learn" to circumvent blocks placed in their way, whether it is an oral targeted drug like Iressa or the carbo-gemzar chemo I am getting. When progression of the cancer happens, the oncologists may - or may not - have recourse to treatments that block the tumor in other ways. So it is a fact of my life that I have to live from scan to scan. Celebrations are however in order whenever a happy family event transpires - birthdays, graduations, wedding anniversaries, etc.
The upshot is that I should be fine for the next few months with continuing good quality of life. Maintenance chemo may be on the cards after the next 3 cycles - that is a 3 or 4 weekly chemo that attempts to "hold" the tumor. If that works well my longer term survival is in prospect. I am lucky so far that I have virtually few side effects of the chemo, which indicates I am a good candidate for a maintenance schedule.
To give you an idea of how I am coping - my mood and health in general, here are photos taken in the past week. On Thursday last week 29 Nov, I had lunch with my ex-student Kevin Irwig in Macquarie Center:

Last weekend our elder son Kerwyn, his wife Mandy and their daughter Lisa took us to Mandy's parents' cottage in Hawkes Nest for a very relaxing holiday. Here is me in the foreground and Lisa and her parents in the background.

Here I am with my elder granddaughter yesterday at the Australian Reptile Park:

At noon today, 4 Dec 2012, I met with the Canadian AI Professor Randy Goebel for lunch in the Topiary Cafe in Epping. Here is a pic of us:

This Saturday several of my friends who are active in AI and related areas and here in Sydney to attend the Australian AI Conference are coming to my house to see how I am faring. Here are some photos of the event.
I am gradually working toward getting back to the gym. So far I have only been walking a couple of kilometers. Soon I will speed up and slowly increase the distance.
Added on Monday 17 December. I went to UNSW to see my colleagues, coffee and lunch, catching the train and express bus there. We had a great time. Here are photos of this pre-X'mas fun meet.
On Christmas day 25 Dec 2012, my sister Alice Foo Wong and her husband Michael Wong hosted an extended family lunch on occasion of the Sydney visits of our siblings Ann Foo Flowers from CT, U.S.A. and Victor Foo from KL, Malaysia. Here is a picasa album of this party.

Update Tuesday 12 February 2013

I had a CT scan last Friday and my oncologist Dr Mark Wong saw me today. He looked at the scan and the report. The summary is that the chemotherapy is still working, still shrinking the tumor but at a slower pace than before. Ten days ago I had some blood tinged mucus and worried that my tumor had progressed. It was a false alarm. The bleeding was due to the tumor position where it irritated the bronchial tube, causing bad coughing. It stopped two days ago. As I had mentioned before, in each cycle of chemo there are two IV infusions. The first has 2 drugs - carboplatin (carbo) and gemcitabine (gemzar). The second a week after only has gemzar. Each cycle is 3 weeks, so I get a week off with no chemo after the second infusion. A very high level description of how carbo and gemzar work is this. Gemzar replaces a building block of the cancer cells by one that inhibits their DNA replication. Carbo interferes with the DNA dynamics of the cancer cells by structurally altering their internal linkages.
Unfortunately carbo is cumulative in the body and past a certain concentration it damages the kidneys, usually only about 9 cycles of it can be tolerated. Also, both carbo and gemzar can cause hearing loss and I may have been so affected. Hence Mark will soon switch me to a new chemo without these problems. the reason for delaying is because I will get a comparative audiology report first - "let's stay as long as possible with a treatment that has so far worked".
I next see Mark in early March after another cycle of carbo-gemzar, and will continue with two more cycles if the audiograms show no objective hearing damage. Otherwise the chemo will be switched. You all know that chemotherapy cannot cure cancer. At best it delays the inevitable. So I continue to live from scan to scan.

In the meantime here are recent photos.

Yokelin and me in mid December 2012 at the 50th wedding anniversary party of my cousin Mimi Foo and her husband Jim Lee.

Me, Aleksandar Ignjatovic and Mohammad Allahbakhsh. Aleks is my UNSW colleague and Mohammmad is his PhD student from Iran. I help Aleks supervise Mohammmad. The BBQ party was hosted by Aleks and his wife Sharon Choi. 9 Feb 2013.

A VI alumni lunch at the Penang Cuisine, Epping. Clockwise from left front: Wan Kee Yio, Zen Loy, Polly Loh, Heng Loy, Yokelin Foo, Norman Foo, Chris Loh. End of Jan 2013.

Prof Mary Anne Williams, me and Prof Peter Gardenfors, dinner in Eastwood, 14 Feb 2013.

Prof Abdul Sattar, me and Prof Abhaya Nayak, lunch at Macquarie Center, 22 Feb 2013, a day after my first carbo-gemzar infusion of the 7th cycle. Appetite great - that's my fish and chips there! 

Yokelin and me with UNSW CSE Finance Officer Kathy Mitris, K17 Cafe, 26 Feb 2013. 

 

 

 

 

Update Tuesday 9 April 2013

I had a CT scan last Friday and saw Dr Mark Wong my oncologist today. The radiology report was pleasing - both the primary and secondary tumors in the lungs have shrunk further, at least 20%. Hence the chemo continued working. But my hearing has gotten worse with the extant Eutachian tube dysfunction playing havoc often with intelligibility. To ameliorate that side effect Mark is switching my maintenance chemo to Alimta. I begin this new chemo next week after taking daily folate for a week to counter its loss due to Alimta. I also need an injection of Vitamin B12 every 9 weeks. The Alimta schedule is less onerous than the Carbo-Gemzar I have had so far as I only need an IV infusion every 3 weeks. 

I hope that I will have benign side effects with Alimta as I did with Carbo-Gemzar. 

How long can the maintenance chemo with Alimta continue? There is no limit so long as it holds the tumor in check. There are patients for whom this period is only months and others have been on it for years. I am grateful for the time and quality of life that my treatment has already given me, so I am not about to mull on my prospects.

In early February Yokelin and I were blessed with our 3rd granddaughter Josephine Mary Yu-An Foo, 2nd daughter of Kerwyn and Mandy,  sister to Lisa, cousin to Noelle (daughter of Lyndon and Petahn).

Here is happy Josie at 7 weeks :-) She is big - 97th centile in weight.

In early February Noelle had her 2nd birthday party in Camperdown Park.

Here she is with her mom Petahn and grandma and grandpa.

Near the end of this month Lisa will have her 3rd birthday party, an event we are all looking forward to.
















There are many fun happenings in our lives indeed. Typical is this party given by my buddy Abhaya Nayak (an AI Prof at Macquarie) and his wife Kamalini on the occasion of the visit of our long time Kings College colleague David Makinson (the M of the AGM belief revision logic) is below. Other AI Profs here are Dongmo Zhang, Michael Thielscher, Rex Kwok.

Guest of honor David is standing on the right. Leftmost is Prof Yan Zhang and Prof Maurice Pagnucco is two to the left of David.

A succession of dear friends have visited me recently. Their unspoken motive is my illness, but they left happy to see me in good shape. Here are some:

Chee Liang and Chee Wah visit

AI Profs visit

Susie Lim visits

AI Researchers Party end Nov 2012

Advance birthday party for Pavlos, Yan, Abhaya and Norman.

Update Tuesday 27 August 2013

I had a CT scan last Friday and saw my oncologist Dr Mark Wong today. It has been nearly 5 months since the previous CT scan. I have been on Alimta, a chemo infusion used for maintenance (i.e. controlling the tumor), for the past 4 months. Today the CT scan showed that Alimta is doing its job - my tumors are stable, no change from the previous CT scan. Mark is happy with that and I am relieved - as I said before I live from scan to scan. I see Mark every 3 weeks and he said that if I feel well when I next see him he may change the schedule to once every 6 weeks, and he will only order a CT scan every 4 months.

Stability of my tumor is of course not a cure. There are patients on Alimta whose tumors continue to shrink but stability is a good result. I hope I will be among the lucky ones for whom Alimta keeps working for many months if not years. It has spared me bad side effects - I only feel fatigued for a couple of days and not severely - so my life is pretty normal. I continue taking Iressa that controls my primary tumor and the 
metastases, both also stable.

Minor Update Wednesday 18 December 2013

We went to Malaysia on 2 November  Mark excused me from one chemo session.

At the end of November I celebrated my 70th birthday in the Lake Club in Kuala Lumpur with my friends from high school (VI, SJI, etc), universities (Canterbury and Michigan), Telecoms, and a number of relatives and friends who did not make it to our other gatherings.

70th Birthday Party

My relatives visit us over Christmas 2013.

Our family Chinese New Year dinner 

We returned to Sydney on 3 December. I had a chemo session on Thursday last week, and today is supposed to be one of my fatigue days. However I went to campus to have lunch with colleagues Rex Kwok and Alan Blair. No real fatigue as such but some indigestion that did not prevent me enjoying food and coffee! In Malaysia my sons hosted my 70th birthday party. Watch for our 2013 family update mail for news on this and other events. My next CT scan is in February 2014.

Below are recent photos of Yokelin and me, and our family.

  




Taken in our backyard in May 2013.

When we visited Penang in June 2013. In the Peranakan Heritage Mansion.

Our family in May 2013. Lyndon and Petahn on the left, Kerwyn and Amanda on the right. Noelle on the left with her parents, and Lisa and Josie on the right with her parents. 
  

My Alimta infusion in Westmead Hospital, late January 2014, exactly 2 years after my 2012 diagnosis. This Westmead Private Hospital Oncology Team that has kept me alive and well so far. Taken in the clinic today at my chemo session, every 3 weeks. Standing L to R: Head Nurse Michael Cresp, nurse Beth Mott, pharmacist Anousheh Page. Sitting: nurse Sally Carey and me. Absent oncologist Mark Wong and nurse Karen Easey.  

Update !2 Feb 2014

I had a CT scan last Friday 7 Feb, 5 months after the previous one in August last year. I met with my oncologist Mark Wong's registrar as he was very busy yesterday. I apologize for the technicalities below as many of you will be bored by them. However, understanding treatments for adenocarcinoma stage 4 has become a hobby for me, alongside my other preoccupations like politics, mulling on game theory and crowd sourcing, ethics, spreading off-color jokes :-). Ignore the details past the summary.

Summary

The scan showed no change in the primary left lung lesion and the old metastases to the hip bone and some spinal regions - stable from May 2013. But the right lung lesion reduced in size, a bit surprising as Alimta that is being used to hold the tumors at bay was simply keeping them in check. But a happy result of course. Next scan about 2 to 3 months from now. I am feeling fine - a side effect of tearing eyes has bothered me from time to time since November last year, but I just wipe the tears away. "Crying for the ills of mankind", I reply when I am asked :-). 75% of my cancer cohorts (same stage 4 diagnosis two years ago) have gone to the happy hunting grounds, so I have no grounds for complaint. 

Clinical details

My treatment has changed. The targeted drug Iressa that blocks an enzyme path for the EGFR+ mutation responsible for my original tumor will no longer be used. From now on I will only be on the chemotherapy Alimta every 3 weeks. A CT scan wiil be made after 4 rounds of just Alimta chemo to see if my tumors are in check. 

There are 3 reasons for this change in protocol. The first is this:

Alimta for maintenance

You will see that the maintenance treatments for NSCLC and adenocarinoma are Alimta or Tarceva. Tarceva is related to Iressa and like it is a targeted drug. You can also see that either alone works better for EGFR patients like me. Moreover they were only recently approved by the FDA for maintenance therapy after clinical trials for effectiveness, Alimta in 2009 and Tarceva in 2010. Quite new. 

Astra-Zeneca that makes Iressa was very generous in providing it free for adenocarcinoma EGFR patients while waiting approval for addition to the PBS. It has now been approved, so the provision by Astra-Zeneca is no longer needed. The details are here:

Iressa PBS 

The third reason is my response to Iressa and Alimta from August last year. As I mentioned above the primary in my left lung and the bone metastases were unchanged since August last year. Iressa was supposed to treat them but now my oncologist Mark Wong is not sure if it is just Alimta that is holding them stable. Certainly Alimta has reduced the right lung secondary. So it seems reasonable to test the hypothesis that Iressa is no longer needed. A simple way to do that is to discontinue Iressa while continuing Alimta for, say 4 cycles, and then doing a CT scan. If the tumors remain stable then Alimta is confirmed to be the only agent needed. Otherwise another regime will be tried.


Added in July 2014.


In April Mark allowed me to accompany Yokelin to KL en route to Tehran to celebrate the wedding of her nephew Andrew to his Iranian wife Maryam. We left in the last week of April. I was permitted by Mark to skip one chemo session while I was away. On my return in late May I have to do 3 rounds of chemo before a CT scan will show if the Alimta alone is working to keep the tumor in check. 


But before I report on the CT scan, here are two photos of us in Iran. Follow the links to the albums.

Yokelin and I are with her cousin Bernadette, mother of the groom Andrew.

This was in Necropolis - where the kings of ancient Persia were interred.


Necroppolis Album

Yokelin and me in Persepolis, the capital of ancient Persia. 

Persepolis Album 

I wrote a report on this Iran trip: Iran travelog.

Update 20 July 2014

Well, I had a CT scan last Friday, after a total of 3 chemo sessions after we came home from Iran. The radiologist's report was pretty good news - my tumors are stable. Thus, Alimta continues to work in its maintenance without Iressa - the experimental design confirms Alimta's effectiveness. This is the kind of experimental design I like - only one variable! Unlike my economist and psychologist friends who have to use regression analysis to isolate the variable of interest.

What comes next? I see Mark on the coming Tuesday. I believe he will schedule my next CT scan in 5 months - mid December - unless there are signs my tumor misbehaves. This tumor has a real life of its own, I read how cancer tumors seem to search for opportunities to mutate into DNA pathways that defy drugs and chemotherapeutic agents like Alimta. So when I say "misbehave" the anthropomorphic is apt.

Whatever, it looks like my "living from scan to  scan" is unfolding ...

Temporary Update Thursday 4 Sept 2014

My tumor unfortunately misbehaved.  

Last Sunday 31August 2014 Yokeiin and I went  to the city  At the Town Hall Yokelin and I went to the Sedap eatery.

As we sat down to order my left face went into a spasm extending to my eye. I then passed out. Yokelin later told me that two young gentlemen behind me supported me and called the ambulance. The next thing I remember was exiting the ambulance at the RPA hospital with nurses and doctors beside me. My sons and wife were behind them.

Soon I was wheeled into a CT scan machine - a scenario familiar to me - and to cut a long story short, the scan showed two new lesions in my brain that the previous CT scan in March did not reveal. The RPA scheduled me for an MRI the next day - it is more detailed than a CT - and you can guess what. The MRI showed the two lesions from the CT scan to be the bigger ones, measuring  little more than 2cm. But it also piked up 2 other smaller 1cm lesions, one of which may be the reason for my recent irritability that Yokelin had noticed. 

One of the bigger lesions is near Broca’s area, causing inflammation there. That was the cause of my partial loss of “names or people and entities” that puzzled me over the past few months. The other larger lesion was responsible for my loss of balance that only people used to my old fast walking pace noticed.  My neurosurgeon Dr Jonker of the Royal Prince Alfred Hospital (one of Sydney's Uni Hospitals)  will operate to remove them on Monday - I will be conscious while that happens as he wants my continual feedback. I kidded him we will carry out a Socratic dialog :-). The smaller lesions will be zapped using of focused radiotherapy. I will be in the RPA for a few days.

None of these is of course without risk. It can cause paralysis, stroke, etc. So I saw my GP to get an Advance Health Directive signed tomorrow so that no “heroic” measures are use to preserve my life, e.g. “just drip feed me.” The risk is small - Dr Jonker put it at 1-2%.

However you can read on the internet that once a stage 4 adenocarcinoma patient has a metastasis to the brain the “curtain call” is perhaps no longer than 4 months despite surgery and radiotherapy. The median - when 50% of the patients exit - is less than a year, and most die within 2 years. But Dr Jonker also confirmed that he is still seeing patients like me 4 years after surgery. It seems very individual indeed.

My granddaughters boost my hopes for a longer life ahead. Here are very recent photos of them.

 



Noelle is the 3.4 year old only daughter of our younger son Lyndon Foo and his wife Petahn McKenna. Here she is pretending to be Mary Poppins with a magic carpet.

Josie 1.6 years old and Lisa 4.4 years old are daughters of our older
 son Kerwyn Foo and his wife Amanda Stephans. Here they are wheeling their "babies" on strollers.

Lisa drew this owl!

Noelle drew this person!

 Lisa now bakes yummy cakes! Here are her banana and nut cupcakes I took to the RPA Hospital to eat after my PET scan on 4 Sept after my lunch.

After my Sept 8 operation