Update from 9 March 2015
Please go to this for earlier posts: For reports on or before Sept 8 2014
There is a new cancer trial in Westmead, a Sydney University Teaching Hospital that I may be joining.
I had a biopsy to see if I qualified. The prerequisite was that my cancer had the LPD-1 mutation. The biopsy was done in PRP near Westmead 10 days ago. I turned out positive for LPD-1. On 9 March I had a CT scan of my chest, abdomen and pelvis. I went to Westmead for a lung function test and a blood test in preparation for joining the trial. The CT scan showed the cancer in my chest progressed. Dr Nagrial, my oncologist, was not unduly alarmed by the progression as the previous existing masses were small, about 5mm, doubled to 9 mm, but the treatment was merited and this trial was appropriate.
The details of the trial - phase II - are these. Patients will be randomised by a computer 2/3 to receive the new immunotherapy drug and 1/3 or an older one. Patients will be told which drug they have been assigned to.
This trial is a study exploring Pembroluzimab (these are a new class of drugs that are looking very promising as a cancer treatment particularly in melanoma and lung cancer). They are an immune therapy that activate your bodies T cells (an important part of the normal immune system) to attack the cancer. Pembroluzimab (Pembro for short - Merck name Keytruda) has the technical name MK3475-010. The older drug with which it will be compared is Docetaxel also known as Taxetore. "In an earlier Phase I for Pembro many patients did well, conferring good results to control their cancers for very many months and often years." Docetaxel also has a good record of controlling the cancers for also many months. So whichever I am given The Grim Reaper may have to wait some before he harvests me :-).
My oncologist Dr Adnan Nagrial outlined the above italicized Westmead quotes above on advanced melanoma patients. It is now in Phase II trials for advanced lung cancer that I am joining.
Immunotherapy drug Keytruda has this mechanism: Keytruda Action. This "generic" action of removing the PDL-1 blocker that prevents our immune response to attack the cancers is allegedly the next promising treatment for advanced cancers. There was once a hope that high LPD-1 cancer tumors would be a good marker, but even some low LPD-1 patients do respond well. Much remains to be discovered. God kinda forgot to make our immune system self-repairing as this cartoon indicates.
As a metaphor for the LPD-1 blocker of our immune system detection of cancer cells, I think of it as a padlock on the mechanism of "search and destroy". To unlock the padlock needs something like Keytruda. But evolution also needs means to overcome that too! So ultimately we cannot win.
Mortality is the price mankind has to pay for evolution. Otherwise we'd all be stuck at being homo erectus, with no meanderings on epistemology and ontology.
While waiting for the new trial, first infusion 17 March, I am not idle. Here is a lunch on 7 March with Yokelin and my firiends at Albees near UNSW on 14 March. The "excuse" - heh heh! - if one is needed is Gerd Brewka's from Germany as a guest of Michael Thielscher.
Michael was away in Perth to attend a conference. Maurice Pagnocco was away visiting his parents. Here from left to right are Gerd Brewka, Dave Rajaratnam, Yokelin Tan, me, Aleks Ignjatovic. All in one way or another formalists of human cognition. We know how hard it is!
The usual measurement for a drug's effectiveness are at least two : median survival time, and progression-free time. The "many months" I mentioned are 15 months survival median for Docetaxel and more than that for Pembro. There is also a Quality of Life measure. We do not never know which part of the curve one lies in. Side effects should be bearable, but hair loss for Docetaxel is common. If one looks at the information on side-effects of Docetaxel one can be very frightened by them! However I had looked at two chemo lines I had before - Carbo-Gemzar and later Alimta - both also had huge listings of side-effects. I mostly escaped them. So if I am randomised to be in the Docetaxel group I hope to be spared the worst.
OK, today 17 March at my chemo I was told that I will be on Docetaxel (aka Taxotore).
How Docetaxel Works
Yes it is a bit technical. The "median survival period" for it was 15 months. That's the length of time half its patients' cancer are still alive after treatment begins. I will kind of "know" which side of the survival curve I am on after the side effects appear,. If they are mild and perhaps 2 or 3 CT scans show reductions in tumor size I can afford to be somewhat optimistic to see this coming Christmas.
My take on this is to stick with my life "from CT scan to CT scan". For the moment it is 9 weeks, 3 infusions.
Today is 18 March, the day after my first chemo. But there is an 80% chance I will lose my hair soon. The patients randomised to receive Docetazel will be given the option of switching to Keytruda if the latter provides better outcomes than Docetaxel at the end of the nominal trial period of 1-2 years ("playing by ear" is what the Senior Researcher Dr Danusha told me about the duration of the trial.) But there is no guarantee Keytruda will work for any LPD-1 positive patient - cancers are very individual indeed. Added on 5 April, I have lost 80%of my hair, and the drug has caused more tiredness tan the Alimta I last had in August 2014, but I eat fine and Yokelin says I am still very greedy!
Here are my main motivations for battling this dread disease!
My youngest granddaughter Josie, just past 2 years old. "Let's play doctors!"
My middle granddaughter Noelle, almost 4 years old.
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My oldest granddaughter Lisa, almost 5 years old.
This photo of me with my cousin Julia D'Silva visiting me from Singapore was taken at Macquarie Center on 8 April 2015. As you can see I had a 1 cut haircut as Docetaxel caused my hair to shed. I will be bald for as long as I am given Docetaxel every 3 weeks.
Small update 15 April 2015
I saw my radiation oncologist Dr Nitya Patanjali re the head MRI I had two days ago. The radiologist said most of my head tumors were stable, but noted two spots which were necroses from previous radiation or small new tumors. After the next MRI he will know whic is the case. So let's wait till July when my head MRI is done.
As I have said before "I live from scan to scan".
It's OK as I am prepared like this. A bit more time to see my grandkids grow up some would be good.
As I have said before "I live from scan to scan".
It's OK as I am prepared like this. A bit more time to see my grandkids grow up some would be good.
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