Revisiting the Results and Looking Ahead

Welcome back to the next Thriving Not Just Surviving blog post. I would like to use this post to further review and discuss the results of the last CT scan.

It’s still sometimes difficult to realize how well everything is going. As I explained last week, no one could have predicted this degree of tumor shrinkage at such an early stage in the treatment plan.  

The most amazing part of the test results showed that only a single tumor in my right lung remained. While this is certainly great news, it’s worth noting that millions of cancer cells need to be present in order to be viewed in a CT scan. Therefore, there is a chance that there are small amounts of cancer still present in these “clean” areas. However, given the rate of tumor shrinkage, it is also likely that the remaining hidden cancer cells will eventually be eliminated over the coming weeks and months.

Despite the smashing success of many immunotherapy drugs, one of the primary critiques against using them is the lack of understanding regarding the massive discrepancies among patients’ responses. Some patients, like myself, experience aggressive responses from the immune system and see significant shrinkage quickly. Others experience a halt in cancer growth and spread, but do not see the elimination of cancer. While other patients see no positive response, despite their cancer exhibiting the specific tumor markers that make them eligible for a specific immunotherapy drug. As more immunotherapy drugs are developed it is everyone’s hope that researchers create methodologies that are much more effective in determining which patients will experience positive results with these types of treatments.

I am grateful and blessed that I am a patient that experiences positive outcomes with immunotherapy. However, my doctor informed me that there is no way to predict the duration of the positive response. The duration could be anywhere from a few months to forever. If the duration is short, the plan is to add an additional immunotherapy drug to my current treatment plan. My doctor is fairly confident that other immunotherapy drugs should be effective, based on my response with Keytruda.

There is a lot to be excited about in the coming years regarding lung cancer treatment. The overnight success of Keytruda and many other immunotherapy drugs have caught the attention of the medical industry. The next generation of immunotherapy drugs are already in the late phases of clinical trials, many of which are accessible at Siteman Cancer Center. Even more significantly, clinical trials are underway in Buffalo New York for a lung cancer vaccine which was imported from Cuba. There is a long road ahead in getting this this treatment approved, but the results experienced in Cuba show that it might be possible to turn stage four lung cancer from a terminal illness to a chronic illness.

I have the next round of treatment on Thursday, August 24 and I expect to have the next blog post published by Sunday, August 27. 

One Tumor Left

Welcome back to the next Thriving Not Just Surviving blog post which will review the CT scan on August 3. Before I dive into the details I want to briefly review the results of the last scan.

On June 1, we observed approximately 50% shrinkage throughout all tumors in my lungs, chest, and lymph nodes. In some areas tumors were completely gone. The remaining cancer included the main tumor in my right lung, several enlarged lymph nodes, and a few smaller tumors in my chest.

The CT scan on August 3 showed significant and amazing progress on the remaining cancer. I have summarized below the major points taken from the pathology report.

•    The main tumor in my right lung shrunk 35% compared to the size observed on June 1.
•     All lymph nodes are normal size and do not exhibit signs of disease.
•     All other tumors are completely gone with no evidence of disease.
•     There is no evidence that cancer has spread to any other organs.
•     The heart and lungs remain free of cancerous fluid.

As I’m sure you can deduce, the only cancer remaining is the tumor in my right lung. My immune system has pulverized the cancer from every angle and eradicated it from almost every place outside my right lung! My doctor now calls me the poster child for immunotherapy. Immunotherapy is far from a perfect cancer treatment, but there are a small percentage of patients that experience stellar results. I am one of those patients.

After the CT scan in June my doctor had mentioned that it might be best to add a clinical trial drug to my current regimen in hopes to enhance the response. As of today, I am ineligible for any clinical trials because there is not enough measurable disease left in my body!

Even with the amazing progress I’ve made in such a short period of time, I sometimes find it difficult to not take this for granted. Therefore, I think it’s worth discussing the initial and likely scenario we were faced with at the initial diagnosis.

•    When I was in the ICU for 5 days at the end of February, many of the symptoms I was experiencing are normally experienced by lung cancer patients in the final few weeks of life. These included pericardial and pleural effusion (significant fluid buildup in the heart and lungs). Fortunately, my body was able to recover and I was able to start treatment.
•     The genetic and molecular makeup of the cancer cells left us with only two treatment options: traditional chemotherapy or immunotherapy. My doctor estimated that there was a 30% chance that chemotherapy would provide a response and immunotherapy a response at 40%. It is worth noting that a response does not assume that shrinkage will occur, but at a minimum slow the progression of cancer. 
•     Contrary to popular opinion, after my own informal research and discussions with my doctor, I have found that age is not a strong predictor of success in stage 4 lung cancer patients. In fact, many young non-smoker lung cancer patients are at a disadvantage because their cancer is not detected until the disease is very advanced. We met a woman during treatment who had a 25 year old niece who passed away very quickly from lung cancer.   

I’m not revisiting these facts to be morbid, but to highlight the fact that I am not experiencing a normal or expected response. My great response is a direct result of many prayers, exceptional medical care, fighting spirit, and my overall good health. Moreover, there are patients that have these same advantages, but still don’t make it. I have much to be grateful for and there is still a long road ahead.

I will be continuing the current schedule of treatment every three weeks and undergoing scans every nine weeks. The biggest concern right now is not the cancer, but if I was to have an adverse reaction to the immunotherapy drug. Some patients using this drug have had their immune systems start attacking healthy tissue and organs. Although serious, there are drugs that can be given to remediate this issue and I likely could continue to receive treatment. However, it is important that I remain aware of any new side effects or symptoms.

I could keep writing, but it’s already a very long blog post so I will try to wrap this up. I do plan to start publishing blog posts more frequently (Expect the next blog post 8/13). In closing, Maureen and I continue to be amazed, humbled, and blessed by the outpouring of support. I never imagined that our lives could be enriched this much as we undergo a serious illness.