Treatment decisions

"If any of you lacks wisdom, let him ask God, who gives to all generously and without reproaching, and it will be given him." (Jam 1:5)

Dear Family and Friends,

Kendra and I went to USC today, had a long, informative meeting with an oncologist who specializes in melanoma and who is a colleague of our friend.  I am really grateful for the amount of time he spent teaching us and his patient answering of our questions.  We came to a better understanding of drug combinations, what the clinical trial options are out there, heard a lot of efficacy percentages, and got a real education.  And...this decision might not be very cut and dry.  I could use your prayers that we will make the right decision.

In my mind it all sort of hinges on which genetic mutation my melanoma has.  If it has a particular mutation, there are very interesting trials called targeted therapies that the USC doctor is enthusiastic about.  The UCLA doctor doesn't think I should enter one of the trials focused on the mutation.  They've been shown to be effective in the short term, but long term results are much more uncertain.  Plus the trials related to this mutation are randomized and double-blind.  In other words I would know I'm getting two FDA-approved effective drugs, but the third trial drug is administered to only 50% of the patients in the trial, and neither the patient nor researcher knows who is getting it or the placebo.

If I don't have this mutation, I think it's pretty clear that I go to the UCLA immunotherapy trial, which gives me one FDA-approved drug and two trial drugs.  Getting a combination of 3 promising drugs that seem to work well together is a great opportunity.  Picking one trial will disqualify me from participating in the other in the future.  So I wouldn't be able to get that other combination of drugs until there is FDA approval for it.

The results of the mutation testing that's happening with my biopsy tissue won't be in until about 10 days from now.  So my plan is to sign up for the UCLA study - I feel fortunate that I was admitted into it - and start the process.  I can back out at any time before (or after) I begin treatment, which probably won't be until the second half of June.  We've long had a family trip planned June 9-19, and the UCLA oncologist feels that we should go on the trip and then start treatment afterward.  He is not concerned that waiting a few weeks will make a difference after I've had this cancer for 11 years.

After the USC appointment our friend took us to his office and showed us the PET scan image, which was the first time we had seen it.  There it was, cancer.  Right there looking at us, the misbegotten, villainous scoundrel.  Artillery jargon alert: I'm very much looking forward to introducing it to the first round fire for effect.  It's just going to take a few weeks to dial in the coordinates.  So the next decision points will likely come 6/1 and then after 6/19.  I'm praying that the path will be clear to me.

With fortitude and prayers for you,

Jim