Last week I had a PET scan to see how things are progressing. All of the previous scans had shown improvement, this time was different.

The PET scan showed some increased activity in the known clusters and some growth as well. The cancer has not spread from the Liver, but the current treatment of 5-FU and Leucovorin which is mainly a maintenance regimen has ceased to be effective. This is likely due to natural selection where the cancer cells that were susceptible to that treatment alone have died, and the ones that remain are the ones that are resistant. What we will do now is add another drug to the cocktail, Irinotecan. This drug is part of a standard regimen known as FOLFIRI. Last year I was following the FOLFOX regimen which consisted of the 5-FU, Leucovorin, and Oxaliplatin. Since the Oxaliplatin had the side effect of peripheral neuropathy which I have experienced, we are reluctant to introduce that again and aggravate the neuropathy, hence going with the Irinotecan. We have every reason to expect that I will respond well to the FOLFIRI regimen since I did well on the FOLFOX previously.

I was approached about participating in a drug study that would combine the FOLFIRI along with an experimental immunotherapy drug. I gave this a lot of consideration since for lung cancer the immunotherapy treatments have shown real progress and have become the standard for that type. I was briefed and given 20 pages of information about the study to consider. After a close read of the information I decided to not participate in this particular study. Although the concept of immunotherapy is very exciting, the first stage testing of this particular drug was underwhelming (only 1 in 6 participants finished the study with no indication of the efficacy of the drug itself), and the potential side effects ( 1 in 10 for some, 1 in 100 for others) where there is a 1% chance that the thyroid or some other organ could be damaged beyond repair for a drug that might have no benefit to my treatment was just too great. The main advantage is that if it worked, it could actually cure the cancer by making my body immune to it, but since we have every reason to expect the FOLFIRI to be effective in attacking my particular cancer, I feel that I have time to let the immunotherapy studies play out and hope that eventually they will find the correct DNA markers to target and a cure could exist in my lifetime.

Isabella is pretty much the same. She is still a patient patient when I give her fluids, but is still picky about her food. She was not eating enough in the last 2 days so I forced her to swallow her anti-nausea medication, and that seemed to help. She eventually ate her preferred wet food and seemed a bit happier later. The kidneys are certainly causing her some discomfort and she cannot seem to get enough water. I have bowls for her both upstairs and downstairs and her preferred pint glass in the living room. At this point we have no expectation of her actually improving so mostly I just want to keep her as comfortable as possible and give her the love and attention that she wants, when she wants it.

Cheers