More Chemo Begins

I am sitting at St. Joe's cancer clinic getting chemo as I type this. I have completed my first drug, Taxol, and have just started the second one, gemcitabine. Here is what we learned today.

The results of the PET showed similar reductions in the masses as the CT. Everything has been reduced since the last CT scan taken at the end of Jan/beginning of Feb. They have reduced dramatically since the initial CT scan. For example, the mass in my abdomen that was originally 9 cm long now measures 2.2 x 1.9 cm. The PET scan revealed two areas that "lit up". This could indicate live tissue, and is measured by FDG uptake (FDG is the drug that was injected into me an hour before the scan). The mass in my mediastinum (chest) had an FDG uptake of 2.6 and in my abdomen had an uptake of 2.1. The remaining small nodules in my lungs had no uptake.

The mass in my mediastinum measured 3.2 x 1.6 cm, of which only 1 - 1.5 cm lit up, indicating that some of the mass was dead and some was alive. One thing that is not clear is what the FDG uptake truly means. Any FDG uptake below 3 could indicate an inflammatory reaction to the chemo/healing of the tumor. So the fact that 2 of my tumors lit up with an FDG of less that 3 may or may not be due to live cancer. In reality, it is likely that at least some of it is the cancer, but it is small and growing slowly. The fact that the nodules in the lungs did not light up is also inconclusive. Any mass less than 1.5 cm may not respond to the FDG and may or may not light up even if the tissue is alive. All of my masses in my lungs are less than 1.5 cm.

So I have 2 sites that have lit up, likely indicating live tissue present, but not conclusively. We discussed removing these sites with surgery. The surgery to remove the mediastinal mass is relatively straightforward. The surgery to remove the abdominal mass is difficult. Due to it's deep location it would be a very invasive surgery. Due to the small size of the mass, it may be difficult to find. In addition to that, if we proceeded with a solely surgical approach, we could not be sure that the masses in the lungs that were less than 1.5 cm were void of microscopic active tissue that did not appear on the scans. The scans are very useful and help in diagnosis, but they are not absolute. Proceeding with surgery to remove the obvious sites of disease may leave behind undetected sites of live tissue and leave us with a false sense of success.

We decided to proceed with chemotherapy. The hope is that the chemo will kill the microscopic live tissue that is not detected on the scans, and reduce or eliminate the live tissue that we can see. After 2 rounds of the chemo I will be re-evaluated.

Dr. Winegarden was very encouraged about the study by Dr. Einhorn regarding this chemo regimen. He was amazed by how closely the study matched my condition, and he was impressed with the success rate. The success rate was 12% without surgery. This may sound low to us, but he said for a Phase II study with such a small and specific group of patients that level of success unusually high. I added that those 12% probably did not feel nearly as strong and healthy as I do now. Also, please do not get hung up on the 12% figure, because that is just 12% of the 32 patients in this study. One of the limitations of a study that small is that the numbers do not translate to the general population. You need a much larger sampling of patients in order to determine a true percentage for a prognosis. This is not my prognosis, it only shows what happened in this very small group of patients. What it does show is that there is a very promising mode of treatment for a situation that previously did not have one. In the end, the success rate for this treatment could be much different than it was in this study. There is no way for the doctors to give me a prognosis at this point, but Dr. Winegarden says these next 2 months will be very crucial.

At this point I don't feel any side effects from the chemo. I am awake and alert, and I began the day with my first walk over 3 miles. I continue to feel better every day, and plan to keep that trend going. This has been a trying few weeks for us, but it feels good to have a plan and to have it underway. It is time to finish this thing off.