Today, January 12, 2019 is National Glazed Donut Day and the day after my most recent post-scan appointment with my oncologist, a day when, if I'm lucky - as I have been for the past 10 years, my world will change - for the better (donut consumption notwithstanding). However, the 'world' to which I refer is one fraught with danger and offers no more guarantees than I've been accustomed to. To invoke the late, great Rod Serling: I am now entering "The Immunotherapy Zone." Yes, a brand new - for me - treatment protocol: new drug, new side effects, new frequency, new lifestyle/fewer hassles - potentially, and most importantly: shrinkage - possibly, of my tumors, especially my "Adams Apple" tumor, as I've come to nickname the mass just below my Adams Apple (which is sort of bothering me, if you want to know the truth).
The nature of cancer treatment as I've experienced it, and learned from my oncologist, is if the drug is working, you continue it until it isn't (sounds simple I know). When it stops working, you change as the cancer has figured out the drug's intent. (Cancer cells are smart that way.) Generally speaking, the cancer drug doesn't start working (shrinking, stabilizing) after it has stopped working (growth). Over my nearly 10 years, I have switched drugs upwards of a dozen times. Now, I am switching again to Opdivo, an immunotherapy drug, a class of drugs that didn't even exist a decade or so ago when I was first diagnosed, and one that has only been approved for the treatment of lung cancer since 2015. A drug that, to quote the television advertisement: "offers a chance at longer life." And so Team Lourie, two-thirds of it anyway, made the decision to switch and fight. Starting this Friday, I will be infused into the great unknown.
From what my oncologist explained yesterday, aside from the possible benefits, Opdivo has some potentially unpleasant side effects. However, continuing with my present infusion drug, Alimta, now that there's been some growth, is also likely to produce some unpleasant side effects: growth and movement. And more growth/movement is the worst side effect, relatively and comparatively speaking. So we chose a definite over a maybe. If we continue with Alimta, there will be growth - definitely (that's how cancer works). If we opt for Opdivo, maybe there won't be growth, and maybe there might even be some shrinkage (the good kind).
As for lifestyle changes, there are, according to my oncologist, some quality of life improvements as well, or at least, more weeks in the month when potentially I'll be less impacted by my disease/treatment. Which along with my quality of life has always been a concern of my oncologist. And, without getting into the details, I'm ready for a change. Combined with the possibility of tumor shrinkage and fewer/different side effects (some patients report few side effects from Opdivo), I wouldn't say switching to an immunotherapy drug was enticing/a "no-brainer", but it does offer an alternative of sorts. And given where I've been treated from and where I'll be treated now, I am ready for something different. Changing drugs is always a risk though; it could improve my life or it could make matters worse, a 'worse' from which quite frankly I might not recover (do you remember my yo-yo down-the-stairs visual from a few columns ago?). And I am familiar, unfortunately, with some less-than-encouraging accounts of patients not fairing so well.
I just hope there's not a hole in my thinking. Oh wait. That's a hole in my donut. No worries. I'm happy to buy the donut and I never complain about the hole. That's the trade-off. I'm hoping, given the potential benefit of Opdivo, I can likewise live/trade-off with side effects.
My philosophy has always been to take the good with the bad - and vice versa, and after almost 10 years of rolling with the punches, I see no reason to change now.
"This column is my life as one of the fortunate few, a lung cancer anomaly: a stage IV lung cancer patient who has outlived his doctor’s original prognosis; and I’m glad to share it. It seems to help me cope writing about it. Perhaps it will help you relate reading about it."