Today, I had my follow-up visit with Dr. Richards regarding my antiCTLA-4 trial. We took all of the kids so they could see the doctor's office, meet the doctor and nurses, and gain a better understanding of what I do each time I meet with an oncologist. They all get an A+ for their behavior and patience. Afterward, we met our good friends Katie Clancy and MC Davenport for a meat-free lunch at Bennigan's (it's a Friday in Lent, remember?). We all enjoyed ourselves and made it back to Milwaukee before rush hour, which meant minimal drive time.
So how did the visit go? Well, the doctor first reminded me that it often takes a full 12 weeks of treatment before he sees results. Then he said my tumors appeared to be stable. The subcutaneous nodes were more numerous; many were bigger than before but some had gotten smaller. This I had expected as I can monitor the subcutaneous nodes on my own. Internally, many of the abdominal tumors had grown, but the CT scans did not reveal any new ones. The CT scan report also mentioned "many of the lesions have low attenuation centers that presumably represents necrosis." That means they appear to be dying from the inside out. I believe it is this statement that led the doctor to say he expects to see more shrinkage in the coming weeks.
The doctor and nurse both presented a cautiously optimistic attitude about the whole business, and Dr. Richards specifically said that he saw nothing that caused him immediate concern. He said all we can do now is wait and watch to see whether my immune system responds to the antiCTLA-4 antibody. Hopefully it will. I will return to his office in six weeks for a checkup of my subcutaneous nodes. Six weeks after that, I will undergo more CT scans and the doctor will decide whether I have shown a positive response and therefore qualify to be given a "maintenance" infusion of the antiCTLA-4 antibody. A positive response means the tumors have shown collectively less than a 20% growth over the 12 week period.
It's not bad news; it's not great news either. I certainly don't feel hopeless about the situation, and I don't want anyone to assume from this information that my days are numbered. Indeed, during our visit Dr. Richards specifically stated, "I think it's only going to get better and better." One thing I've learned through this experience is that these doctors deal with facts and don't dally with the truth. I do not think he would make that statement if he did not believe it. The doctor was happy that I have been eating well and feeling more energetic. I feel good about these things, too. I try to be as honest as I can on this blog, and I am being completely honest when I say I feel better than I have in at least four months and that I do feel optimistic about my chances of holding this disease at bay for a long time. And I'm talking decades, not just years.
In that same spirit of honesty, however, I have to admit that I have a difficult time getting enthused or feeling especially pleased with the type of review I had this morning. It isn't easy to read a CT scan report that states (note: all measurements are compared to CT scans taken 11/29):
". . . again seen is a pancreatic head lesion that is probably stable, measuring 1.9 x 1.3 cm. . . . The right adrenal gland is normal. There is a large left adrenal mass . . . (that) measures 4.3 x 4.9 cm compared to 4.4 x 4.4 cm. There are numerous nodules along the inferior margin. There has been interval enlargement of the right renal lesion, which now measures 5.5 x 4.5 cm compared to 4.7 x 3.8 cm. Multiple masses are again seen in the region of the gastrohepatic ligament and in a peripancreatic location. The celiac artery and portal vein are displaced. The most anterior node measures 4.1 x 3.3 cm and is slightly larger. Some of the other nodes are stable. The lesion posterior to the pancreas has enlarged, measuring 4.8 x 3.0 cm compared to 3.2 x 2.0 cm. There is a larger left flank mass situated at the level of the lower pole of the left kidney and invading the quadratus lumborum and left flank musculature that measures 4.7 x 5.5 cm compared to 4.6 x 4.9 cm. The extraperitoneal midline mass inferior to the xiphoid measures 2.7 x 2.2 cm compared to 2.0 x 1.7 cm. The right perinephric mass appears slightly larger, measuring 3.6 x 1.9 cm."
You don't have to be a medical professional to get the gist of what's going on: a lot of bad stuff is happening inside me. If I'm not leaping for joy after receiving such a report, I trust you can understand why.
On a lighter note, the weekend is almost here and the kids are making plans. Regan is plotting to have a playdate (if she gets her chores done!) and Aubrey wants to go shopping with the money she earned helping me do our taxes. I'm sure Jack will spend much of the next two days outdoors with the neighbor boys, and Kelly and I will try to get away for a couple of hours of adult conversation. I hope you all are able to rest a bit this weekend and that your favorite actors/actresses/films win Oscars (if you're into that kind of thing).