And So We Enter the Guinea Pig Stage of the Cancer Treatment

Let's cut to the chase: the news from today's oncology appointment was pretty much all bad. All of my tumors are bigger than they were, one of them significantly so. Moreover, the "indeterminate" mass in my lung was mentioned for the first time as being a point of concern. And while my vacation from the Xeloda makes a definitive determination somewhat challenging, the fact that I've been back on the pills for two cycles and yet am still showing disease progression is pretty suggestive.

In short, what I've been doing for the last nine months is no longer working. Thus, we move on to Plan C.

My oncologist came prepared with three options for Plan C. I'll get to the details in a moment, but first want to acknowledge that all three options wound up with what I'll call the "prime" alternative -- as in Option 1', Option 2' and Option 3' -- in that my one non-negotiable point is that I'm not going back on a forty-eight hour infusion pump, which is the standard for colon cancer. Thus, while his plans can accommodate Xeloda in place of the 5-FU infusion, I'm pretty sure the doc was hoping he could convince me to go back to the forty-eight hour infusion since that's the "normal" treatment.

Not. Gonna. Happen. 

So, in any case, here are the three (modified) options I was given:

Option 1' -- Go back onto the chemo regimen I was on before...

Standard treatment for colon cancer is a combination of oxaliplatin, Avastin and 5-FU, which is what I was on for the first six months of treatment. Potentially I could go back onto this -- modified to replace the 5-FU with Xeloda -- though there are significant downsides. Most notable from the doctor's perspective, oxaliplatin causes the neuropathy I was dealing with last December, and that combined with the foot problems the Xeloda is causing would likely be pretty hard to deal with. More problematic from my point of view, oxaliplatin would basically force me to cancel my Antarctica trip. Oxaliplatin is administered every two weeks which would have me about five cycles in before my trip, and given the way it accumulates I probably wouldn't be able to tolerate the cold by that point. Once that got sorted out, Option 1' pretty much came off the table.

Option 2' -- Add an infusion of irinotecan to the current regimen...

Again, doc's preference would be Avastin, 5-FU and irinotecan, but since I won't do 5-FU it got adjusted to Avastin, Xeloda and irinotecan. Basically, this option just ups the chemo drug content I'm getting, but swapping the oxaliplatin and it's neuropathy-based side effects for irinotecan, which is known more for causing gastrointestinal distress. And I know I'm going to regret asking this question, but as bad as the gastrointestinal distress has been already, how much worse can it get?

Option 3' -- Take Option 2', but add participation in a clinical trial to the mix...

My oncologist is currently an investigator on a trial looking at whether or not the addition of a particular form of radiation treatment improves patients undergoing second-line chemotherapy. It's a pretty simple trial. If you enroll, you get randomized into one of two groups: the first group gets their normal chemotherapy treatment and answers some quality of life survey questions, while the second group, before undergoing the new chemo, has radioactive "beads" implanted in the tumors in their liver. Eventually, the outcomes of the two groups will be compared. 

I decided to go with the trial. There's a 50/50 chance of being assigned to either group, and since there's no real difference between Option 2 and the first group in Option 3, there's really no downside for participating in the trial if you wind up in the control. On the experimental side, the procedure, while not entirely risk free, is pretty well-established and has been proven in the treatment of other types of liver cancer. So what the heck? Maybe I'll get lucky, get in the experimental group, and find the radioactive beads have a significant impact. If I wind up in the control, I haven't really lost anything. And if the worst happens, and I suffer some weird side effect from being in the experimental group, ah well. Nothing ventured, nothing gained.

All that said, there is one slight downside* of learning about the trial: the radioactive material in the beads is yttrium-90, so now I of course want to redo my square for yttrium. If I get in the experimental group, I assume they'd scan my liver to make sure the beads landed in their intended locations. It would be cool to get a copy of that scan to use on the square. 

But I'll deal with that after the computerized coin gets tossed and I find out which group I'm in. 


* Well, one plus the fact that none of the options dropped the Avastin which means I'm still prevented from getting a tattoo...