Surgery at MD Anderson

It has been a long day, but a successful surgery. Dr. Gershenwald removed two tumors, one about 4 cm deep and another, deeper, about 7 cm. Both look like good candidates for lymphocyte harvesting to create the TIL. We will know in about 4 weeks if the TIL growth is looking good and 8 weeks to know if it is successful and ready for possible use. The plan now is to recover in Houston until Saturday, fly home and start a new treatment in about 2 weeks

Back to Houston

This week we had new CT scans.  The CT scans are the litmus test for how effective the treatments have been.  The CT scans take cross-sectional pictures every 5 millimeters throughout my torso. These images show the tumors in the lungs and in the groin.   The Radiologists are then able to compare Wednesday's images with those of previous scans.

This time around we're seeing the tumors going in the wrong direction.  The lung nodules have grown and the number has increased.  The lymph node tumor to the right of my groin has grown from about 3 centimeters to almost 6 centimeters in the largest diameter.  Obviously not the results we hoped we would see.

Step 1 from here Allison and I leave on Sunday for Houston  for a week.  I have a clinic visit with doctors there on Monday and then surgery to remove the tumor from my groin on Wednesday.  From that tumor they will harvest lymphocytes, on the order of a couple thousand, I believe.  The harvested lymphocytes will be grown/multiplied in the lab to a couple hundred thousand.  These lymphocytes are important because they are preprogrammed to fight the cancer.  They call them Tumor Infiltrating Lymphocytes or TIL.  The growth/multiplication of the TIL takes about 7 weeks with about a 50% success rate in growing them in the lab.  The reason for growing the TIL in the lab is to reinject me with them at a later date and send them through the body to attack the melanoma wherever it exists. 

After the surgery comes Step 2 which is a little unclear.  We will discuss what comes next with the doctors at MD Anderson and my doctor here at HCI and then determine what will be our best treatment.  They tell me I'll need about 4 weeks to recover from the surgery before they consider any more treatment.  That leaves at least 3 weeks before the TIL would be ready.  So currently my doctor would like to start me on one of a couple different chemotherapy regimens.  The regimen is undetermined at this time and these regimens would last 8 weeks.  We would need to complete the chemo regimen before we could consider the reinjection of the the TIL.  In fact at the end of the 8 weeks we would do new CT scans, and if those scans show that the chemo is effective we may not use the TIL.  But since the TIL appears to be one of the most effective treatments, we want to 'bank' it in case the chemo is not effective.  If that's the case at the end of the 8 week chemo regimen we will most likely turn to the TIL. 

So as is par for this course, we don't know all the answers. But we are proceeding with what we feel gives us the best chance for success, and expecting zigs, zags, and forks down the road.

We're doing well, the kids are doing great and we have much to be thankful for, not the least of which is the great support and prayers of friends and family.  We appreciate everything that has been done on our behalf and hope for the best in all your lives.

Home Again

Yesterday around noon I left the hospital.  What a beautiful fall day on which to finally get a breath of fresh air.  I got to spend a couple hours in a chair on the front lawn watching the boys play and enjoying great fall colors around the neighborhood.  A nice reprieve from a week in the hospital.

We were told by Dr. Grossmann going into last week that the side effects from the IL2 would set in quicker the second time around.  And true to his word, I started feeling rather poorly from the first dose.  Thanks to a great medical staff and their attention, I received the first 8 doses on schedule (one dose every eight hours).  After dose eight, the nurses and the doctor felt it best to wait for a bit.  We ended up skipping two scheduled doses and then Thursday afternoon receiving my ninth dose, which would be my last.  This dose packed the most punch.  A couple of close friends that happened to stop by for a visit that night got to see me at my worst, but also helped immensely by being there.  Thanks to a good nights sleep (thanks to an ambien sleeping pill), by Friday morning I was feeling much better.  Friday was a day for monitored recovery and then I was released to go home on Saturday.

Now we wait for a bit.  We won't know what the next treatment step will be until after I have CT scans done the first week of November.  These scans will show us whether or not the treatment is being successful, i.e. tumor is reducing in size.  If the IL2 is working, then it is likely we are in for a couple more rounds of the same.  If it isn't we'll consider other options. 

Special thanks to go out to all those who took care of the kids so that Allison could spend time at the hospital.  And continual thank to everyone's thoughts, expressions, and prayers of support, they mean more than we can ever say.

Week 4

I am back up at HCI for another round of high dose IL2.  I checked in Sunday night so they could start me on antibiotics and fluids.  Then Monday morning around 9:00 AM they hit me with my first dose of IL2.  Since then we've received 3 more doses (1 dose every  8 hours) and I'm due for 5th dose in a couple of hours from now. 

The drug side effects have kicked in sooner with this second round compared to the first round.   Because of that it is anticipated that I will not receive as many doses as the first round and they will probably spread them out to try to better combat the side effects. 

We appreciate the many people that are helping out in many ways, especially those watching the children so Allison can spend  a good part of the day here with me. 

It was great to have two weeks off prior to coming back up here.  I got to be home for Cameron's birthday party. 

The plan going forward is to do scans near the end of week 7.  Based on the results of those scans we'll determine whether we continue with the IL2 treatment or consider some other alternatives.