Merry Christmas

We are enjoying a very nice Christmas Holiday.  The first week and a couple of days after the last chemo infusion weren't great.  However for most of this week I have been feeling reasonably well during the days.  I've been able to go work and feel fairly decent during the days.  There is still some discomfort and pain that comes and goes and occasional body aches and mild nausea, but overall I can say I feel relatively well.

There has been some good news we have received in the meantime.  The TIL (Tumor Infiltrating Lymphocytes) that were harvested during the surgery at our last visit to the MD Anderson Cancer Center are growing well.  I believe we were told that they have grown to around 400 million cells and they are looking to have a couple of billion cells ready to infuse in February or March.  We are excited about this news for a lot of reasons.  We had a about a 50% chance of actually growing cell, and we won that coin toss, so we like that.  It means the trip, the surgery, and recovery was worth it.  And this now gives us another possible treatment in our quiver with some of the best odds of defeating the melanoma.  This doesn’t mean for sure that we will use this treatment.  If the chemo we are doing now is effective we won’t stop a working treatment to try something else just because the odds are better.  But like I said we’re glad to have that arrow in our quiver.

Yesterday I got to do something that I thought I might not get to do at all this winter.  I got to go skiing!  And those who know me well, know how much I enjoy being on skis.  First thing yesterday morning Curtis picked me up and we met with Lars and Brit and headed out for a backcountry tour into Silver Fork.  It was cold and beautiful and cold, but well worth a few shivers to get out and enjoy the wonderful Wasatch mountains.  We had a great run in the meadow chutes and headed back to the car.  I was slow, and had some significant pain in the pelvis where the tumor remains, but I was very grateful to have the chance just to get out, and especially grateful to Lars, Curtis and Brit for the patience with my slow pace.

After we finished, I met with Allison, Sarah and Cameron who picked me up in the canyon and we headed up to Brighton where we met Uncle Andy, Grandpa Ted and Grandma Charlotte to spend the afternoon riding the lifts and skiing.  Again it was cold, but the kids said they were warm and had a great time skiing with their grandparents and their rockstar skier uncle.

It meant a lot to me yesterday to be able to ski with the kids and to be able to get out into the backcountry.  Here's to lots more days like that in the future.

Heading down the road for treatment, there's quite a bit going on in the next week or so.  Monday (Dec 28) I have new CT scans that will tell us if the current chemo treatment is working.  Following the scans I meet with Dr. Grossmann at HCI to discuss the results of the scans and to map out the next several weeks of treatment.  And then on the following Monday (Jan. 4 - Happy Birthday Laura) I am going back into HCI for another chemo infusion.  I won't know what happens after that until I meet with Dr. Grossmann this week.  

We hope that everybody is enjoying the Christmas season.  We have much to be grateful for not the least of which is the birth of The Child in Bethlehem.  Merry Christmas and a Happy New Year to all.

Back in Treatment

It's probably about time for an update. 

I am writing this as I sit at HCI waiting for them to prep the drugs fom my next round of treatment.  The surgical incisions from the surgery in Houston have healed up well and I'm starting my next round of treatment today.  I'm sitting looking out the east side of HCI enjoying the view of the fresh snow that fell last night.  It's great to have snow again in the valley and the mountains.

The next treatment is a Carboplatin/Paclitaxel chemotherapy.  This regimen is considered moderate in its toxicity and the potential side-effects.  The chemo is delivered via an IV (that they just put in) for a couple of hours as an outpatient procedure.  The regimen is not terribly demanding.  I have to come to HCI once every 21 days for the infusion.  So I'll get an infusion today, and another one 21 days later, and then another one 21 days after that.  Following the third infusion we will likely do new scans to see if the treatment is being effective or not.  At that point we will reevaluate treatment.  If this chemo is working, it is likely that we'll continue with this treatment, otherwise we may resort to the TIL in Houston. 

We are looking forward to Thanksgiving and having a chance to be with family.  We do have much to be grateful for. Not the least of which is great support and prayers extended to from great friends and family.  We hope you all have a great Thanksgiving.

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.