Chemo Treatment Number Five

I had radiation this morning and then went to chemo. I was late to radiation because of traffic (the bridge was closed again) and subsequently I arrived late to chemo as well. I was suppose to get a blood test and go straight to chemo treatment, but Scott Lunin saw me in the hallway with an FSU cap and sweatshirt. He began to tell me about the Florida Cancer Center dress code...but then asked to see me for a quick second. When I followed him into the exam room, he wanted to see the rash. Ah Ha! So he HAS been reading this blog on a regular basis. Good for you Scott. I am going to have to think of some way to honor you next time I see you.

We had a short talk and Scott addressed the issues I had raised in my last blog. First, the low dosage approach is designed to provide continuity. That is to say, the dosage should kill the cancer cells without giving me severe adverse reactions. It is better to not have reaction and continue the regiment for the seven weeks than to risk that the treatment be interupted because of complications. It use to be that practioners felt they the treatments were not effective if the patient was not experiencing severe adverse side effects. That has proven to be false. The lack of side effects should have no bearing on the effectiveness of the treatment.

I asked Scott what the expected outcome of this round of treatments will be. He is expecting shrinkage of the tumor, on the order of 50% or more, but it depends. We'll have to see. Some people have better outcomes than others. He plans to take the pictures and have Dr. Robinson examine them again. He does not expect Lary will come back and say that surgery is now possible, but it would not hurt to ask. He says that after this treatment, there is no accepted clincal practice. Scott considers my case challenging and unusal because of my age and general good health. I am not like most of the lung cancer patients he sees. I am decades younger and tolerating these treatments extremely well. For most of these people, a second round of chemo would be hard to take. So Scott is somewhat at a loss as to what to do after this round is completed. He was considering a Taxatere/Cisplatin regiment...but the studies to date don't reflect much observable improvement in survival rates by doing this kind of continued treatment.

I told Scott that, assuming surgery is out, and the tumor is only, say 50% reduced, doing nothing does not seem to be a good answer. Seems like a new "cocktail" of some sort would make sense. Whatever the case, a cisplatin (platinum based) treatment on a continuing basis now raises other toxicity concerns. Nuropathy, hearing loss, kidney failure etc. may become more likely if cisplatin based chemo is continued indefinitely.

I asked Scott how many lung cancer patients he has had. He said it was the MOST common cancer patient he sees. I said that my impression was that prostate and breast cancer were the most common. And then he said something that surprised me. He said these kinds of cancers have a more vocal lobby and bigger political voice because they, frankly, have much higher survivor rates. Lung Cancer, even though it is far more prevalent, have a weaker voice, one, because it is more fatal and so there are fewer survivors to raise a voice, and two, because people have less sympathy for lung cancer patients in general. They are viewed as having brought this on themselves by smoking or leading unhealthy lifestyles. Scott has sent a letter off to experts at the Cancer Centers at Moffit in Tampa and MD Anderson in Houston to see what suggestions they may have. I raised the issue of participating in trials, but Scott reiterated that I am not the profile and were are not there yet.

Scott mention that he would be interested to see how I resolve the "who do I tell" issue. As we walked out, he asked me to wait in the waiting room while he checked to see that they were ready to take me to treatment. When he came back, he called out "Bill, they are ready for you" to show that he was "on board with the privacy issue." I just hope they gave me the right drugs today!