Health Update #19: Six Months

This is my first update in about 6 weeks, since the past month and a half has essentially been about flushing the chemo out of my system and getting in a few rounds of immunotherapy. I’ve now surpassed the 6 month median survival rate or life expectancy (outdated statistics, perhaps) for Stage IV adenocarcinoma non-small cell lung cancer, counting from the initial staging on February 28. That’s certainly reason to celebrate. Physical Therapy is going well and I’m developing much more mobility in my right shoulder with the humerus implant as well as gaining a bit of strength. I still can’t lift a coffee cup to my mouth with my right arm, but it’s getting there. I’m largely alcohol free, but if I could stomach a martini or Manhattan, I’d probably spill quite a bit of it trying to get it to my mouth, whether with my bum right arm or my non-dominant left hand.

My PET scan was a week ago in a trailer connected to the Reed City Hospital -- I guess a semi-mobile lab for the area similar to those mobile classrooms in the past, crammed with pallets of flotsam and jetsam from the hospital proper. After nearly a week long wait, I finally got the results on Thursday night, which were difficult to interpret, and I met with the oncologist on Friday. The tumor in the lower right lobe of my lungs appears to be dying out. There is still some moderate hypermetabolism on the PET scan, but it seems to be shrinking and developing cavities. No sign of hypermetabolism in the humerus. Those are both positive outcomes. 

Unfortunately, the PET scan also picked up multiple metastases — areas with high levels of hypermetabolism that show up brightly on the scan indicating malignancy. As the oncologist said, the cancer is popping up in various places throughout my body.  There’s a small (2 cm x 2.5 cm) mass on my right kidney that’s doubled in size since the July CT scan. There is also a small soft tissue mass in the lymph node above my clavicle on my left side, and a pathologic (cancer-related) fracture on my posterior right 6th rib (in my middle/lower back). No wonder my back has been hurting. My sacrum also has a transverse fracture, but that does not appear to be cancer-related. It’s most likely a traumatic fracture from my fall in July. It’s taking a long, long time to heal and is still quite painful, so I may schedule another consultation with my orthopedic surgeon to talk about the recurring fractures — both how to treat them (or relieve the pain while they heal) and how to prevent them. I expect I can rule out motorcycle rides in the near future. My oncologist has prescribed Zometa (Zoledronic acid) to help with bone density, as well as taking over-the-counter Vitamin D and calcium. 

What all this means is that the current treatment plan involving infusions of carboplatin, paclitaxel, and atezolizumab (bevacizumab discontinued after the first session) didn't work the way that they wanted it to in order to contain and eliminate the cancer cells and replication. Essentially, the PET scan showed evidence of disease progression and further multiple metastases. I’m not sure what it means now that it’s in multiple systems —  pulmonary, skeletal,  lymphatic, and renal — but it can’t be a good thing. The oncologist has suggested that I get a second opinion at the Rogel Cancer Center at UM in Ann Arbor to see if there are any trials that are promising that I might qualify to join. The University of Michigan is ranked #1 for cancer treatment in Michigan and #9 globally for cancer research. 

Specialized language trigger warning here: Apparently, there are drugs (Sotorasib and Adagrasib) newly approved in May 2021 available for those with a predictive biomarker of KRAS G12C, but not currently available for for those with a biomarker of KRAS G12A, the latter of which is a part of my molecular profile. The University of Michigan may have treatment trials for those with KRAS G12A, or may be able to try a trial of Sotorasib or Adagrasib since it's FDA approved for G12C but not G12A. I know, it doesn't quite make sense to me either. I'm just copying and pasting randomly. Here's the obligatory wikipedia entry on KRAS, as well as a good explanation at the Sotorasib site.

If I don't qualify for a clinical trial, I’ll start another 12-week regimen of chemotherapy in Reed City using different drugs to see if a different cocktail might have a better outcome. The oncologist I spoke with suggested that they'd consider carboplatin/pemetrexed and cemiplimab-rwlc, but that would be up to my primary oncologist. They also put in orders for a CT scan to rule out brain metastasis and an X-Ray to check out my knee that has been hurting since shortly after I fell. I’ve assumed that it was a pulled hamstring, but they want to make sure it's not metastasis. [Update: the X-Ray showed no evidence of disease, though apparently both of my kneecaps are rotated. There's nothing really that can be done about that.]

This is all quite sad and disappointing, but I feel lucky that I have such strong support from family, friends, and colleagues, and I am currently feeling much, much better than I did in June and July. I can't imagine how people without a support system go through this. I feel lucky in a lot of ways, so for now I’m focused on celebrating this 6 month mark and looking forward to surviving the first year. I'm trying to get as much done as I can before another round of chemo kills my productivity. I should be able to set up my Creative Nonfiction course to practically run itself with a bit of feedback and scoring on the good days when I restart chemo. I'm looking forward to a bit of travel at the end of September as well -- the first outside of the state since March. I feel good, for now.

Dark Brandon and a little patch of silver hair

September 12, 2023