Health Update #26: Dear Committee Members

Back in Chicago

Erstwhile: after researching the University of Michigan's clinical trial for treating advanced Stage IV non-small cell lung cancer: Ramucirumab Plus Pembrolizumab vs Usual Care for Treatment of Stage IV or Recurrent Non-Small Cell Lung Cancer Following Immunotherapy, Pragmatica-Lung Study, I finally decided to sign up for the study and start treatment in Ann Arbor. I cleared all their protocols and scheduled the first session for December 19th. I'll still check in with Dr. H from time to time in Reed city to keep that link open.

In mid-December, Dr. Q called me to tell me I've been randomized into the control group. This means that a computer has decided that I should be in the group that receives the standard care for 2nd line treatment for metastatic lung cancer after an unsuccessful first line treatment of chemotherapy (carboplatin) plus immunotherapy (atezolizumab). At least it's not a placebo. The experimental group, as opposed to the control group, receives Keytruda (a promising immunotherapy drug) plus ramucirumab (an angiogenesis inhibitor). The standard care is exactly what I was scheduled to receive on December 1st at the Reed City facility: Docitaxel (2nd line chemotherapy) plus ramucirumab. But the computer has randomized me and cast my lot in with the control group. So much for my love of technology. Then again, I don't know if I would feel any better if my fate had been decided by drawing straws rather than electrical impulses of 0s and 1s pulsing through a machine. 

So, in all that, the only difference between my planned care in Reed City and my participation in the trial in Ann Arbor is that my standard treatment was delayed by about 3 weeks.  I won't, at this time, receive the promising Keytruda infusions. That doesn't seem like such a big deal. Unfortunately, because Dr. H. had already prescribed several sessions of the infusion in Reed City, my insurance company pushed back on paying for ramucirumab at the University of Michigan. The clerical staff told me to sign a waiver saying that I would pay out of pocket if my insurance didn't cover it, but Dr. Q said that she couldn't in good conscience recommend that I do that. The compromise was a dose of Docitaxel without the ramucirumab on December 19th and the hope that the latter is approved by my next infusion on January 9th. 

Infusion Bay

We had lab work first thing in the morning, then met with Dr. Q to talk about the treatment. My first question for Dr. Q -- what's the bright side of my being in the control group? Prior studies have shown that Keytruda has fewer side effects, so quality of life is higher, and it results in longer survival rates by a few months on average. A modest but significant benefit over standard of care. The bright side, from what I could figure, is that we don't know for sure that I would have responded to Keytruda, and my lack of response to atezolizumab (a similar immunotherapy drug) suggests that I probably wouldn't have responded particularly well. And I might possibly qualify for Keytruda in the future. The other upside is that Ann Arbor is slightly more convenient than Reed city when it comes to geography and commuting from Chicago. Finally, the Rogel Cancer Center at the University of Michigan has more resources and is ranked higher than the Spectrum Health cancer centers. I knew I could sour grapes myself into a sunny side, to mix metaphors. I had to come to those conclusions on my own, though. When I asked Dr. Q about the upside to being in the control group, she looked a bit startled and then shrugged. 

One other question I had for Dr. Q was about the timeline. First line treatment was an infusion once every three weeks for twelve weeks total followed by up to 2 years of immunotherapy. Still, that's a finite amount of time for chemo, and in the larger scheme of things, 3 months of treatment is relatively expedient. Dr. Q said that this time, since I wasn't cured of the cancer during first line therapy, I would have infusions every 3 weeks indefinitely -- until either I became hyper-toxic or a periodic scan detects significant disease progression in the form of tumor growth or further metastasis. Then they'd switch to another chemotherapy drug, probably paclitaxel, and start all over again until I say enough with chemo. In other words, there will likely not be a break in the three week cycle of chemotherapy until I decide to stop treatment altogether. They'll do new scans every three months. Luckily, the side effects so far seem much more bearable than this summer, mainly fatigue, weakness, shortness of breath, and some joint and abdominal pain. Anna, the nurse practitioner said that days 10-14 would be the worst, so we'll see. I'm at day 11 now and don't feel too bad. If I stay on the same schedule as this past summer, my hair should fall out on day 18 or 19 (January 7th or so).

Chemo Date

After talking with Dr. Q, we met for a while the the nurse practitioner, Anna, to go over side effects and how to combat them. She and Corrine got quite explicit about implications around intimacy, and I just sat there and blushed.

The infusion itself only took an hour, but I was at the hospital from 7 am until 1 pm. We went out to the Gandy Dance for a post-chemo lunch, and then up north to the lake house for a few days before heading back to Chicago.

I spend a lot of time in bed these days. Some days, I move to a comfortable chair in the living room and look out on the Chicago skyline with coffee and breakfast and manage being upright through the mid-afternoon. Then it's more narcotics and back to a prone position. I have a little more energy this time around to be awake reading or writing or watching the latest season of Fargo or binge watching video shorts on youtube or TikTok. My appetite is fair, though my taste buds are off. I can't handle spicy foods. And it looks like I'll be having a mostly dry January and the rest of the year as well. The taste of liquor is abhorrent. I have less pain in my ribs and sacrum now, though my knee is still bothering me a good bit. I'm getting around with a cane, partially from the pain and joint weakness, but also to steady myself from falling down. I don't want any more of those kinds of injuries. 

The department and college have been incredibly gracious at helping me navigate (or navigating for me) the byzantine medical leave process so that I can extend my leave through winter semester. If I'm not doing any better by summer, I'll probably start the retirement process before the fall semester begins. If I do feel better, maybe phased retirement is a better option.  

Lately, thanks to my sister-in-law Catherine, I've been reading Julie Schumacher's epistolary novel Dear Committee Members about a crusty English/Creative Writing professor in his waning days at a small, not very prestigious liberal arts college in the midwest. It's written in the form of letters of recommendation for students and colleagues and memos to the chair and dean and other members of the academic community. It's a breezy read, sardonic and misanthropic and verbose, providing a glimpse into the many foibles of academics -- angsty undergraduates and graduate students, small-minded and self-important blowhard scholars, overworked part-timers and compositionists, bean-counting administrators, rivalries and petty disputes. It's a relatively witty encapsulation of academia, especially for those of us in the humanities and liberal arts. 

I find Dear Committee Members bringing up a lot of cringe-worthy memories of my own bad behavior as a student, an adjunct, and tenured faculty member, inevitably pissing off someone wherever I went. It also makes me a little sad for the impending close of my career and loss of professional identity. Don't worry, I don't need a pep talk. I know there's some good things there. I just need to wallow a bit and take a minute to remember those cringe-worthy missteps climbing half-way up the academic ladder.

I'm leaving out a lot of holiday cheer that's happened, but need to draw this short. On this eve of New Year's Eve, here's hoping that 2024 brings a bit of comfort and joy to each of us, and, Inshallah, we all make it to see 2025.