Marshall's Cancer Updates

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 grou...

The short version  For those whose impulse is "too long; didn't read" but still want to be in the loop, this section should get you caught up. I emailed a version of this to family members, so some of you may already be familiar with this information. I've joined the clinical trial at the University of Michigan's Rogel Cancer Center. Pre-trial scans (CT and MRI) over the last couple weeks all look good: no new brain metastases and little disease progression with bone mets and other lesions, which was surprising to me.  Over the next couple weeks, I will be sorted into Group A (control group/standard of care chemotherapy with Docetaxel) or Group B (experimental group/immunotherapy with Keytruda).  I should know right away which group I'm sorted into. I'll start infusions every 21 days beginning on December 19th for up to 2 years, or until the drugs become hypertoxic or stop being effective. -------------- The long version It's been one year since the fi...

Giving Thanks, November 2023 In my last update a couple weeks ago, I wrote about needing to make a decision about next steps for second line therapy -- whether to go with the Pragmatica-Lung Clinical Trial, a prospective randomized study of Ramucirumab plus Pembrolizumab (Keytruda) in a 3 hour IV infusion every 3 weeks for 2 years (or until it stops working or becomes hypertoxic) or to go with standard of care, which is Ramucirumab plus Docetaxel chemotherapy for two years or until hypertoxic. In messaging with our primary oncologist, Dr. H., we learned that if I start another round of chemotherapy, I will be disqualified from joining the clinical trial. In that case, it would make more sense to start with the Pembrolizumab trial first and then switch to Docetaxel later if that's not working. Of.course, if I end up in the control group, I'll be prescribed Docetaxel anyway. When pressed about whether to join the clinical trial at UM in Ann Arbor or one of the same trials at ...

MRI: Not quite sure what I'm looking at here, but I thought the eyeballs looked cool.  Teaching   There are only a few active weeks left in the semester, and my students in creative nonfiction have been incredible. They're a small group of very talented and self-motivated writers and have been gracious about my lapses. I've nearly caught up on scoring and commenting on their work, but there's also a lot of peer feedback and they are all quite skilled at that. Nearly all of the students are writing consultants in either the writing center or the embedded writing specialist program. We had a fantastic face-to-face session this last week with Curtis Chin , author of the new memoir Everything I Learned, I Learned in a Chinese Restaurant .  Curtis Chin. That's me in the (back left) corner. I'm thinking that this might be my last semester of teaching, and what a good class to go out on. I'm looking into extending my paid medical leave through May, taking summer of...

From the New York Times : "One of the great joys of the Jazz Fest is the odd parade that occasionally takes over the pedestrian paths, bursting through the center of the fairgrounds with an explosion of color, sun-brellas, horns, feathers, and fancy footwork. This apparently chaotic event is called a second line. "The second line is a type of parade historically associated with jazz funerals; the term "second line" is often thought originally to have referred to the secondary group of participants in such a parade, behind the band and the family . "Second line" is also used to refer to the distinctive dance moves that can be glimpsed during New Orleans street parades of all sorts." It’s clear that my treatment team is transitioning me from curative treatment to palliative care that attempts to arrest disease progression and provide a measure of comfort. I've reconnected with the palliative care team for pain management and to alleviate side effect...

An existentialist gazes into the abyss; the abyss gazes back.  Existential Comics: The Elflord and the Mayfly In " Hour of the Mayfly: Life and Death the Existentialist Way ," Tim Raynor writes, "The Existentialist philosophers . . . were so impressed with the transformative power of death that they made confronting death central to their philosophical way of living. Death, Existentialists argue, brings life and its possibilities into focus. In the process, it reveals what we are ultimately capable of being. Heidegger argues that confronting death brings to light ‘the totality of our potentiality-for-Being.’ In a moment of vision, we grasp our full sphere of potential – a realm of potential that is ours and ours alone, that we may or may not take advantage of. We catch a glimpse of our whole person, our total capacity to exist. "     “There is no Stage 5.”  John "Johnny Sack" Sacrimoni,  The Sopranos ,  Season 6, Episode 14 .   I talked to Dr...

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 t...