[Cancer]
[cancer] Yesterday’s second opinion consultation
Yesterday, Dad, Lisa Costello and I met with an oncologist at M.D. Anderson. Donnie Reynolds was there, too, documenting.
The oncologist conducted a very thorough physical examination of me, and discussed my medical history in some detail. They then went over their view of my treatment options, focusing as my medical oncologist back in Oregon has recently come to do on treatments for life extension rather than treatments for cure.
Basically, there are two options. One is to continue with the treatment guidelines which we have been following. The other is to engage in investigational/experimental treatments.
Regarding option one, the oncologist at M.D. Anderson believes that the right way to proceed is to shift directly to Regorafenib, which is third down the line in the current treatment plan at my home hospital. Their logic for this is that we have effectively proven that the proposed continuation of Vectibix will be ineffective given my most recent metastases, and they feel it will be a waste of my time and effort.
The other option is to embark on a investigative/experimental clinical trial. The oncologist said if I were local to Houston, they would enroll me in a current trial combining Erbitux (Cetuximab, a close cousin of Vectibix/Panitumumab) and Aflibrecept, which the investigators believe will facilitate the effectiveness of the Erbitux.
The challenges of enrolling in an investigative/experimental clinical trial out of state are immense, and we are still working to understand the rewards. As the oncologist here in Houston said, there’s no particular guarantee of success down any path. They declined to give a firm recommendation, saying this choice was up to me. My parsing of their comments about effectiveness is that none of my choices have an especially high probability of success.
I did speak to a knowledgeable friend afterwards about the question of why I would choose to go the route of investigational medicine when there were still approved treatments available. Their response was that for late stage patients such as myself, Stage III clinical trials can sometimes be more effective. My cancer has proven resistant to most of the available drugs within the clinical guidelines, so doing something new has a better shot. Also, patients in clinical trials are monitored much more closely than patients in mainstream treatment, which can have a positive effect on outcomes.
I also spoke on the telephone yesterday evening with the M.D. Anderson oncologist, who confirmed they have talked to my medical oncologist back in Oregon about the treatment recommendations. I’ll be seeing the medical oncologist at home on Friday, so we can review these outcomes and consider next steps, such as whether to make a serious effort at working out the logistics of a clinical trial in Houston. This very much includes significant questions about the impact on ![[info]](http://l-stat.livejournal.com/img/userinfo.gif?v=1){kind=small}
the_child
There’s still the potential wildcard of the genomic testing results, which I am expecting to see any day now. Also, we have a meeting today with the chief scientists from the group doing the clinical analysis, which will both shed more light and further muddy the waters.
At this point, it is very unclear to me which direction I might choose to follow. I have questions out to both the M.D. Anderson oncologist and my home hospital oncologist, and am awaiting more answers from them, which may influence my choices. It’s a tough call at best.
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Posted: 5:51 am Wed March 06 2013 |
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Tough call for sure. The Huston option seems best if you can swing it, but I wonder if those conducting the program could simply ship the drug to an oncologist in Oregon with monitoring instructions.
Hugs.
@Rajnar – No, with clinical trials, the administration processes are very tightly regulated to comply with FDA requirements. As the oncologist says, if something goes wrong for a patient, *everything* is scrutinized in depth, so they can’t do trials that include disparate facilities with different management and treatment routines.
Putting the “clinic” back in clinical trials.
I am struck, not for the first time, by how much drug names seem to originate from someone who had aspirations to write fantasy novels but no talent: “With one blow of the enchanted sword Aflibrecept, Prince Erbitux of Regorafenib struck off the head of the evil wizard Vectibix.”
Tough call. I really hope the genome sequencing offers a good new approach.
I wouldn’t discount the importance of support/familiarity/feelin’ the love of one’s network on longevity, particularly since the treatment focus is not on cure. The black dogs of depression and despair often circle when we’re feeling alone.
I apologize for being presumptuous since I don’t know you IRL, but reading your blog, it really sounds like Portland is your home, where your heart is.
Houston is a wonderful (if humid) town, and I know two members of my family who went to M. D. Anderson years ago and are completely healthy (if old) now. That said, though, I don’t know what I’d do. My gut feeling is to go with the clinical trial and go on faith and hope. I know there would be a ‘net person whom you could stay with or stay near in Houston. We’ll just be still and wait for the answer from the Universe.
Jay, I think you can’t begin to make choices until you know the outcome of the genomic testing; I continue to hope that this may shed useful light for you…
Perhaps a third opinion might be in order? My experience with Dr. Fisher at Stanford was quite good, and he is involved in trials and the local expert in colon cancers.
http://med.stanford.edu/profiles/oncology/faculty/George_Fisher/
Hope the genetic data gives your some viable additional options.