In the three and a half years I've known I have cancer, I've come to expect a certain result whenever I meet with my oncologist Dr. Kennecke about a CT scan: after 16 or 17 of those scans now, I know that most often, my tumours have grown a little, not a lot, and there may be one or two new little ones. That's my default position going in, before I know anything. If things are better, I'm happy. If they're worse, I'm sad. But if that's roughly the result, I may be disappointed, but I'm not crushed, as I might be if I were a relentless happy-happy must-think-positively type.
And that was roughly the result this month. I had another scan a few weeks ago and met with Dr. K. at the B.C. Cancer Agency this past Tuesday, the day after returning from my family trip to California. As usual, things have grown a little in both lungs. Nothing has spread to any other organs, and there's no change in my left kidney, which has been slightly wonky ever since my major surgery back in 2007, when my surgeons managed to save it instead of having to remove the kidney altogether.
The growth is enough that Dr. K. thinks the current chemo is no longer working. Somewhat like antibiotic drug resistance, chemotherapy drugs often become less effective over time in patients like me, who take it over the long term. (Coincidentally, in fact, CBC Radio's science show "Quirks and Quarks" recently rebroadcast an excellent program from last October, which describes the phenomenon in the context of new treatments that allow people—again like me—to live with cancer as a chronic disease.)
Essentially, a particular chemo regimen poisons and kills cancer cells that are susceptible to it. But cancer is a disease of mutation, and there may be mutant cells left over that can resist the poisonous effects of the drugs. As the poisoned cells die, the more resistant cells can come to dominate, and then grow more tumour tissue, requiring a change to different drugs to poison them.
So that's what comes next. We're discontinuing my current three-drug cocktail of 5-FU, oxaliplatin, and leucovorin (known together as FOLFOX), and will replace it with another drug (which, like FOLFOX, I tried previously some time ago), called irinotecan, perhaps in combination with other agents. This is sucky news, yes, but as I mentioned, it's the kind of sucky news I expect and have encountered many times in the past few years—indeed, I've lost track of how many different drug combinations I've tried by now. For me, it's more a bummer than a crisis, though it's harder for the rest of my family.
There is one big, nice benefit. Dr. K. recommended that I let my body—especially my immune system—recover a bit from the FOLFOX treatments before I start the new stuff. So I'll have no chemo until after Labour Day, about six weeks away. I can enjoy the end of summer without being laid out in bed for three days every couple of weeks. Maybe, with luck, my oxaliplatin-induced neuropathy will abate somewhat too.
When I'm supposed to be taking things one day at a time, six weeks of summer in one of the world's most beautiful cities, and feeling what's likely to be somewhat better, is an unexpected bonus.