Off we go - or not, into the wild blue yonder. It seems that my most recent CT scan's results, described as "a little worse" by my oncologist, are indeed cause for some reflection and change. (I'm not quite able to say "cause for concern" yet.) As such, to make the most effective change, per my oncologist's orders, I am scheduled for a needle biopsy on the Wednesday this column publishes. This procedure will determine, if there is a match, to the specific type of cancer tumor that I have. (Without boring you with too many details, the short version is that all cancer tumors are not alike. Biomarkers/genetic mutations such as ALK, BRAF, EGFR, NTRK, PD-L! and ROS1 are the most common, and certain medicines work better against certain tumor types. Variations in the tumor types, such as the ones I've described, is a relatively recent discovery in lung cancer research.)
What this research has led to is another new kind of cancer treatment known as "targeted therapy." This means rather than "flying blind"--to use one of my brother, Richard's, favorite expressions--and employing a one-size-fits-all kind of approach to treatment, oncologists now have specific medicines to infuse when the tumor's genetic mutation is confirmed. Wednesday, hopefully, will confirm something. However, researchers have not discovered all the tumor types so it's possible that this biopsy will reveal nothing useful for me and in effect, I'll be back to square one-ish.
As for what 'square-one-ish' means? It means that I'll likely be infusing medicines that previously worked for a time but whose infusions were stopped after they all ran their successful course years ago. As I've been told whenever this change became necessary, cancer cells eventually figure out what's happening to them and then the tumors begin growing. Once this growth is indicated on the CT scan, a new medicine is usually started, and on and on it goes until, apparently now, for me anyhow. "Targeted therapy" offers lots of new medicines. I just need a match. Unfortunately, there's no guarantee the biopsy will provide just such a match. There's only one way to find out. On Wednesday, we will begin to find out. To say I have a lot riding on this determination is the understatement of the year; at least for Team Lourie, it is. If I'm forced to repeat infusions from medicines that stopped working years ago, it'll be "Katie, bar the door," as we say in Boston which means, "Look out!"
I'm trying not to 'look out' though. I'm trying not to look anywhere, except straight ahead. Just because my life may be at stake, is no time to deviate from the norm that has been my modus operandi over the past 11 years. I'm not quite ready to consider that my stage IV lung cancer survival is coming to an end. Maybe it's just staggering and within a week or so, I'll get my bearings again. New medical information getting me new medical treatment is sure to put a bounce back in my step. For the first time in 11 years, to quote George Costanza from Seinfeld: "I'm back, baby." This could be the jolt my body needs to get me through to the next research level. The Team Lourie strategy has always been for me to try and live long enough to reach the next medical breakthrough. So far, I've benefited from a few: tarceva, avastin and alimta; all miracle drugs according to my oncologist, and here I am, living proof that it has all worked.
Until I hear, post procedure, from my oncologist, in the interim, I am re-experiencing many what-happens-if-and-when emotions that I've not wrestled with for years. Unfortunately, this hospital visit is taking me back to the visit/biopsy I had in Feb. 2009 which confirmed the malignancy in my lungs in the first place. And here I am, hopefully not in the last place, waiting for the results of a biopsy yet again. It didn't work out so good in 2009. I just hope I have better luck in 2019.