Sunday, September 19, 2010

I may be the first medically documented case of . . . (drum roll)

Satellite lesions in a cancer other than melanoma that has been treated with adoptive t-cell therapy.

In other words, a phenomena that medical professionals thought was unique to melanoma is now happening, right now, in my body!

I always thought I was *special*! LOL

I had my visit at UW on Thursday and talked to Dr. D. Boy, is she smart and very very up on the medical literature. She was quoting immunological studies, cancer studies, t-cell therapy studies.

I followed along, but lord knows I won't be able to remember it all, let alone report on it.

Instead, I will tell you what I remember, but please remember that I may have details wrong. So don't quote me. Talk to a medical professional if you have questions!

First, the satellite lesions. As I may have discussed in an earlier post, it seems that the main lump or lesions has shrunk. That is the one that is leaking exudate and where there has been some breakthrough (an area about 4cm long and a 1 cm wide) in the skin. This was the first time that Dr. D saw me, but she felt it was smaller, too, based upon the digital pictures we sent as well as Dr. K's description.

And then she said, "Deanna, your case is very interesting." (Aside: be wary when a doctor says your case is interesting. Could be good. Could be bad. But usually means something is out of the ordinary.)

Turns out that the medical literature reports an "interesting" phenomena that happens in melanoma patients with advanced melanoma who get adoptive t-cell therapy. What happens is that the main central lesion shrinks but these satellite lesions crop up that tend to be more resistant to t-cell therapy. Medical researchers thought that this phenomena was unique to melanoma but now I have shown that this isn't the case.

My case is the first documented case in which satellite lesions have cropped up in a cancer that is not melanoma. Should one cheer at this news? Hmmm, not sure . . .

Anyway, Dr. D feels that these satellite lesions will not respond to the t-cell therapy as well. I also have some lumps in my right clavicle that have grown a bit in the last month (from over 1cm to 2 cm and the other is now about 1cm). Dr. D says that these are cancer, so in her opinion, I need to start systemic therapy sooner rather than later.

I could do radiation, but that just treats the local area (under the armpit), not the whole body. Since there is evidence that cancer is elsewhere in my body, systemic therapy would be better. If systemic therapy doesn't quite do the trick in my armpit, we can always do radiation.

I should also say that radiation would hurt the skin's ability to heal. Dr. D thought that once the cancer in the armpit was killed through systemic (i.e. Chemotherapy) treatment, the tissue could heal within about six weeks.

Radiation would delay the healing and might also impair the healing process.

So the drug of choice is Abraxane. Side effects include hair loss (about 50%), neuropathy (numbness and tingling in the extremities), fatigue, and maybe nausea. I wasn't so sure about this chemo unil Dr. D explained that Abraxane works a little more like a targeted therapy rather than a traditional chemotherapy. There is something about how the drug is created, at the molecular level, that causes it to pause or stop where the cancer cells are. Then it releases a chemical signature that mobilizes the t-cells to attack the cancer. (I will probably butcher this explanation, so don't quote me!) Abraxane finds the cancer cells, coats them with a chemical that makes the cells look like a bacteria. This is important because while the body's immune system sees the cancer as abnormal (a mutated version of your own cell), it doesn't see cancer cells as foreign bodies. So the antigen presenting cells (cells that roam around your body looking for foreign cells like viruses and bacteria) don't send out a signal to the t-cells (that Dr. D described as hanging out drinking coffee in your lymph nodes waiting to for the alarm to seek and destroy - loved that image, BTW, makes me chuckle) that there is a foreign body. Abraxane changes that by giving the cancer cells the look of a foreigner, so the antigen presenting cells start sending out the alarm, calling for the t-cells to attack the "foreign" cancer.

So, I will start Abraxane in two weeks. I will have a CT scan next week. I wanted to wait two weeks because Puttin' on the Pink is in four weeks and I want to have as much of my hair as possible. The hair doesn't start falling out until 2-3 weeks afterwards. I don't mind the hair loss. Fatigue is fatigue. Have experienced that before. It is the nausea that I don't like. And the neuropathy will be weird.

I hope that I only have to do this for a few months. It will depend on how my body responds. I think it will help get us back in control of the cancer and then when the t-cell therapy kicks in, I won't need anything too strong. (Dr. D reiterated that the average time for complete response to t-cell therapy in leukemia is 45 weeks or 10 months.)

So, Abraxane on October 1st. My visualization while getting it will be the construction of a red flashing light and a siren at the site of cancer cells, so that it can sound the alarm to those coffee drinking t-cells ha Ginger out in my lymph nodes. Time to sound the alarm!


Carver said...

Well I am of course sorry you are dealing with this but it is interesting. I am familiar with the T-cell therapies that are being done (primarily in trials) for melanoma patients and didn't even realize that were trying this for breast cancer until you mentioned it on your blog. I hope that abraxane will be a success and that your side effects won't be too terrible. Take care, Carver

Joanna said...

It sounds like you are a trail blazer. It feels like things are progressing the way they should. I am glad you are getting additional treatment to kick any leftover cells to the curb.

Joanna Moore

Dee said...

Thank you both, Carver and Joanna! I am not looking for wars to the Abraxane; I am trying to keep the visualization in mind, though! Abraxne will tag the cancer and send the alarm to the Herminator-2 cells to attack!