What Lies Ahead - May 6, 2010

On Tuesday, May 4, Pete and I met with Dr. K at Memorial Sloan-Kettering Cancer Center in Manhattan. Friday evening Pete had already been given the good news by Dr. W that the tumors had diminished in size, but since the appointment was not until 4 PM, Pete had time to pick up a copy of the report from the medical imaging facility. He showed it to me as soon as he got home. The largest lesion, the one that had been reported previously as 7.7 x 6.4 cm., is now down to 4.7 x 2.3 cm. Another tumor, according to the report, has gone from 1.0 x 0.8 cm. to 0.5 x 0.4 cm. Two others had significant reduction, and there was "resolution of a second left anterior pericardial node which previously measured 1.2 x 0.7 cm."

Dr. K seemed quite pleased with these results. She explained that Pete will continue with the current regimen of Dacarbazine (aka DTIC) at 3 week intervals and maintain the daily oral dose of Sirolimus (aka Rapamune). She will discuss doubling the dose of Sirolimus with Dr. W.

Pete will periodically have CT scans to monitor his status. To determine the next stage of treatment they will be watching for no new lesions (indicating no progression of the disease) along with continued reduction in size and/or number of existing lesions, and/or stabilization. When stabilization is attained, a thoracic surgeon at MSKCC will be consulted regarding removal of any remaining tumors in the lungs. She said that it is highly unlikely, though it is possible, for all the tumors to resolve. And even if the CT scan identifies a certain number of remaining tumors, there may be additional tumors found during the surgery. The reason for this is that the scan takes incremental "slices" and it's possible that a tumor can fall between these slices and therefore not be visible on the scan film.

The bottom line is that Pete will most likely have several more months of chemo, perhaps six months or so. Hopefully he will continue to tolerate the treatments well, continue working, and be able to enjoy a relatively stress-free summer.

That said, he has his next infusion on Wednesday (May 12), and his brain MRI is scheduled for Friday (May 14). Here's hoping that the 3 mm spot there has either disappeared, or at worst, has not changed.