Thursday, March 27, 2014

PET results

 I had an appointment with Dr. Laudi this afternoon.  He looked at all my data and pulled up my last 3 PET/ CT scans (Oct, Dec, last Monday) for comparison.  Here is what we learned:

-My weight is down another 3 lbs. 

Tumor spots:
-In my liver (there in Oct, gone in Dec): Still gone!
-Left armpit (appeared in Dec): Gone!
-Right scapula (appeared in Dec): bigger
-L4 (improved in Dec): now advanced and includes L5
-Left hip/ supra-acetabula area (not new): still there

-New neuropathy (tingling/ numbness) in legs and fingers: could be chemo-related

-Hormonal Therapy: I tried Tamoxifen early on
 (Remember, I did not do well on this in the past.  It didn't work and I felt like I was living my life through an out of body experience).

-Chemos used so far: 
*Adriamycin- Cytoxan (worked the best, but there is a lifetime limit)
*Gemcitabine (tried to kill me)

-Could possibly try Liposomal Doxorubicin (Liposomal means it is mixed in a fat solution. Doxorubicin is the same drug as Adriamycin- all these drugs have a couple different names depending on which company is producing it.  Drove my mom and millions of students taking Pharmacology Classes crazy.)

-Find another chemo or clinical trial.  At this point Dr. Laudi expressed frustration, because the tumor samples they took from my original tumors in my breast are gone and I have never had significant tumor size or location to get more.  Since the tumors never recurred in my breast, he wonders if they have mutated.  My original tumor was Estrogen+, Progesterone+, Herceptin-.  If the cells have mutated they could be Herceptin + now and that would open up more chemo drugs and clinical trials for me.

-Targeted Therapy. This got Mark's attention! Mark discovered this therapy in his early research and has been asking for it all along.  Dr. Laudi explained that Targeted Therapy is not chemo.  Chemo affects cell DNA. He used a car analogy.  To get a car to go, a lot of things have to happen in a certain order.  It's like a domino effect. Which pathways feed these particular cancer cells?  Once the pathways are determined- and tumors can use multiple pathways- then the therapy tries to block them. 

"Steve Jobs lived 5 years using this type of therapy." Dr. Laudi said.

"Well," said Mark, "Sarah will go beyond that." 

Dr Laudi said I would need to have another biopsy.  The L4, L5 spots are accessible, so they would most likely be used.  The tumor tissue would be sent to a lab called Foundation One.  They would look at 500 genes within the tumor cells and determine which genes are activated and which pathways feed these particular cancer cells?  He googled "Genetech" and showed us diagrams of these growth factor charts. 

At this point, additional chemos will be a last resort.  Chemos work blindly and affect other healthy cells.  Chemo has a short longevity.

The plan:
I will have a biopsy of the tumors next week.  The bone will be sent to Foundation One.  They will also look at Estrogen/ Progesterone/ Herceptin receptors.  If they are now Herceptin +, I will have many more treatment options.  We will get a printout of all the data and mutations.  My therapy will be targeted to MY cancer cells.  

Prayers would be deeply appreciated...

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