Tumor is Shrinking! — Loong Chen

The first of the progress scans, scheduled for every 2 cycles, was this week. The good news is that the tumor is responding the chemo and immuno therapy drugs! That is quite a relief, though we had been hopeful that would be the case given that my ear pain has largely resolved and it is easier to relieve pressure in the ear. What this means is that we should expect to continue the chemo/immuno course for the full 6 cycles (though early August) and then see what the next steps will be. We are still hoping this is a curative treatment program that will eventually lead to killing all the cancer cells.

The regular progress check consists of three different evaluation modalities: a) CT chest scan to check for spread; b) MRI of my head & neck; c) endoscopy (camera inserted through my nose) to visually examine the tumor. On Monday (16 May), I got the CT and MRI scans and then saw Dr. Roxbury, the ENT, for the endoscopy. Dr. Roxbury was “very pleased” with what he saw, or rather what he couldn’t see. He was not able to see the tumor through his scope. The tumor is largely located in a hard to see area, but that is definitely good news that he wasn't able to see it through my nasal cavity.

We met with Dr. Rosenberg, our oncologist, on Wed (18 May) to get the results of the scans. Fortunately, the results were not released before seeing our doctor (as had been the case previously - the lack of context caused a lot of stress). The news about CT scan being clear was more of a relief than anything else. The cancer had not spread before starting treatment, so it would have been devastating and a major surprise if it did.

The results of the MRI confirmed what we were hoping - that the resolution of the ear pain was a result of the tumor getting smaller. Dr. Rosenberg (and Dr. Roxbury) showed us the images from the recent scan vs the one from February. The images are not apples-to-apples comparisons, since they were taken by different machines at different centers. We don’t yet have the radiology report to get measurements to see how much it shrank, but even though it’s hard measure given the tumor is an irregular shape (more of an elongated shape). It appears that the boundaries of the tumor appear to shrank in all dimensions. Hopefully this means that if I need radiation in the future, the radiation field should be smaller. That means that the risk of damaging surrounding structures is lower, and the side effects should be less severe.

We don’t know how the tumor will respond in the future but this is definitely a good start. We had been told that the first few cycles will be a good indicator of how the cancer will respond to drugs and also to radiation. So a good response at the beginning hopefully means that future treatments will be effective. At the very least, we can plan around doing the full 6 cycles of chemo.

Besides the scan results, I’m feeling pretty good. I’m currently in the second week of cycle 2, having received all three drugs on day 1 and then a chemo drug on day 8 (cycle 1 skipped the day 8 infusion due to low blood counts). In this cycle and going forward, the plan is to reduce the dose of carboplatin (from AUC6 to AUC5, which translates to ~15% reduction in the drug) to ensure that my blood counts remain at a sufficient level; the dosage for the gemcitabine and Keytruda were unchanged. As in cycle 1, I experienced a bit of mild nausea and fatigue in the 36-72 hours following the infusion and then my energy recovers. I took a few more anti-nausea medication this time, as the care team said it’s better to get ahead of it than to try to manage once nausea sets in. I’ll plan to continue that going forward. I am also pleased that the day 8 gemcitabine infusion doesn’t seem to affect me much - minimal side effects. So essentially, once I manage the first few days after the day 1 infusion each cycle, I’m pretty close to my normal self for the remaining 2 weeks of the cycle. Let’s hope that pattern continues for the rest of the cycles.

Finally, the treatments still have not had a negative effect on my ability to eat and drink. In pre-treatment days, good news like this might call for a celebratory drink, but I’m strictly adhering to the alcohol ban during treatment. So we’ll have to find another way to recognize the good news.

Door leading to an MRI machine - no metal allowed inside

In case anyone is wondering, the picture is of a CT scanner. A CT uses X-rays to image the body. For a CT scan of my chest, it took about 10 minutes, and I was able to bring in my bag and didn’t need to change. On the other hand, the MRI (magnetic resonance imaging) uses magnetic fields and radio waves to create the image. The images are usually taken with and without contrast. For an MRI of my head, it takes about 30-45 minutes during which there are loud sounds from the machine and I have to lay still. Normally, I either meditate or doze off (despite the noise) during the scan. Because of magnetic fields, I definitely could not take in a camera, nor any metal. At a previous MRI, I forgot to take my wedding band off. My band is a mix of platinum and meteorite, enough that I could feel the pull from the machine’s magnetic field as soon as I walked into the room.

I’m still behind on the food updates, but I’ll plan on that the next time. Thanks again for continuing to follow the blog and our journey.