Mark had another PET scan this past Monday and learned the results on Wednesday at his appointment with Dr. Taylor. With Covid precautions, I can’t go to the appointments, so Mark patched me in via phone. He could tell from the doctor’s countenance that something was amiss. Dr. Taylor pulled up the images manifesting a golf-sized tumor in Mark’s liver. There was only one, but it indicates that the cancer has found a pathway around the medications, and other tumors will likely start growing. We have known all along that the current therapy is only a stall, so it was just a matter of time. Fortunately, this round provided 10 months with an excellent quality of life. Tafinlar and Mekinist were started on the 21st of February 2020. Despite all the craziness with a pandemic, natural disasters, and political unrest, we have had a wonderful year. Covid-19 allowed us to have more time together at home, and every day was a blessing!
Dr. Taylor went over several treatment options:
1. Remove the tumor in the liver. The liver grows back quickly, so that wouldn’t be a problem, but the surgery is not easy, and other tumors will likely start growing soon. Why go through the surgery if it's not going to make a difference?
2. Radiate the tumor. The same problem exists-- the problem is likely more systemic, which would require therapy for the entire body.
3. Go back to Keytruda. It worked well before with minor side effects, but a tumor grew several months after the round of infusions, so it is not durable, but could be used again for a stall.
4. Clinical Trials – None currently have proven positive outcomes.
5. Interleukin 2. This therapy has been around for over 20 years. We have not used it because it is so hard on the body, but it does have a chance of complete response. The window of opportunity of using this treatment is closing, as Mark needs to be in good general health. It is typically not used in patients over age 65 or 70. Mark will soon be 69. Interleukin 2 involves one week in the hospital with daily infusions. Multiple side effects must be monitored. Two weeks at home and another week of infusions in the hospital. If scans reveal shrinkage or at least no growth, he can go to round two, which would be the same procedure. Three rounds are the maximum dosage, as long as there are positive results, and he can handle the side effects.
Our current best option is Interleukin-2. The snag is that Mark must pass the stress tests. His lungs seem to be in good shape, but he continues to have irregular heartbeats. If his heart is not strong enough, that will nix the deal. The stress tests will be scheduled soon. He will stop the current medications about a week before the tests. Dr. Taylor believes he has a better chance of passing the tests if he is off the current medications. They could be affecting his heart.
About 25% of patients receiving IL-2 have a positive response, meaning that the tumor either stops growing or shrinks. Somewhere between 5-8% have a durable response, a prolonged response beyond what is ordinarily seen with treatment, perhaps extending life for a year or so. A complete response can only be determined if the patient has no evidence of cancer for an extended period of time and lives years beyond what is expected. When Mark was first diagnosed with cancer almost 9 years ago, he had about a 3% chance of survival, so we’re okay with small percentages!
While it is always hard to get negative news, we knew it would eventually come. Now, we will get on with the next treatment hoping that it gives us more time together. If Mark passes the stress tests, he will begin the first set of infusions on January 18, 2021. The typical hospital stay is 6 days (and I can stay with him – YEA!)
Our ultimate hope is in our Savior. Recently, President Nelson said, "The question for each of us ... is the same. Are you willing to let God prevail in your life? Are you willing to have your will swallowed up in His?'
Recently, we came across a poem that was helpful to us years ago when we lost a business, resulting in severe financial challenges: (There are various renditions, but this is one we first heard.)
My life is but a weaving, between my God and me.
I let Him choose the colors. He worketh steadily.
Ofttimes He worketh sorrow, and I within my heart.
Forget He sees the pattern, while I see only part.
The dark threads are as needful in the weaver’s skillful hand
As the threads of gold and silver in the pattern, He had planned.
Not till the loom is silent, and the shuttles cease to fly,
Shall God unroll the canvas and explain the reasons why.
Elder Neal A. Maxwell said, “Now, as you and I look at our lives . . . , we sometimes do not understand that through which we are passing, but, being submissive, we can trust Him.
“The day will come when the tapestry of your life will be unfolded, and you will see divine design all through it, and praise God for the experience and the tutoring which, in His goodness, He has given you” (“Willing to Submit.” [address given at BYU—Hawaii devotional, 9 Feb. 1988], 8).
That said, it is NOT easy to go through these challenges. Tears and heartache are real. Talking about it now, when Mark feels great, is vastly different than when he is weak and sick. During those times, we will lean on the kind, loving support of family and friends. The love of others and the peace that comes from our Savior bring sweetness in the midst of pain.
Also, we recently have had some special feelings that give us much hope. They have led us to "fear not" but to have faith. We are truly grateful for your faith, hope, and prayers.
