No More Wondering

Yesterday Mark went in for the PET scan that Dr. Urba had ordered. Within a few hours we got this text from him:

Hi Mark, 
I tried to call.  We can try again tomorrow.  It is important to listen to your body.  The PET scan is bright in the left adrenal gland where you hurt.  I have to review the scans with the radiologist as there is one other very small but bright spot in the liver.  I'll reach out sometime tomorrow.  
Walt

(Bright means an active tumor.)

Of course, this isn't the news we wanted, but it is good to know the reason for the pain, and be able to move forward with treatments.  There are still several directions we can go.  

1) Back to targeted therapy, Tafinlar and Mekinist - to reduce the size thus reducing the pain. It is not a cure, but a good stall. 

2) Back to Ketruda, the single immunotherapy drug that worked so well before, or Opdivo which is similar and reacts the same.  Last time Mark was on Ketruda for a year and the tumors stayed away for another year.  This time he will stay on one of these treatments for two years.  That means infusions every three weeks.  His side effects were minimal last time so we expect the same.  Yervoy is out of the picture now because of the adverse side effects.  

3)  Hmmm, surgery doesn't seem likely if there is cancerous activity in more than one site.  

4)  There is also Interleukin 2.  We understand that the rate of cure is not nearly as good as the other immunotherapy drugs, and the side effects can be undesirable.  If it's the only option left, it is a possibility.  

We will meet with Dr. Urba soon to discuss the next steps.  Because we expected this, it has not been a shock and we are doing well.  

Our time together is precious and we are making the most of it!