Yippee! Mark’s a lab rat!
We found out a few days ago that Mark has been admitted to a clinical trial. It was challenging to keep our spirits up as we waited for the screening results to see if he qualified. For this trial, his cancer had to be causing a high level of inflammation in his body. A blood test measures the level of inflammation, and according to the clinical trial research assistant, most people don’t qualify. But Mark did, so yesterday he started the new regimen.
In this trial, the chemotherapy is administered through pills. Mark takes a daily set of pills of Xeloda, and another daily set of pills that are either the experimental drug or a placebo. Not even our physician knows if Mark is taking the new drug or the placebo, because this is a blind trial. But even just Xeloda alone will hopefully keep the cancer at bay, at least for a while. There are always side effects, but for most people on this drug, they supposedly aren’t too bad. We’ll see.
I’ve been reading The Emperor of All Maladies: A Biography of Cancer by Dr. Siddhartha Mukherjee. (PBS is airing a documentary based on this book in a few days.) I’m not a glutton for punishment—I just really want to understand as much as I can about this loathsome disease. The book is challenging, but very well-written and for the most part understandable to a lay person. Dr. Mukherjee provided the best explanation I’ve found for why any particular chemotherapy usually only works for a while:
“Every generation of cancer cells creates a small number of cells that is genetically different from its parents. When a chemotherapeutic drug or the immune system attacks cancer, mutant clones that can resist the attack grow out. The fittest cancer cell survives. This mirthless, relentless cycle of mutation, selection and overgrowth generates cells that are more and more adapted to survival and growth.”
Mutant clones…But we’re heartened, because at least we’re back in the battle. And as I see it, new treatments are being developed every day, so our best bet is to keep going as best we can.
A friend recently sent me a New York Times article touting the value of clinical trials and bemoaning the fact that so few adults enter trials (March 23, 2015, in the Personal Health section). I read it with interest, but I think it really missed the mark.
First, you have to be screened into a clinical trial. As far as I can tell, the test sponsors want their participants to be extremely healthy, except for having the disease under study. So if you have other conditions, like diabetes, heart disease or a limited liver function, you’re likely to be screened out. Lucky for us that Mark is otherwise healthy, not so lucky for so many others who have multiple challenges. You also have to be at the right point in your treatment. Some trials will only take the newly-diagnosed, and I think it’s quite a leap of faith to turn away from a standard course of treatment to an experimental treatment right at the time of diagnosis.
Secondly, the trials often require that you adhere to a tremendously intrusive and rigorous schedule. Mark’s trial is very easy that way. He will only have to go to the clinic once a week. We heard about another trial that required visits to the clinic four times a week. At some point you’re trading off the chance for more time against quality of life issues.
Also, if you’re in a blind trial (like Mark), you won’t even know if you’re getting the experimental drug. You’re just as likely to be getting a placebo.
Finally, you better pack your suitcase. Dr. C asked us at one point, Are you willing to travel? We’re lucky that this trial is here in Seattle. However, some of the trials are only taking place in cancer research centers in other parts of the country. Since the trials seem to require very close monitoring with regular clinic visits, I think the only practical way to participate would be to temporarily relocate, a pretty tough requirement for most people.
So off we go, galloping into this next phase, cautiously hopeful. The sun is shining today in Seattle, and the trees are pushing out the first shiny green leaves of spring. Life is good.