Unstoppable Dr. Detroit

Just before the weekend I heard from Dr. Detroit and according to her, there has been a delay in my starting treatment with the Karmanos Centre clinical trial because “we are still waiting for the Canadian government to approve your treatment here.”

Um, yeah… Approval from the Canadian government…for my treatment in the U.S.  …Pardon me?

First of all, that’s just what you need when you’re desperately awaiting life-saving treatment: a gargantuan bureaucratic behemoth squatting in your path and waylaying the approval process.  Second, what in the holy bejeesus could the Canadian government be approving, since we are paying for every penny of my treatment ourselves?  And which branch of the government?  And at which level – Provincial?  Federal?

I shared the e-mail with my family and we did a lot of looking at each other and blinking in utter confusion at the total absurdity of the Canadian government’s involvement.  As far as I’m concerned my government lost its say in my treatment right around the time I was told that they couldn’t do anything more for me and I had better look into clinical trials for experimental treatment options.  Which of course I did.  And now they’re holding me up?

We’re all totally stymied, and I vow to get to the bottom of this Big Brother-esque mystery just as soon as I can devote some energy to it.  At the moment however, my focus has to be on regaining my strength and appetite after a weekend of adjusting to the new painkillahs.

Actually, the main reason I’m not banging down doors for answers (other than having no idea upon which doors to bang) is that I don’t have to; Dr. Detroit went on to say that as an alternative to the delay they are opening a compassionate use trial for me that is monotherapy (which is how the drug will be FDA approved in the U.S.) She says they anticipate it opening up in a few weeks.

Okay so how’s that for a doctor?  Something gets in her way – something like, oh I don’t know… a government – and she just goes around it to come up with another solution to get me the treatment I need in a timely manner!  And not just the treatment I need, but the dose at which it will be approved when it goes to market.  In other words, the dose that worked for people in clinical trials! She’s like the superhero of oncologists – she should be wearing a cape, not a lab coat.

We can’t celebrate yet — I still need to hear that they have been successful in opening the monotherapy compassionate trial, and of course that my government hasn’t stopped up the process any further.  And until then, I need to do my part and stay in good enough health to make it to the new start date in a few weeks.  I think I can do this.  I have to. 

Hold on Detroit, I’m coming!

Advertisement

Dr. Detroit!

We love Detroit!

Well, maybe not the urban wasteland / don’t-take-a-wrong-turn-sucka city proper – but we definitely love the gleaming, amazing Karmanos Cancer Center, stuck incongruously in the heart of it.  And we especially love the brilliant clinical trial leader there, who shall hereafter be referred to as Dr. Detroit.

Dr. Detroit is world-renowned for her work in testing new cancer drugs. She’s been at Karmanos for 21 years and in that time has brought so many important anti-cancer drugs to market that she’s become a bit of a cancer legend.  In person, she’s a thorough, straight-talking, personable, smart, get-it-done whirlwind of a woman – but what we liked best is that she seems completely unafraid to give us hope.  Specifically, hope that this drug will work for me. Hope that I might live.  She did it in part by saying that for HER2+ cancer, TDM1 is the best drug she has ever worked with. 

This is the first time we can remember sitting in the presence of an oncologist who will use a word stronger than “interesting” to describe a trial drug and its potential benefit.  And frankly, I really would like a drug to do more than “interest” me, especially if we are going to have to travel several hundred miles every week and raise several tens of thousands of dollars to get it.

Anyway, there we were, listening to Dr. Detroit and feeling the unfamiliar buoyancy of hope for the first time in forever. Amazingly, I was also feeling more energetic than I had in weeks, which was unexpected, especially after the long drive Wednesday (we’ll be taking the train next time.) In fact I’d been totally exhausted when we checked into our room on the hospital campus the evening before, and had a low fever as I got into a hot bath while my husband went out to forage for food.  (Let’s just note here that driving around downtown Detroit after dark with Ontario plates and no idea where he’s going is not what I would describe as typical of his intelligence and good judgment, but he did make it back in one piece.) By the time he came back, I was feeling better, sitting up reading in bed, and he remarked that I had colour in my cheeks again and wasn’t coughing continuously.  “I don’t want to jinx anything,” he said, “But do you think the chemo could already be working?”

In the morning, I was even better.  Neither of us could believe that I was able to walk across the hospital grounds to the clinic, and then sit, eat, talk, and just generally function at an almost normal level.  It was a surprise to both of us; hard to believe I was the same woman who, four days earlier, couldn’t get out of bed to get a glass of water. Mind you, four weeks earlier I could go for long walks and chase pigeons through the park with my kid…  Anyway, we were just happy that I didn’t seem quite so ready for the Final Curtain anymore.

So when Dr. Detroit remarked that I presented a pretty darn healthy picture for someone whose records note that her oncologist had been recommending palliative care, we confessed that this returned energy was new.  “Hm,” she said, “Maybe the vinorelbine is already working.”  (More hope!)  It turns out that far from disqualifying me from the trial, she wholly endorses me getting chemo and has encouraged me to continue to get it weekly, if possible, until the 21-day cut-off point.

So, if all goes well, I can begin the trial in May. I will get TDM1 plus two other drugs, pertuzumab and Taxol.  They’re being tested in combination for the first time together, which is why this is called a Phase 1 trial, but the drugs themselves are not Phase 1 drugs – they’ve reached far beyond that – and I am optimistic that they can really help me.  

What if it works?  I think it really could.  Really, I do, because Dr. Detroit does, and she’s been around the cancer block a few times.

But first, all must go well. Meaning I have to get through at least five more weeks without my health deteriorating any further, I have to navigate the not inconsiderable administrative hurdles of getting my records transferred to Karmanos, I have to continue to get vinorelbine (and even lobby to get an extra dose, if possible) and I have to raise massive amounts of money.

But most important of all – and here, ladies and gentlemen, is the catch – there can be no brain metastases. Because if there is, I am not eligible for the trial. Period.  

Or, as I like to say, if there is cancer in the brain, I can’t get on the train.

So, even though the CT scan was clear, everything now depends on an MRI of my brain. I believe I can get through all the other challenges, but this one thing I just can’t control.  Why is there an aura in my right eye? Go away, damn aura. Out damn spot!   Becasue having just found hope again, I can’t stand the idea of losing it so soon.

The Narrow

Still exhausted and weak but now capable of being vertical for short periods. Thank-you, thank-you, thank-you — your words carried me and comforted me.  As did my mother, my dearest friends, my family, and my incredibly incredible husband.  Everyone managed to hold me together, distract Georgia, feed and water me (despite my protests), prop me up, tuck me in and generally get me through.  Their care and your messages reached me through the fog of fear and pain and reminded me that when I fall I can stay down for a while.  And then I can come back up swinging. I’m not lacing up my boxing gloves just yet, but at least I’m eyeing the ring again.

My husband on the other hand seems to be in full swing.  Today he woke up and left the house early for an unscheduled confab with my oncologist.  By 10:30 I was having a CT scan of my brain, by noon, bloodwork, and a couple hours later, chemo. It’s the one we were holding in reserve, vinorelbine, and my oncologist made special arrangements to get it administered today so that I can still go to Detroit tomorrow.  And I am going to Detroit tomorrow, oh yes I am. If I have to be carried into the car and out again at the other end, I’m going.

My uncooperative and obstinate cancer may not respond to this chemo — given its history of response to standard treatments — but then again, it may. Even if it slows down just a little bit, it will be worth it.

This chemo may also get me disqualified from the Detroit study, but then again, it may not. My family, my oncologist and I all agreed that we have to take that chance; I simply can’t go another 5 weeks without trying some kind of treatment.  Some kind of something.

So, even though I am typing this with one hand and only one eye open while lying down in a vegetal state with an excruciating, pounding headache, I am actually feeling better.  All is not lost.  There is action, so there is hope. 

And best of all? The CT scan showed that my brain is CLEAR!!!  I was warned not to get too excited since an MRI will be required to be sure that there is nothing evil lurking in the neuro-spaghetti, and of course those pesky “auras” and headaches still need to be explained… but don’t get too excited about a clear brain scan??? That’s a tall order, given the shortage of good news around here.  How about just being incredibly relieved and grateful that today at least I don’t have to reckon with cancer in my brain.  Today, and maybe a few more days.  Maybe lots more days.

Yes, I can hope, and I try to.  But yesterday I met with my cancer shrink whose horrific job it was to tell me that I also need to recognize that this cancer is crashing through every obstacle we put in its way, and the reality is that maybe nothing — no treatments or trials or anything we can throw at at it — will stop it from killing me.  My amazing cancer shrink who by the way I truly believe is one of those rare people who is doing what he was put on this earth to do (he really is that good at it.) Unfortunately this is what he was put on the earth to say to me yesterday.  

Not that I hadn’t already recognized it and begun to wrestle with it on my own, and with my family and friends.  But when your shrink tells it to you… ouch.  Holy Moses, it’s real.  It’s moments like those that you realize this isn’t one of those nightmares you get to wake up from. It’s moments like those when the world freezes and you feel like you have just glimpsed the way the whole thing works but it doesn’t matter anyway because all you want to do is love the people you love and live the life you love living… except maybe you won’t get to do that anymore. 

What do you do at a moment like that?  I just cried big fat gigantic splashing tears, and when they slowed down enough that I could look him in the eye I said, “My god. I’d really f**king hate to have your job right now.”

So this is where I am.  This is where my family and I have to live right now: on this razor’s edge, this impossibly narrow place right smack between the terrifying reality that perhaps nothing can stop me from dying from this cancer, and the slim shiny hope of a clear brain scan and a meeting in Detroit.

And so far, the only way I have found to stay sane while living in this narrow place is to say it to myself every day, several times a day, and many times throughout the night: 

but what if it works?

Let’s Hear it for Motor City

Detroit said YES!

It’s a clinical trial testing the promising TDM1 in combination with two other drugs, and the doctor leading the study is a very well-respected and renowned oncologist.  Plus, I spoke to her on the phone and I really liked her moxie. Detroit is the closest-to-home of all the cities I have applied to – and we have almost-family friends there, which is a great comfort to me as I consider being away from my own little family for long stretches.

BUT…

I am not in yet.  I still have to qualify for the study, which means passing a barrage of physical exams.  My most specific fear is that these migraine auras I’ve been getting and the blurred vision I sometimes experience portend brain metastasis, which would exclude me from the trial.  On the other hand, I’m totally exhausted and all I do is work on a computer all day long, so maybe it’s just eye-strain.  I was saying to a friend earlier today, it’s funny when it gets to the point that the idea of cancer in the brain isn’t scary in and of itself but rather because it might mean I’m not eligible for a clinical trial. (Well, I guess that’s funny surreal, not funny ha ha.)

AND…

There’s another problem. Assuming I qualify, my place on the study will not be open for another five weeks from now. 

Five weeks.

I think we all know I can’t go another five weeks without treatment. I barely have the strength to type this post. And if I fear brain metastasis now, I can be fairly certain of further metastasis to somewhere in five more weeks without any treatment whatsoever.

The good news is that this trial doesn’t require patients to be treatment-free for four weeks prior to start-date, only three.  So I need to access some kind of treatment now, for the next two weeks, and then stop 21 days before the start date of the trial.  This is precisely what the study doctor recommended on the phone this afternoon.  In fact her first questions were all about how I’m feeling and what we can do to improve things before I begin the trial.

So, what indeed can we do?  Radiation? The last-straw chemotherapy? A combo of approved drugs not currently approved in combination?  I have a call scheduled with my oncologist when she’s out of clinic later today to discuss the options. 

Stay tuned…

Chasing Trials South of the Border

Yesterday marked five weeks since I last received treatment for my cancer, thanks to low white blood cell counts preventing treatment in the weeks before my last CT scan.  Five whole weeks since the last time I was given anything at all with which to combat this disease.  They may say my cancer is unresponsive to treatment but something must have been making a difference, because in the past few weeks the cancer has noticeably advanced. I can literally feel it advancing. There are lumps in places there never were before, and the old, familiar (once disappeared!) lump in my neck has grown to the size of a ping pong ball.  Plus, my breathing has become a bit more laboured, and my coughing fits are sometimes so violent and unrelenting that I end up in tears.

To have the little flickering light of opportunity that the Montreal drug trial represented snuffed out at a time like this was utterly devastating.  Universe, you are a turd-head.  I ask it again: Why do Nazi war criminals and child molesters get to die of old age?  Who’s in charge here? And don’t give me that “mysterious ways” crap.  Come over here and watch me try to catch my breath long enough to read my kid a bedtime story and then talk to me about mysterious ways. It’s like the universe is being run by a schoolyard bully who is high on acid and has grown weary of torturing cats.

Alas, crying “Not fair! Not fair!” isn’t going to get me anywhere. My husband and I wiped our tired eyes and dusted ourselves off.  Time to get back on our feet, yet again.  Time to act.

So yesterday we went in to see my oncologist, fully prepared to coerce, plead, blackmail or otherwise drag her into a more active role in our desperate pursuit of a drug trial.  Instead, we were pleasantly surprised to find that she was instructing us on the need to take immediate action and to move ahead with applications for all potential TDM1 clinical trials simultaneously. Her sense of urgency, it turns out, is equal to our own. Perhaps greater — I was almost alarmed at her no-time-to-lose approach.   

In addition to the Great Trial Chase, we covered every physical concern I have, from the ping pong ball to the coughing fits. She made suggestions, proposed options, and was sympathetic but serious.   

In short, I felt in every important way that I’m still her patient, and that she is committed to giving me the best care she can, even though this clinical trial quagmire is relatively uncharted territory for her too.  She is “very busy” it’s true, but she is not the problem in this equation.  If I point my finger (and I do) it’s not at her. I’m pointing it at the system’s treacherous gap, the one into which I have fallen and am struggling to clamber out of.   

Anyway, while feeling good about my oncologist is important, what really matters is that we are once again moving toward doing something to push back against this cancer: We left with the enrollment process underway for three different TDM1 trials at six different sites in the U.S — several of which we have unfortunately already heard are closed.  It’s a nail-biting time, trying to get into these trials. And while we have always said that what matters is that I get the right drugs, and not where I get them, the logistics and finances of pursuing treatment in the States are a bit daunting.  But we’ll figure something out. First, I need to be accepted into a trial somewhere, then we’ll figure out how to get me there.  We have to.  What choice do we have?

I really believe TDM1 is promising, and right now all my energy is being directed at getting into one of these trials. I’ve literally been at it since I woke up this morning.  I forgot to eat.  I forgot to take my vitamins. I ran a bath and let it get cold.  All that matters is getting into one of these trials.  Okay, eating matters too.

But will it work?  Something has to work.  Last week, caught between the nightmarish fear of my own death and clinging to the faint glimmer of hope represented by the Montreal clinical trial, I tearfully asked my friend Eden, “But what if we go through all of this and the clinical trial doesn’t work?”

And she said, “I know. But what if it does?”

Stop The Ride, I Want to Get Off

My oncologist’s secretary just called me to tell me that the Montreal study is closed. 

I’m flabbergasted and enraged. Enragergasted. Flabberaged.

First of all, it took them a week to find that out??  When did this trial close?  Please don’t tell me it closed within the last few weeks.  Please don’t tell me that someone with medical experience could have tracked it down in time and started the application process for me in the past few weeks while I was flailing around desperately trying to navigate clinical trial research on my own.

On the phone with my oncologist’s secretary I skipped over all that and jumped right to the point: “What do we do now?”  My question was answered not with a list of options or an outline of an action plan, but with another question. The ball was thrown right back at me: “Have you tried looking at any trials in the States?”

Yes of course we have, and what’s more, they already know this because I provided them with a document outlining the shortlisted clinical trials that we found. I can accept that they are so overrun that they don’t know my case by heart. What scares me is that they haven’t even checked my file before calling me. 

Calmly, I answered the question.  I didn’t cry or shout the entire time I was having this ridiculous, unbelievable, horrific conversation.  I only lost control once, when I raised my voice a little, asking that my doctor and her secretary treat my situation with the urgency it requires. “It’s my life we’re talking about here.  Please, I just need you and Dr. XX to take it a little more seriously, to work a little harder for me.”  

She said “We’re trying.  We’re very busy…”

I almost laughed.  Really. It would be funny if it weren’t so scary.  Because you can tell me that you are very busy if your job is, let’s say, filing lawsuits, or repairing bicycles.  You can get backlogged or let things pile up without too much risk to human life.  But telling me that you’re too busy to help me survive is not acceptable. Not in the breast clinic of one of the biggest cancer centres in the world.

It makes no sense.  It is a nightmare. It’s a horrible joke. It’s my life.

So I asked for three things: 

1) Research whether there are ANY open TDM1 trials in Canada for which I might be eligible.

2) If there are none, look at our shortlist of clinical trials at U.S. sites and tell us which one to pursue, since we are not equipped to make an informed decision on our own.

3) Tell me if Health Canada’s Special Access Program would apply in this case — in other words, can I get TDM1 on compassionate grounds?

I should have asked for one more thing:

4) Stop the ride, I want to get off.