I don’t know where that came from but I feel like I’ve just fought my way out of one and now see the path to Rivendell…over the Sierras, across the salt flats and the Rockies, to the mile-high city in the High Plains. Yes sir, I’m finally on my way to Denver (Aurora, to be exact), to that heretofore mythical University of Colorado, (to attempt) to enroll in a clinical trial of BIBW2992 (afatinib) and cetuximab (Erbitux). I’m not in yet, so I can’t get too excited. January 25, the day before Hub’s birthday. Prayers and mantras respectfully requested on that day. Hope against hope the cancer holds still until treatment, hopefully Feb. 1st.
Just in from my oncologist: “Colorado lab called. You have the T790m at exon 20.” He’s king of one line e-mails. So there it is.
In theory, this means my performance status would be better than someone who doesn’t have that resistance mutation, which is acquired by exposure to EGFR tyrosine kinase inhibitors (TKI’s), in my case, the wonder drug Tarceva. My cancer became resistant to it some time ago. A period away from these targeted therapies can restore cancer cells that are addicted to TKI’s, thereby renewing sensitivity. I’ve already re-challenged Tarceva once, with good results (16 months). The question is, will this novel drug combination of afatinib – a second-generation, irreversible TKI, and cetuximab – a monoclonal antibody/EGFR inhibitor be effective on my particular cancer?
Why not? Because lung cancer is a maddeningly individual, heterogeneous disease. No lung cancer is like any other, although in the old days they thought it was enough to divide them into groups (Non-small cell, small cell, large cell, squamous, non-squamous, adenocarcinoma, BAC, etc etc). Those groupings sprout subsets every day, and now it’s realized that each lung cancer patient is their own subset. Treatment is like a shot in the dark, even if one gains the knowledge of a molecular biologist. What we need is Elf Magic.
There are a few details to iron out, and if I get in, there’s the question of whether to commute or stay in Aurora for 6 weeks, since I have to go every week for one thing or another. After the initial period, treatment is every two weeks. Still grueling, but if I show any improvement at all, I may actually get to enjoy the Rockies and tour a bit.
The elevation and temperature might be difficult at first, but I’m excited for spring and summer. I’m hoping for improved breathing and some outdoor adventure in the mountains! If this proves to be as promising as the data, I’d even consider moving there temporarily (cost of living is less than the Bay Area, I’d imagine). I’m already envisioning participation in a lung cancer research fundraising bike ride in Albuquerque, NM in March…