Chemo Again?

Posted 4 May 2016

The news from last Friday’s CT was not what we had hoped for.

There are two issues:

1. The original tumor’s overall size has increased. This doesn’t necessarily represent tumor growth, because it is partially necrotic (dead), which means that the radiation did its work to some degree.
2. There are new spots on my liver that did not show in previous scans.

This morning Irene and I met with Dr. Brett, my main oncologist, to discuss the CT results in more detail. I had remained focused on the original tumor, but the bigger issue turns out to be the new liver metastases.

From the radiologist’s report:

“Liver: Multiple new rim-enhancing, hypoattenuating lesions measuring 9-11 mm diameter left and right hepatic lobes compatible with metastatic deposits.”

The fact that these new lesions are not tiny, yet were not there in the previous scan, suggests that they are growing rapidly. I now have what is called a secondary liver cancer: metastases of a primary cancer elsewhere in the body, but present in the liver.

If these metastases keep growing, they would quickly reduce my liver function to a point that would significantly affect my quality of life. Dr. Brett estimated that I might feel fine for a month, but would then have a couple months of decline, as my liver becomes unable to support everything my body needs.

No one knows how long any of these times will really be, of course. I appreciate Dr. Brett’s willingness to stick his neck out and make an estimate; I find it helpful to have something to ground myself with, though these are shockingly short time periods, even with all of the preparation I’ve had.

So, Back to Chemo?

Going into the meeting with Dr. Brett today, Irene and I knew that chemo would be an option, and I thought it extremely unlikely that we would decide to do it. I am well aware of the almost irrepressible desire of the medical world to try any available treatment, and how hard it is for doctors to give up.

By the end of the appointment, we were leaning toward giving it a try.

The goal would be to shrink, or at least stall the growth of, the liver metastases, to give me a little more time. How much more is unknown, but it isn’t a lot — maybe a few months. But when I’m looking at increasing from only one month of “feeling decent” time to perhaps 3 or 4 months, it is pretty compelling, if it works.

Dr. Brett estimated that the new chemo regimen would have a 30% to 50% chance of being effective against the liver metastases.

The new chemo, Abraxane and Gemzar, would be significantly easier than the FOLFIRINOX regimen that I endured for 12 weeks. It would be a couple hours of IV infusion, once a week for three weeks, and then a week off. That’s one 4-week cycle.

Unlike the previous regimen, the IV time in the office is much shorter, and there is no pump to take home for two days. So it intrudes significantly less into “normal” life.

The side effects are also less bothersome than with FOLFIRINOX, especially with regard to GI effects. But like all chemo, tiredness and lowered immunity are key side effects. I would really hate to end up back in the ER every two weeks with an infection, as I did through the entire 12 weeks of the previous chemo.

My Choices

Here’s how I see my choices:

1. No treatment other than simple palliative care. Focus on quality of life and slash time spent on treatments and doctors. Accept that the likely prognosis is a shift to hospice within two or three months.
2. New chemo treatment. If it works, I have a little more time of feeling good enough to be active. If it doesn’t, I’ve given up some of my precious time to treatments, and suffered some side effects, for no gain.

And that’s where I leave it tonight.