Next Stop, Clinical Trials

Posted 10 March 2016

Today I met with Dr. Ko at UCSF, who specializes in GI cancers. Irene drove me down through two hours of pouring rain.

Dr. Ko does not think that any of the conventional chemotherapy regimens are likely to help at this point. That leaves clinical trials of new drugs as the only real option, since surgery and radiation have both been ruled out.

The next step at UCSF is to get an appointment with the investigational medicine department to see if any of their trials would be a match for me.

Unfortunately, my particular tumor characteristics are not a good match for the new immunotherapy drugs; they have been effective primarily on tumors where there is extensive DNA damage, whereas I have a relative handful of common mutations.

I have a report from Foundation One, a lab that tested my tumor biopsy for a few hundred mutations commonly found in cancer cells. It suggests a few experimental drugs, based on the particular mutations I have. Dr. Ko did not, however, think that any of the suggested drugs (such as cobimetinib) made sense in my situation; while I have the mutation, my tumor is very different from those with which these drugs have been tested.

So I am left with looking for new drugs through clinical trials. UCSF deals only with UCSF-based trials, so going to M.D. Anderson remains something to consider to gain exposure to a different batch of trials. It seems like an awfully inefficient system.

There is one silver lining here: no more chemotherapy, at least until there is a matching trial into which I am accepted. It is a big relief to be able to stop poisoning myself for a while, at least.

I’ll be seeing my regular oncologist and another oncologist next week, and the week after I’ll meet with the UCSF investigational medicine folks. After all that, I’ll reassess and decide what, if anything, to do.

The news was not entirely unexpected, but it has still been a hard day. Irene and I are both feeling new waves of grief, but we are coping ok.