Friday, May 6, 2011

Surgery and Decisions

Underwent surgery yesterday in Houston to remove a cancerous lymph node under my right arm and another cancer met (metastasis) on my left hip.  The scientist at MD Anderson will extract the t-cells that are located within these tumors that are trying to fight the cancer and see if they can grow them .  If they can - we'll know in about four weeks - then we can put them back in my body to fight the cancer.  They say the chances are about 50-60% that they will grow, and if it is successful then the TIL (tumor infiltrating lymphocytes) procedure has about a 40% response rate.  That's a 20-24% overall success rate but with some very promising long lasting results (a link to the details of this clinical trial is below).  The problem is that this is a slow, longer-term treatment that can not be started for at least six weeks.  The question now is what to do between now and then to slow down the cancer?
I have boiled down my systematic treatment options to two - biochemotherapy or high dose IL2.  The first is very aggressive and only regularly done at UCLA or MD Andserson , and is controversial.  In 2002 results for biochemo were promising, especially over the unsuccessful chemo treatments at the time.  It seemed to offer higher response rate than high dose IL2, but subsequent studies have questioned the long term higher success.  Places like MD Anderson state that their care centers are better than a typical hospital or cancer center and their patients have higher success rates because they can give higher toxicity treatments and  keep their patients healthy. They also have more treatment options overall and can guide their patients into treatment protocols best suited to their particular situation.  All this leads to them having higher response rates than other facilities with the same protocol. Other facilities disagree and claim that biochemo is higher toxicity for questionable results (at their facilities).  This is what Mount Sinai and Sylvester cancer center also said to me, and both suggested I go for traditional high dose IL2 instead.   So what to do? Less toxicity - especially no chemo element - in a local facility sure seems easier than flying to Houston.  But walking around the Texas medical center yesterday, seeing the thousands of cancer specialists in their state of the art high-rise facilities, it is hard to imagine that there is no truth in the claim of superior care and easy to suspect some ego in the claim of the smaller cancer centers.  When I'm wretching in the hospital at 3 am I'm going to want to be surrounded by the best care I can find. And I decided early on to go for the most aggressive options available to me to take advantage of my strengths, even if the more aggressive option only improves my statistical chances slightly, because I believe that faith in the process contributes to success. Myth is that when Cortes landed his invasion force from Cuba on Mexico's shores he burned his landing craft to underscore his commitment to the mission, and to motivate his men to fight only onward.  I'm ready to commit. On May 20th - my 45th birthday - we begin.


  1. Go Bro Go! I know you can do it. Sending you prayers for healing and patience during this process...

  2. Son, your always in our thoughts and prayers and are on call to help you And family! Go "Devil Dog" Kick Ass"