The Big Guns and the God of Thunder

OK, so it is time to bring out the big guns for this fight with cancer.  I mentioned the TIL clinical trial before and I've gotten a lot of questions about it.  On the right side and down a bit are permanent links to the study details and a great article about the process and Dr. Steven Rosenberg at the National Cancer Institute that developed it.  Dr. Hwu at MD Anderson used to be at NCI and brought the study with him to Texas.  The article in particular does the research work more justice than I can do here, but I'll give it a college try.  The TIL study utilizes adoptive cell therapy (ACT) which is also call T-cell therapy.  The acronym TIL stands for tumor infiltrating lymphocytes, my personal favorite because it sounds like a covert special operations military unit led by Steven Seagal.  My understanding is that in every melanoma tumor lesion there are some immune cells trying to do the job.  They are in the tumor but obviously they are not doing a good enough job because the tumor is growing, and that if we could reinforce these t-cells the body can successfully beat back the cancer.  The process developed at NCI involves removing some tumors and extracting these t-cells from within them and then growing the t-cells in vitro in a lab.  Then, to prepare the body for the new t-cells, they wipe out the body's entire immune system (lympho depletion) and replace it with the new t-cells.  The result is a cancer patient with a new immune system specifically trained to fight melanoma, and that immune system will fight that cancer for the rest of its life.  The durable results are over 50%, which is amazing compared to the other standard treatments that have a 5-15% response rate.  Many researchers believe this is the future of fighting cancer, even a potential cure, but up to now very few people have undergone the treatment (about 95 at NCI, 45 at MD Anderson and some others at a research center in Israel).  The reason so few have undergone the treatment, and that the clinical trial has not moved on from Stage 2, is that the patient needs to have an accessible tumor, t-cells that will grow in the lab and be strong enough to handle the tough treatment.  The list of health factors required to be considered for the study is 23 items long with 8 exclusionary criteria.  These criteria eliminate four of five potential candidates.  Fortunately for me, I meet all of those.  The treatment is also terribly expensive and is currently being undertaken at only the three research centers mentioned.
     My treatment at MD Anderson will start with seven days of lympho depletion with chemo therapy (fludarabine and cytoxan).  I'll be in sort of an isolation setting, we don't want anyone sneezing on me at this stage.  The lympho depletion is is supposed to be easier than the biochemo protocol I already underwent and Dr. Patel is even working on getting a stationary bike into my treatment room for that phase (her estimation of my constitution is refreshing).  Then, they'll grow the t-cells from the existing frozen millions into the billions in a special laboratory in Houston.  On Day 0 they reintroduce the cells into my body.  Then up to a week of consecutive high-dose interleukin (IL2) treatments, a biologic drug that will kick-start my new immune system into high gear and help my body to start utilizing the t-cells.  This has similar side effects as biochemo and is no picnic.  Low dose IL2 was a not to pleasant part of the cocktail in the biochemo I've already gone through so I'm sure high dose IL2 is even more fun.  They want to give me as many high dose IL2 treatments as I can stand (specifically what my liver and heart can stand) up to 15 doses,  most patients get 5-10 doses.  I told the docs to give me 15 even if I am unconscious to which they smiled as if to a child asking to go to the moon, but I think a little bravado - however unwarranted - goes a long way in reinforcing my commitment to this treatment.  I'll spend a few days to a week recovering in the hospital and then I'll go home for a couple weeks.  Then I go back to Texas and we do the high dose IL2 treatment a second time.  And then we wait, because the new immune system will take time to seek out and destroy the cancer.  The next scans will be in six and twelve weeks after the "birth" of my new immune system where we’ll see if there is any progress.  It may take many months before we start seeing results.  It is interesting that my new immune system will be the same as a newborn's and I'll lose all my existing immunities that I've worked so hard to develop.  That means next year I'll need measles, mumps and chicken pox inoculations.  It will be interesting to be sitting in the pediatric office waiting room next year with a bunch of toddlers.

     I believe cycling, and very often professional bike racing, to be an accurate metaphor for so many things that happen in life.  In Stage 3 of this year's Tour de France Tyler Farrar, the best sprinter America has ever produced, looked like a possible to win the stage.  It was also July 4th and for an American on an American team to win the stage that day would be a phenomenal achievement.  However, the odds were long and Tyler faced many stronger and faster foes also fighting for the stage.  The racing had been touchy and a tour-ending, or even career-ending, crash was a definite possibility.  On Tyler's team is Thor Hushvold, the Norwegian "god of thunder" who was wearing the yellow jersey as the overall race leader in the Tour de France.  Thor also wears the rainbow jersey signifying that he is the current reigning world champion road racer.  Coming in together to the hectic last half kilometer of the stage, Thor jumped through a blind corner towing Tyler to the front of the nervous pack.  I've never seen a yellow jersey lead out a sprinter at a Tour de France but Thor is like that, a team player confident of his world-best skills and always willing to jump after any potential victory.  After Thor gave it his all he pulled over and let Tyler go on to sprint the final meters against his foes to win the biggest stage victory of his life.  You can see Thor smiling in this picture, resplendent in his yellow jersey, a few riders back from Tyler.  In many ways MD Anderson, and Dr. Patel, is my yellow jersey teammate leading me into the final section of the most important race of my life.  They are world champions in fighting cancer and they go aggressively after any possibility of victory.  And I know that they can get me close - closer than anyone else - but it is critical to remember that victory will require me to sprint the final meters alone and I know this will take everything I have.  But I also know that cancer will not beat me to the line, cannot beat me to the line,  when I have a world champion leading me into the finish.