More fun with words

I commented to a friend, as I did here in my last blog post, that the new drug I’ll be taking has a name I can’t begin to pronounce: Ipilimumab. My friend happens to be a doctor and he said, “The MABs are monoclonal antibodies.” That was a term I’d heard my doctor use, but it didn’t occur to me until he said it that the drug’s name incorporates an acronym.

I still don’t know how to pronounce Ipilimumab, but it comforts my brain to know that its derivation has some meaning, that it’s not simply marketing gibberish.

New treatment

I met with my doctor to discuss the results of my latest scan and the news is, well, mixed. There are still no hot spots on the PET scan, but the largest tumor has actually increased in size a small amount. The remaining tumors appear to have developed resistance to the chemotherapy.

My doctor says she wants to intercept this new trend early and switch my treatment. Her new plan is to pull me from chemotherapy and start immunotherapy instead. This type of treatment takes a different approach in that it doesn’t attack the melanoma directly. Instead, it is an antibody, a common blood protein that stimulates the body’s immune system to a higher level of vigilance.

A healthy immune system’s T-cells attack foreign bodies, and are normally modulated by a protein called CTLA-4 that shuts down the process when it’s no longer needed. Without CTLA-4, T-cell activity can continue unchecked and become an auto-immune disease. But in the case of cancer, CTLA-4 may suppress the immune activity prematurely, giving the cancer an opportunity to grow without T-cell intervention. Research indicates that interrupting CTLA-4 can allow the immune system to continue to attack the cancer.

In a couple of weeks I’ll get my first infusion of Ipilimumab, this new drug whose name I absolutely can’t pronounce. The treatment will be simpler than what I’ve been through: one infusion every three weeks for a twelve-week cycle. Side effects can include fatigue, itchiness, rash, and diarrhea; they may be minimal, and I might even get my hair back.

How do I feel about all of this? I’m not happy to find out how resilient this damn melanoma is. It’s pretty distressing to be reminded there is still cancer in my body and it can thumb its nose at my attempts to get rid of it. Additionally, starting a new treatment fills me with the dread of the unknown. It may be simpler, the side effects may be minimal… but I don’t know that yet. I’m sure I’ll feel better about the process when it’s underway.

On the other hand, my doctor says that patients who undergo this new treatment after taking Temodar tend to do really well. Temodar may somehow set the stage for very efficient T-cell activity.

Time will tell….

Follow-up

Walking toward the hospital yesterday, I noticed an awning that read “Pete’s Sake.” What an odd name for a Japanese restaurant, I thought. As I got closer I noticed it wasn’t a Japanese restaurant at all. It was an Irish pub... named “For Pete’s Sake.” Oh dear.

I was on my way to the hospital to visit my sister, whose recent, terribly invasive surgery went very well. But it didn’t end there with medical success. My sister is tough, determined, and focused. In the ten days since her surgery I’ve seen her go from groggy, in bed on her back, to achieving all the rehab goals that will allow her to leave the hospital shortly. Every day her voice is stronger; I could hear that on the phone. But to see her physical progress is truly amazing.

Initially, she couldn’t do more than stand and walk a few steps in place with the physical therapist. It was painful to watch those first attempts to get in and out of bed while someone held her legs. Now she climbs in and out of bed on her own. She periodically grabs her walker and tours the halls of the unit without prompting or assistance. She's learning to master steps and walking with a cane. She sits in a chair and laughs with her visitors. She even took a shower by herself!

I know there are those of you who think of me as a “tough old broad.” But you should see my sister; she is truly an inspiration!

For my sister

My sister is scheduled to have major surgery on Thursday. She’s undergone this procedure before, so she knows what she’s in for. She put it off as long as she could, weighing the misery of the anticipated surgery against the chronic back pain it will address. But the time has come and she’s nervous, preoccupied, and upset by the prospect.

My relationship with my sister has taken various twists and turns through the course of our lives, but most recently, I'm aware of how precious she really is. We’ve put a lot of our ancient competitiveness behind us, and are able to accept each other more readily than ever. I don’t know why it took so long, but this stage is a treasure nonetheless.

My head is filled with thoughts about her coming ordeal, and my heart goes out to her.