What is not clear is what has caused the growth. Dr. M says it's 50/50. It could be treatment effect, meaning there is new mass because of the chemotherapy. (I still don't completely understand this.) Or it could be new tumor cells.
Either way, the Spot is bigger on the right side. It is taking up more space on the right side of his brain stem, which is causing his left-side weakness.
In the past, the symptoms he's had were controlled with Decadron because inflammation was causing the problem. Today the problem isn't as easy to treat. It is the tumor that is causing the problem, and steroids don't make tumors smaller. Until we find a way to make the mass smaller, he's going to struggle with left-side weakness and instability.
So we need to make the tumor smaller.
Unfortunately, it looks like Temodar, the oral chemotherapy he's been taking since February, is no longer going to work. It's either causing too much damage or the tumor cells have become resistant.
The next line of defense will most likely be a combination of Avastin and CPT-11. I'll explain more about this protocol soon. From what I understand, Avastin is a biological therapy that attacks blood vessel growth. CPT-11 is chemotherapy.
The drugs are given intravenously, once every two weeks. Steve will need a port placed in his chest to allow access. There is no way his fragile veins will handle frequent IVs.
Our prayer is that those two drugs will start attacking the tumor, taking care of what Temodar no longer can.
We're not there yet, though.
Just after our appointment with Dr. M, she was headed to the UT-SW tumor board meeting. That's when a bunch of doctors look at scans and listen to other doctors present symptoms. All those great minds work on identifying problems and creating solutions.
She wanted them to look at today's MRI to see if there's consensus on what is causing the growth.
Then she was going to call or e-mail Dr. C, our neuro-oncologist at M.D. Anderson. She'll share with him Steve's current status. Her office is also overnighting Steve's scans on disk to Houston.
They will confer on options. They will discuss whether Steve needs to be seen in Houston. There's a chance that Dr. C knows of another drug trial that would suit Steve's condition.
Steve has an appointment for Monday morning at UT-SW to have a port placed in his chest. We think this is a place-holder appointment, so that if they decide Monday morning he needs to start the Avastin-CPT-11 protocol soon, he'll be ready.
He also has a PET scan scheduled for Wednesday morning. His first and only PET scan this summer showed no live tumor activity. The new scan should show us more clearly what is going on.
We knew that one day we'd deal with this. We've known since we started this journey that there is no known cure for brain cancer, that those tumor cells hide out and come back. We know that you joined us in praying that that day would be years and years from now.
Dr. M told us that this "is not the bottom." She agreed that the news is bad news, but she pleaded with us to not expect the worst. Avastin and CPT-11 have high response rates. They eat away at tumors. We have every reason to believe that this next round of treatment will be successful.
I would be lying, though, if I told you we are feeling good about today.
As we head into Thanksgiving week, we count our many blessings and we continue to pray for a miracle.
Steve and Katie at her preschool feast this week