My CO-1686: The Progression Plot Thickens!

It’s my 20th month of participation in the CO-1686 clinical trials and my life on the edge continues. Edge is good. It keeps me on my toes. I’ve always been off on a tangent but at times in the past when I was part of a herd, I was on the fringes of the ever moving pack. I was the little one that the predators were trying to separate from the herd so that they could feast on me. Imagine the adrenaline that rushed through me as I tried to outfox the bastards! Oh, okay, I woke up this morning with an overwhelming need to showcase my grasp of the NatGeoWild shows. It happens when the blogger is irredeemably self-absorbed.

Participants in clinical trials are always on the edge. A new nodule or a couple of millimeters increase in size of an old nodule makes a difference between staying in the trial train or falling out on the tracks. It’s a scan-to-scan cliffhanger. Of course the scan-to-scan thing applies to anyone who has cancer. And being on the edge applies to everyone, with or without cancer. Like other living things, humans are terminal. If old age or disease doesn’t get you, violence or accident will. Talking about accidents, the freakiest one that I’ve read happened inside a building elevator. There, a healthy man quietly minding his own business was killed when underground gas blew a steel manhole cover from the street surface upward over to the building roof then down the elevator shaft, and smashed his head.

I have been tee-tottering on the very edge here lately. A recent event involved the Grand Guru of Radiologists. Dodged that bullet. Now, the Shanghai/Tokyo trip-caused upper respiratory infection (URI) threatens Tiger X Kitten’s tenure in the CO-1686 trial academy. Having survived the URI and the subsequent antibiotic side effects, I decided to audit some courses at Google University. I had this need to know how recent URI’s show up on CTscans. I visited a radiology site and sure enough, image after frightful image of recently infected lungs appeared before my eyes. The pictures had captions as to how a radiologist should discern the faint differences in order to write accurate reports.  In the middle of the slide show, it dawned on me: I better tell my Club Med buddies to give Dr Ray Deologist a heads-up on my recent malady. On the eve of my CTscan, I did just that. I emailed my concern to my trial coordinator.  She emailed right back: “Tell the CTscan technician to give a note to the radiologist.” I did just that. Or at least I tried.

October 23, 2015 UCI; CTscan day

The CTscan technician, a thirty-something full-blooded Chinese man born and raised in Viet Nam, married to a Filipino woman born in Nebraska, swabbed alcohol on the skin of the crook of my arm. He was preparing to drill the needle of the intravenous contraption into the same area that had been poked over and over the last three and one-half years.

“Are you the one who should tell the radiologist that I have just recovered from a lung infection?” I asked Techie.

“Oh, he’ll see the nodules,” he responded with finality.

Just like that, he dismissed the Google U alumna. Of course, the radiologist will see nodules!  It then became clear to me that it would be a monumental task for my inner linguist to translate in street English the phrase “discerning faint image differences.”  I clammed up for a nanosecond to strategize my approach.

“Have you eaten at the Chinese seafood restaurant in Irvine?” he broke the silence as pushed me closer to the CTscan tube.

Techie’s words of Asian persuasion distracted me. In a heartbeat, my steely resolve to reach through him Dr Ray Deologist’s discerning eyes melted at the prospect of talks of salted mackerel, fresh oysters on half shells, and steaming Manila clam soup.

November 3, 2015 UCI; Blood Tests and Onc Discussion of CTscan result

Onc and I shook hands as always.

“Didn’t you have a fever after your Asian trip?” asked Dr Brevity.

“Yes, I did have URI.”

“The scan showed new nodules.”

He turned on the computer monitor and together we looked at an image of my lungs. A mass as big as a dollar pancake hit my eyeballs. I knew it was an enlarged picture.

“OMG. That’s huge!” I exclaimed, palms of my hands pressed on my chest as in a heart attack – movie background acting talent at work after being absent from the film set for five years. My former co-star Jackie Chan would have been proud.

“Actually it’s not that big,” Trial Coordinator encouraged the unsung has-been. “It’s only 1.4 centimeters.”

Onc gave me a copy of the radiologist’s report. It called all existing nodules STABLE. It stated a NEW nodule and its location but no descriptions such as ground glass opacity, tree-in-bud, or spiculated yada yada.  Dr Ray Deologist’s discerning eyes did not work for me.

Onc disappeared. Then he reappeared,  a pen and a notepad in his hands. “When was your  trip?”

“September 1st to the 9th.” Out of the examination room he marched again.

So my world at Club Med is once more split into two factions: Is-Progressed and Not-Progressed. The Not-Progressed faction must prove its case. I’d assume Onc asked for my trip date to document the activities needed to determine if my new lung spot is the ruin from the recent battle between my immune system and the Asian bacteria.  An interim scan is planned to revisit the nodule.

“If it’s progression, there are many other treatment options,” Onc said reassuringly, and he mentioned at least three. “I don’t want you to be worried.”

“I’m not,” I reassured him back. I wanted to add, but didn’t: “I’m worried about the adjectives that my heirs will use when they eulogize me.”

November 13, 2015.  My dear Onc, Dr Brevity himself, joyfully  informed me through cellphone message that AZD-9291 aka Tagrissa has been approved by FDA and he’ll see how the December 2, 2015  interim CTscan goes.

The Burning Question: Did the 1.4 cm nodule grow or did it stay the same?

The drama queen must rehearse a convincing reaction for each case.