Since my last post, I had endured 6 days of torture with the catheter. Because surgery (my second TURBT) was performed on Tuesday I would have had the catheter for two days, but the doctor's office was closed for Thanksgiving (Thursday and Friday), so I'd have to wait until Monday to have the catheter removed. I was tethered to my 'ball and chain' and was on self imposed house confinement. I just waited out my sentence and meandered from bed to couch trying to get into a comfortable position. This was nearly impossible, but I soldiered on.
I ate various 'finds' from my freezer, some dated back to 2019, but it didn't kill me. My thanksgiving consisted of my own recipe for chicken wings and rice. Wasn't the regular turkey dinner, but it was good and hit the spot. When Monday came and the catheter was removed, it was such a joy. A shower, trip to the grocery store, daily walk and lots of cooking (to replenish my freezer food). Just doing the simple things felt so good.
Good News/Bad News
I had my follow-up with Dr Previte today. I hardly slept last night worrying about what he would say. Given the large number of tumors he found and removed, I was fearful that he would say that the cancer had invaded the muscles.
When I met with Dr Previte, after pleasantries, he sat down looking like business and the first thing he said as he shuffled through my file was:
"I have good news and bad news. The good news is the biopsies indicate that the cancer is still non-invasive muscular (stage one - T1/Ta). I found one big tumor that was the cause of your bleeding and removed it. I found 6 other tumors scattered in the bladder and removed those. I found no cancer in the diverticulum. The bad news is you are a BCG failure.
At this point you have three options: 1, do another round of BCG with interferon; 2, seek a different treatment (drug names were mentioned but I didn't get them), however we don't have those. You'd probably have to go to Lahey. Or 3, remove the bladder.
What would I do? I'm 75 so the safest is to remove the bladder. You are 70. Once again the safest is to remove the bladder because this cancer can kill you."
I was relieved to hear that the cancer is still stage one. But was interested in the options. As we were talking he was looking through things and quickly consulted one of his colleagues about the BCG with interferon. Apparently, they don't do interferon with BCG treatments since the data didn't support its effectiveness. So the first option was modified to be just another round of BCG (which I I failed first time around). Of course I am still averse to bladder removal until all options are exhausted or if it is no longer stage one.
We then started talking about the alternative option of immuno-therapy cancer treatment. I had mentioned that Dr Mehta (my oncologist) had discussed an FDA approved treatment for bladder cancer and asked that I reach out to him if the BCG wasn't effective. Dr Previte immediately called Dr Mehta and had a consult with him. Although I could only catch a few things in the conversation, Dr Previte said that Dana Farber (Dr Mehta's office) will be in contact with me.
In the interim, we will be scheduling another round of BCG that will start in about a month and will last for 6 weeks with a follow-up cystoscopy/biopsy. He did ask me to be proactive and call Dr Mehta's office to get that ball rolling.
So at this point, I'm back to square one. I got home and called Dana Farber and waited for a call back. By happenstance, I received a newsletter from Dana Farber discussing new treatments for bladder cancer. A sign?
From the news letter:
Immunotherapy for cancer is a form of treatment that uses the body’s immune system to combat the disease. Today, immunotherapy is being applied to a wide range of cancers, often in combination with other agents, and clinical trials are exploring ways of improving and expanding its effectiveness.
A particularly promising form of immunotherapy, known as immune checkpoint inhibition, uses antibodies to block proteins on cancer cells, such as CTLA4, PD-L1, PD-1, and LAG-3, that impede an immune system attack on the cells. The antibody therapies allow such an attack to proceed.
Immunotherapy has been approved for the treatment of the following cancers:
- Bladder cancer
- Breast cancer
- Cervical cancer
- Colorectal cancer (subset)
- Esophageal cancer
- Head and neck cancer
- Kidney cancer
- Liver cancer
- Lung cancer
- Lymphoma (Hodgkin’s)
- Melanoma
- Merkel cell carcinoma
- Squamous cell carcinoma of the skin
Not all patients with these cancers are eligible for immunotherapy. A variety of factors — the genetic makeup of the tumor cells, how far the cancer has advanced, and whether it has responded to previous treatments, for example — determines if and when it may be used as part of standard treatment.
Bladder cancer
Patients with early-stage, moderate- to high-grade (fairly fast-growing) tumors often receive a vaccine consisting of a weakened, live bacterium called bacillus Calmette-Guérin (BCG). The vaccine reduces the risk of bladder cancer recurrence by sparking an immune attack on the bacteria as well as nearby cancer cells. Several immune checkpoint inhibitors have been approved for patients with advanced bladder cancer including:
- atezolizumab
- avelumab
- durvalumab
- nivolumab
- pembrolizumab.
So, my understanding is there are checkpoint inhibitors available.
No comments:
Post a Comment