When Fourteen Equals One

Headed to Treatment #14 / #1

Occasionally, the numbers just don't seem to add up.  In the case of this blog title, they actually do make sense.  Nine months into my cancer diagnosis -- and fourteen treatments along, I've started a targeted therapy only protocol (no chemo therapy).  The first targeted therapy (number one) was just three days ago.

Given the number of questions we've fielded about targeted therapy -- and how it differs from chemo, I thought it may be informative to dedicate a blog to answer (hopefully most) of the questions about this approach battling cancer.  Please recall the experts study this stuff for many, many years -- we've been absorbing as much evidence-based information as we can for only nine months.  This response is based on our short-research of the very long study of treating cancer . . .

• The best explanation I know of regarding targeted therapy (absent a consultation with our super-hero oncologist), is from the National Cancer Institute:
• Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression (my cancer currently is progressing), and spread of cancer.   Targeted cancer therapies are sometimes called "molecularly targeted drugs, molecularly targeted therapies, precision medicines," or similar names.  
  Targeted therapies differ from standard chemotherapy in several ways: 
  
• Targeted therapies act on specific molecular targets that are associated with cancer, whereas most standard chemotherapies act on all rapidly dividing normal and cancerous cells.
• Targeted therapies are deliberately chosen or designed to interact with their target, whereas many standard chemotherapies were identified because they kill cells (quite indiscriminately). 
• Targeted therapies require the identification of good targets—that is, targets that play a key role in cancer cell growth and survival. (It is for this reason that targeted therapies are sometimes referred to as the product of "rational" drug design.)  Targeting does not depend on the location of one's cancer (somewhat counter intuitive, I know) rather on identifying the targets based on medical signs of what they (the targets) do.
• From our first appointment way back in August, Dr. Rixe sent my tissue and blood samples to two agencies for analyses (CARIS Life Sciences and TEMPUS). The results provided pathogenic information, to which Dr. Rixe referred to develop my targeted therapy when my chemo became ineffective (chemo resistance is not unusual and targeted therapy very often is used (and is most effective) after an initial standard of care protocol (i.e., chemotherapy)). 
• My new protocol targets two biomarkers (indications of medical state) that are involved in my disease progression: 
• The first is a mutation of my B-Raf gene, which produces a kinase protein that sends signals directing cell growth.  My mutated B-Raf is spurring uncontrolled cell growth. The first my two new therapy drugs targets that mutated B-Raf (protein) to "reduce the volume" or (better yet) completely close down that signal transmission.  These are the four pills I take each morning.
• The second drug is a monoclonal antibody designed to target a different protein associated with cancer growth: EGFR (epidermal growth factor receptor) which is usually high in in the presence of cancer.  EGFR "receives" epithial growth factor, and as such is a driver of cell proliferation.  The drug I receive for this is delivered via IV -- through my port, every two weeks.  It is a direct cancer killer that works to inhibit EGFR signaling, reduce cell proliferation and induce apoptosis (cellular suicide). 

Dr. Rixe's goal with the targeted therapy protocol is to get me to complete remission.  This is a cutting edge approach, which has produced good outcomes in Europe.  Dr. Rixe constantly collaborates with colleagues in the US and abroad regarding therapies -- and drug side effects (looking to minimize hardship for the benefit of the patient).  I am experiencing a whole new set of side effects now -- and adjusting my rhythm to adapt.

I know this has been a departure from how I usually blog.  However, I hope it may be helpful for readers trying to understand the changing terrain of our "Unexpected Journey."

In closing, I'll say this: Most people -- like Cliff and I -- arrive on the path already in motion.  We are learning as we go -- while trying to avoid the overload of info out there regarding cancer and treatments.  We generally get our info from four sources: The National Cancer Institute, The National Institutes of Health (particularly valuable for understanding therapy and clinical trial outcomes), Memorial Sloan Kettering Cancer Center in New York (the standard setter for many cancer protocols, and for colon cancer in particular), and of course, from the inimitable Dr. Olivier Rixe -- the super hero with whom we literally trust our lives.

And finally, I think whatever medical approach we follow, my job to show up as a worthy team member -- Every. Single. Day. -- (among our incredibly skilled team of doctors, surgeons, nurses and technicians and the abundant and love and spirit of the Warrior Team) continues to be integral to slaying this beast.  In that regard I continue to meditate, connect, cook and eat healthfully, exercise, dance, read, sew, enjoy the company of my amazing spouse and incredible canine family members and to live in this moment.  I never want to miss a second of this blessed life or an opportunity to express my boundless gratitude to the team.  Thank you all!!!

Quote of the Day:

“Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.”                        ~ Marie Curie