Dealing with metastatic cancer is a bit like a cross between playing the Hunger Games with a Sisyphean game of blindfolded Whack-a-Mole thrown in just for fun.  Almost no one wins; the only question is whether you can actually hit any or continue to hit all of the targets while blindfolded.

The goal of treatment is to kill the cancer, but the cancer keeps moving around and popping up somewhere else.   The only unknown is time - how much time will a particular treatment work before the cancer starts growing again?  And how many more treatments are left until either there are no more options,  the cumulative toll of the repeated rounds of chemotherapy is too much, or the growth of the cancer causes unbearable side effects?  

Not all treatments work on every patient.  Right now, the state of the science with breast cancer is that there are very few assays that can predict, a priori, whether a treatment will work or not. So the path forward is a game of trial and error, with each successive treatment round having a lower probability of working.  

Periodically, the metastatic patient is scanned to determine if treatment is effective.  If it is, everyone breathes a sigh of relief, and the current treatment continues.  However, if the treatment isn't working, it's time to look for something else.

People with indolent cancers can be on the same treatment for years before they have progression.  Unfortunately, the cancer I have is the opposite of indolent.  Treatment seems to work for about six weeks before there is new growth that shows up on an eight week scan.

I had a scan last Thursday and unfortunately that scan, like every scan before it, showed progression.  Anticipating this result, three weeks ago, I scheduled an appointment the next day at the Center for Targeted Therapy at MD Anderson to see if there was something there that might be suitable.  

I have pretty good access to clinical trials in St. Louis,  but MD Anderson is a larger cancer center and has more clinical trials at any point in time.   Ironically, both cancer centers are offering the same clinical trial to me.  

By necessity, the next few posts will focus on the quest for a new treatment plan.  I hope to explain why I believe a clinical trial is a good next step, how I determine the best potential clinical trial for me and how my physician and I determine where we go from here.  

As always, I appreciate any and all comments, and will be answering the questions you have left for me in future posts.  Bear with me as we endure a slight detour from the original path.

Photo:  Daveynin / Flickr  

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