Watch My Oncolytic Virus Destroy Cancer!

Today is my second infusion of Enad, the oncolytic virus that attacks the cancer cells.  Lee found this short article that has actual video footage of the Enad virus killing cancer cells. Cool!!    Click on this link:   http://www.cancercentre.ox.ac.uk/cruk-science-blog-training-viruses-to-be-cancer-killers/

All of this action displayed in the video is going inside my body and caused severe fever with temps  in excess of 102, combined with intense coughing spasms on Monday  night.  Monday was not a relaxing evening, but probably more relaxing for me than some of those cancer cells residing inside me.   Ha!

Other than being tired, yesterday I felt fine and today I feel great.  After visiting with Dr. M yesterday, Lee and I are more prepared tonight if the internal battle causes the same collateral damage. Dr. M reminded us that the fever is an indication that the virus is causing havoc with the enemy.

In it to win it!

Game On!

At the moment I am sitting in Chair One in my private chemo suite with a nice view of the trees in the courtyard and my own private toilet. And a huge staff onhand to attend to my needs. Jimmy be stylin!!

This is the first day of my phase one clinical trial of 

.  

I have no idea where they came up with that name, but you have to admit that the logo is cool. It will be a long day, about 11 hours here at the University of Arizona Cancer Center in Tucson today. I will repeat this procedure on Wednesday and Friday, with two hour days on Tuesday and Thursday. My infusion of the virus today lasted about 5 minutes. So why am I here for 11 hours? A clinical trial is experimental medicine. First they draw 16 tubes of blood for all kinds of analysis. Then they watch me like a hawk, checking my vitals and drawing more blood every hour or so to see if there are any changes.  They are also constantly checking on me to see how I feel, if I need a pillow or blanket or something to eat, even dropping by to tell me the soup of the day (split pea). They want to make sure I am not having any negative reaction. I am the second patient they have for this trial, there are only about 10 nationwide at the moment. For this study there will only be 40 nationwide over five sites.  

Three hours ago my body was infused with 12,000,000,000,000,000 live  oncolytic viruses whose sole purpose in life is to seek out cancer cells, infiltrate tumors and start killing them while notifying my immune system there is a battle to fight. I will have two more of these infusions this week. Although this virus is effective in penetrating tumors, but is not strong enough to eradicate them by themselves. So, in ten days, they will give me a dollop of the immunotherapy  drug Opdivo to hopefully fully activate the immune system to begin destroying those tumor discovered by the virus.  

So far so good.

Another Cancer Victim

Cotty A recent photo of my 16-lb Cotty enjoying my soft belly as I am laying on my back in a vain attempt to nap!

First Lee, then me, and now Cotty, aka, Lord Cotswold the Handsome. All of us are members of the cancer club. Cotty is the latest addition to this shitty club. He has lymphoma in his sinus cavity. As with me, there are no treatment options that make any sense.This afternoon Lee and I were given the option of euthanizing him while he was still under anesthesia or taking him home for kitty hospice care. We chose the latter.

I am glad we did. We have a bird’s nest outside our home office window. Cotty discovered it yesterday. One of the first things he did when he came home this afternoon was to jump on the counter to check on “his” nest.

Cotty will be treated with steroids and antibiotics to hopefully keep symptoms under control. Nurse Lee also has kitty morphine to use as needed. We were told that in some cases the steroids actually slow the cancer growth. However it is a day by day thing. No one can say how well he will do, but I gathered from the conversation with the doctor that a month or two is the norm. We will be quick to pull the plug. We will not let him suffer.

Cotty is my best buddy and provides mountains of joy to my everyday living. This is very difficult for me.

Here we go…

As I have mentioned before, the life of a stage IV cancer patient is a turbulent life. Full of ups and downs and all arounds. It is a life living on shifting sands, a life without solid ground. It is a life that needs to be focused neither in the past or the future, but in the present, as much as that is possible. I work at continually “chucking” the setbacks and disappointments, working my plan of action, and doing stuff I enjoy. But it is a challenge.

My immediate family consists of my wife Little Lee and our two fluffers, Miss Bubble and Cotty, our fat gray cats. For some time now both of our cats have been quite sick with illnesses from which they may not recover. During this time Little Lee has needed to run a kitty infirmary in addition to being my caregiver. Both cats require multiple medications each day, as well as injections and lots of vet visits. It has placed an added layer of stress on our day-to-day lives. When we have to be away for medical treatment, our super-awesome cat sitter Sandi, becomes the cat nurse. Here is a photo of the feline pharmacy complete with instructions for Sandi.

                                   Kitty Pharmacy

You may remember from my last post that shortly after I signed on to do a clinical trial in Scottsdale, I was diagnosed with pneumonia. The same day I was feeling a bit discouraged about the delay, the phone rang and much to my surprise, it was the University of Arizona Cancer Center, offering me a slot in a clinical trial I was on the wait list for. Back in late January they told me the roll-out of this trial would was delayed and the roll-out would be very slow. The trial director estimated it would be about 5 months before I might have a shot. Was I still interested they asked? Yes, yes, yes was my reply.

Jimmy signs the consent form, let the trial begin!

While I am very pleased to have a shot at this promising, cutting edge immunotherapy trial, I also know that the patients ahead of me on the waiting list either got too sick to participate or passed away. My plan to pursue clinical trials while I still feel pretty good is paying off, and I am grateful to Dr. P for encouraging me to do so.

The trial is composed of a two-pronged attack at the tumors. The first weapon is an oncolytic virus. This virus is specially engineered to attack cancer cells only. It cannot enter healthy cells. The virus begins to break down the cancer cells and although its not strong enough to kill off all the tumors by itself, it helps to make the enemy more visible to the immune system T-cells. The virus helps make my “cold tumors” look more like “hot tumors,” or so the theory says.

.

Once the virus is in place, the second weapon is deployed. This is an existing immunotherapy drug you may have heard of called “Opdivo.” If the virus has done its job, then Opdivo will supercharge the T-cells to attack the tumors and hopefully, this one-two punch will take care of the bad guys. Only 40 people in the world will participate in this phase of the research and I am one of the first ten. It’s a bit scary. But when the plane is going to crash and somebody hands you a parachute, it is time to learn how to skydive.

           Lord Cotswold and Miss Bubble

 

 

Delay of Game

I’ve been feeling rather crappy the past few days, with increased cough, dizziness and a low grade fever in the afternoon and evening.  However this morning my fever started early and was over 100 degrees when I got up.  I sent an email to the trial nurse telling him of my symptoms and asking if they had a look at my CT scan from Wednesday.   After looking at it closely it appears that I have a touch of pneumonia in my right lung.  This is my third lung infection since mid December.  

As a result they cancelled my biopsy and treatment dates.  I am now on the antibiotic Levofloxacin for seven days.   Once I sign the consent form, I must complete all tests and begin treatment within 28 days.  So that gives the clinic a little two weeks after I get off the antiboiotics to complete a biopsy, get the data back and begin treatment.  

In the Playoffs

March is Colorectal Cancer Awareness month.   Yesterday, March 1,  I marked the occasion my signing the consent form for participation in a cutting edge immunotherapy clinical trial. It will hopefully harness my immune system to attack and destroy my colon cancer.img_0860

Just last week it seemed to me that it was in the bottom of the ninth with two outs and two strikes on me. After going 0 for 3 in my previous clinical trial attempts, I hit a home run. It was a big at bat, it propelled me into the playoffs.  A championship is still a long shot, it is unlikely that I’ll win with a cure.  But at least I’m in the game and that is the first essential element to winning.

As I’ve mentioned previously, Lonsurf is beginning to wane.  My ability to avoid the side effect infections common with Lonsurf is weakening and my ability to rebound from them is diminished.  Tumors were growing. Immunotherapy clinical trials seem like the best option, the best chance I have  to get lucky. It is weird in that in my prior experience, the medical  white coats primary purpose were to make me all better.  Not so with these white coats.  Don’t get me wrong, they would be very happy if I were to get all better, but their primary purpose (and my primary purpose) is research.  We are there to find a more effective way to treat cancer. But cures in trials do happen, so why not me?  I have a dear friend who was on a clinical trial for Leukemia about 20 years ago, it saved her life.  Below is the congratulatory bouquet she sent me in the appropriate Duck colors to celebrate my initial clinical trial victory.harmonys-flowers

As you know, chemo is just sophisticated poison that targets cancer.  However it is not all that sophisticated, it usually also effects innocent by-stander non-cancerous cells. Chemo can cause serious side effects that lead to poor quality of life and may eventually to death, it has a accumulative effect so the effects worsen over time. Immunotherapy  harnesses our immune system to fight the cancer.  The immune system is very powerful and effective at eliminating threats to our health. Unfortunately cancer hides from our immune system, my powerful immune system is not aware that my body is riddled with tumors.  Immunotherapy tries to  alert the immune system to the presence of the cancerous tumors.

Immunotherapy drugs are already FDA approved for a few types of cancer.  You may have heard of the brand names Opdivo or Keytruda. These are immunotherapy drugs currently in use. However, they are successful with only about 10% of the cancers. Scientists are working on the other 90% and they are moving at lightning speed. Thousands of brilliant minds and hundreds of billions of dollars are working on this complex puzzle.

Advances in genomics and molecular biology have revealed how shockingly diverse cancer is, one size does not fit all. Each tumor has its own generic mutations and molecular abnormalities that will potentially define successful treatment options.  There are about 1,200 immunotherapy clinical trials being conducted right now in the United States. More trials exist throughout the world. These immunotherapy trials utilize different technologies  and variations to attack the cancer based on the biological profile of the cancer. Lee and I tried to find trials that matched the make up of my tumors based in data from my December biopsy report. That report from only two months ago is not thorough enough for this trial, which is one reason they require another biopsy. Science is moving fast. Each trial is usually composed of a small number of participants scattered among several different locations. The trial I have just joined will only have 160 participants scattered over six sites.

Among several types of cells in the immune system are T-cells that relentlessly circulate throughout the body, looking for infections to snuff out. But cancer tumors are super sneaky and they hide from the T-cells, allowing cancer cells to grow unabated and form tumors. The cancerous tumor covers itself with certain proteins on its surface that allow it to escape detection. An elaborate masquerade. When our T-cells encounter a tumor they give it a tip of the hat, say “good day mate,” and float right by.

My trial uses two different types of human monoclonal antibodies to attack the tumors. Hit high ’em high and hit ’em low, I say. One of the antibodies is  Durvalumab, it has been around for a year or so and is approved by the FDA for certain bladder cancers.   It is a PD-L1 inhibitor, the PD stands for Programmed Death. It sticks to the protein disguise on the tumors and flags down the T-Cells, hopefully providing a pathway into the tumor for my immune system. The second drug is Monalizumab.  This is a brand new drug.  This is the first drug that incorporates Natural Killer (NK) Cells in addition to the T-Cells.   Jimmy like!  Thank you to Cardiff University for this ‘Kerr-pow!” graphic.killer-cells

There are many different types of immunotherapy treatments being used or investigated today but they all have one thing in common. They are designed to unmask the cancerous tumor to our T-cells. The disguise comes off the tumor and bam, the immune system attacks it.

Yesterday we spent most of the day in Scottsdale as they poked, scanned and drained me of vital fluids to establish a baseline for evaluation of the effectiveness of the treatment. Monday I go back to Scottsdale for a biopsy of a lung tumor.   The following week the treatment begins!  Jimmy’s big adventure continues….I’m hoping for a long run.

I was able to complete a pet portrait this week. Please meet Harley. Painting is really good for stress release, Harley and I got along great. He is a biker dog from Omaha. Quite stylish in his kerchief, don’t you think?harley