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.
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.
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.
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?