The scan taken at the end of October showed some pleural thickening (minor according to radiologist's report). It also showed a "new lymph node about 1.5 cm in size" to use the doctor's words. I am kicking myself now that we didn't ask a few more questions about this aspect of the result. However, we were still digesting the news when the registrar moved on to talk about options....
Option 1 is do nothing for the time being, as Steve is largely asymptomatic and enjoying "normal" life; keep under review and take action only when he has problems.
Option 2 is to have another regime of pemetrexed and carboplatin; it resulted in shrinkage before with no lasting ill effects and may have the same positive effect second time around.
Option 3 is to go on another drug trial.
Oxford has a two part trial open at the moment. Although Part 2 is aimed at Non-Small Cell Lung Cancer (NSCLC), Part 1 is also open to other types of cancer. The drug trial is called "VANSEL 1" for short. It's a Phase 1 dose escalation trial of the oral VEGH/EGRF inhibitor Vandetanib (ZD6474) in combination with the oral MEK inhibitor Selumetinib (AZ6244). Details of the trial can be found by clicking here
Vandetanib is a type of biological therapy called a tyrosine kinase inhibitor (TK1). Tyrosine kinases are proteins that sends signals to cells telling them to grow and divide. TK1 blocks these proteins which can stop cells growing.
Selumetinib is another type of biological therapy called a MEK inhibitor. MEK is also a body protein that sends signals to cells to grow and divide. Blocking MEK may also stop cancer cells growing. Researchers think that using both drugs together may may be better than having one or the other on their own.
We asked about the current trials at Barts and Leicester (MESO 2, COMMAND, ADAMS and SKOPOS) but the registrar knew nothing of these. She made notes and will follow up with the consultant Dr T.
Steve said that he doesn't want to sit back and do nothing. He thinks that if he leaves it until the disease takes off properly, his treatment options will close down or be less effective.
His gut instinct at the moment is to go with the drug trial option, if he is suitable. However, that involves a decision as to whether to chose the local Phase 1 trial and be a guinea pig to help establish the most effective combination of dose and frequency, or go on a Phase 2 trial and run the risk of getting a placebo rather than the drug (plus there is the time, cost and energy implications of traveling to London or Leicester). Decisions, decisions....
We need a bit of time to digest this news, do some more focussed research and consider the best option for Steve, so we have arranged to go back on 9 January, talk it though and make an informed decision. In the meantime, we will concentrate on having a wonderful Christmas and enjoying life before treatment begins again and takes us out of circulation for a while.
I wasn't sure whether we would be breaking open the fizz tonight given this news. However Steve is already one of the lucky one in ten alive three years after diagnosis and in six months time will be one of the 5% still going strong five years post-diagnosis. Looked at that way, we have a lot to celebrate and he still has options! I think I will put the bottle in the fridge after all :-)