Dr. T called me Friday afternoon with the results from my PET scan. The scan showed progression in the liver, bones, and lymph nodes. The lesion in my liver increased from 6.6 to 7.7 cm, there are two cancerous lymph nodes in my abdomen, and a new bone lesion on the right side of my pelvic bone. None of these are huge changes, but they do mean that Gemzar isn’t working. It’s always tough to get this news, which is why I waited a few days to post about it.
Dr. T thought that my best treatment options were either Carboplatin chemo or Afinitor pills and felt that there was little information to suggest that one was better than the other. I decided to go with Afinitor since it addresses one of the mutations found during the Foundation Medicine testing. Afinitor is an mTOR inhibitor which affects the AKT1 mutation downstream somehow (not clear on the specifics). I feel better about choosing a drug that has some biologically plausible reason to work. Afinitor is a daily pill; no IVs needed. I’ll get monthly checkups with Dr. T while I’m on it and still get my Xgeva shots every 4 weeks. I go for a “teaching session” this week with the nurse practitioner to get any necessary prescriptions and learn about the side effects – the main one is mouth sores and associated weight loss – and then I’ll start the drug as soon as I get it from the pharmacy.
We also talked about whether I should get another liver biopsy. I’m not sure whether it was clear in my post about the Foundation Medicine DNA testing results, but they were only able to analyze the tissue from my mastectomy in 2009. I had 2 liver biopsies since I have been diagnosed with stage IV disease and those samples did not contain enough tissue to do DNA testing with. This was a huge disappointment for me. As I understand it, while a mutation that existed 4 years ago might still affect growth of my cancer now, it’s likely that several more mutations have occurred since then and are really fueling the growth of my cancer. So identifying RECENT mutations gives me the best chance of slowing or stopping cancer that is growing NOW.
All of that is to explain why I’m considering another liver biopsy, even though it’s an awful procedure. I realize that the doctor doing the biopsy can’t tell whether the sample is sufficient for DNA testing, but my question to Dr. T was – what’s to say I won’t have a third unsuccessful biopsy?
With that in mind, I asked about the possibility of a laparoscopic liver biopsy. I had a robotic laparoscopic surgery in 2012 and the hardest part was getting the IV started for the anesthesia. I know that there is a rather large chunk of tumor in my liver which has to contain enough cells for the DNA test. I’m planning on talking to a surgeon to find out if it’s even possible and whether there are additional risks besides anesthesia (like bleeding or spreading cancer cells) that would outweigh the benefit of being sure of getting a good sample.
Please let me know if any of this is confusing; you’re not likely to be the only one confused. Thanks to all of you for your continued support.