013.07.30: 16 - Changing Medication and Changing Homes

我与癌 (16-换药换房) 接受18 个疗程的Topotecan+ Avastin（T+A）是2012年7月，历时11个月，Ca125 （Cancer Antigen 125) 降至77 时，我对再次 in remission 抱有巨大希望（正常值是0-35），可Ca125缓慢上升的趋势却将希望吹的无影无踪。8月查的Ca125 虽已升至200左右，PET-CT 的 结果显示癌组织并没有增长（通常血的检测较扫瞄敏感），故还是说明（T+A）已渐失效或者说肿瘤在耐药路上大踏步前行。 医生K主张我采用 Alimita+Avastin . Alimita 抑制癌细胞生长是通过干扰癌细胞DNA的合成所致，主要用于肺癌的治疗。我之前提到Avastin 是通过切断供应癌细胞的血管而起作用。经过三个疗程，Ca125仍是缓缓上升，无显著疗效。除了皮肤异常敏感外，也没有不可忍受和无法减轻的副作用，期间还参加了十月侄女的婚礼，十一月赴Yale帮闺女恢复腿伤。决定再次换药是在我的Ca125升达480，PET-CT显示多处肿瘤有梢梢变大，是2012年底。 这次和以往的换药有所不同，医生K是准备让我用处于二期临床试验药物PD0332991, 是药丸，便携，付作用似乎也不多。倘若有效，我就可游走四方与服药同时进行，不用因去医院静滴困扰，且已是二期临床，不用因药毒而担心。趁机科普什么是临床试验各期。一般来说临床试验分三期，一期的主要目的是检测药物的毒性，二期是将药物用于少量病人，疗效是追踪的目标，三期是大量病人用药，有对比组。我用的PD0332991 是CDK inhibitor，此药在治疗乳腺癌已经是临床三期。（ 卵巢癌的治疗与乳腺癌治疗关系十分密切，一般是紧追不舍）。我犹豫许久，还是于2012年12月初开始口服此药，Ca125是480，4周一个疗程后，2013年1月2日，Ca125是574，月底升到692。又该换药吗？还有选择吗？？？ 体内的肿瘤可对药物产生耐药性，我的心对生活依然是寻寻觅觅。每逢周日下午， 观赏 周边 open house 是我夏日的重要日程之一，使散步有了目的性，既锻炼了身体又给我的居家艺术知识添了砖加了瓦。记得是七月中的周日下午，例行公事去看我的open house. 那房子坐落在我家北面的山坡上，有心旷神怡的海景和诱人的舞房。散完步，让LG去开开眼，竟一去不复返，才意识到情况的严重性，我给自己挖了一个无比大的坑！LG回来后郑重告知，要买他的 dream house。我晕！浩大工程，因只有先卖现住房，才可能买呀。 感谢我的家人，尤其大闺女和她的好友L，在回校前打包全部大小家当，搞定Stage house ( 请专业人士布置居家，便于出售），感谢LG一贯我行我素的作风，尤其赞一下，他在老房烤制的火鸡在感恩节的聚餐上得到一致的好评，希望再接再厉，我拭目以待今年的火鸡节的来临。2012圣诞节前，我心不甘情不愿卖了老房，全家跃居LG的 dream house。 通报一下我嫂子已康复，在家闲的慌，又回归做职业女性。谢谢网友们的关心。

Cancer and Me (16 - Changing Medication and Changing Homes) After 18 cycles of Topotecan and Avastin (T+A) over 11 months, in July 2012 my CA-125 (Cancer Antigen 125) levels had decreased to 77, and I held high hopes to be in remission again (my chances were 0-35%). But the slow upward trend of my CA-125 levels made my hopes completely vanish. In August my CA-125 levels were around 200, though the results of my PET-CT showed that the cancer tissue had not increased in size (typically scans are more sensitive than blood testing). This showed that T+A was losing its effectiveness, or in other words, the cancer was making great strides in its drug resistance. Dr. K advocated that I use Alimita and Avastin. Alimita inhibits cancer cell growth by interfering with DNA synthesis, and is primarily used to treat lung cancer. I previously mentioned that Avastin works by cutting off the blood supply to cancer cells. After three cycles, my CA-125 levels were still slowly rising, showing no effects of the treatment. Other than extremely sensitive skin, none of the side effects were unbearable or were ones that could not be mitigated, and in that period I even attended my niece’s wedding in October and went to Yale to help my daughter recover from her leg injury in November. It was decided to change medications again at the end of 2012, when my CA-125 levels were up to 480 and the PET-CT showed multiple tumors were slowly increasing in size. This change of medication was different from previous times. This time Dr. K planned to use the Phase 2 clinical trial drug PD0332991. It was a pill, so it was portable, and there didn’t seem to be many side effects. If it proved to be effective, I would be able to go anywhere while still going through chemo without having the inconvenience of going to the hospital for an IV. In addition, since this drug was already in Phase 2, I wouldn’t have to worry about drug toxicity. I’ll take this opportunity to talk about the phases of clinical trials. Typically clinical trials go through three phases.  Phase 1 is primarily for determining the toxicity of the drug, in Phase 2 the drug is given to small numbers of patients to assess its effectiveness, and in Phase 3 the drug is given to large numbers of patients, with a control group. PD0332991 is a CDK inhibitor, and it’s already in Phase 3 trials for treatment of breast cancer. (Treatment of ovarian cancer and breast cancer are very closely related, and progress on drugs for them usually follow each other very closely). I hesitated for a long time, but in early December 2012 I started to take this drug, when my CA-125 levels were 480. One 4-week cycle later on January 2, 2013, my CA-125 levels were 574, and it rose to 692 at the end of the month. Do I need to change medications again? Are there still other options??? Though my tumors were developing drug resistance, my heart was still hopeful for life. Every Sunday afternoon, going to nearby open houses had been an important item in my summer schedule, as it gave purpose to the walks I took, allowing me to both exercise and learn about interior decorating. I remember on one weekday afternoon in July, I went to go see an open house as planned. That house was on a hill north of mine, and had a refreshing view of the ocean and an enticing ballroom. After my walk, I told LG to take a look, and when he didn’t come back for a long time, I realized the seriousness of the situation. I had dug myself into an enormous hole! After LG came back, he solemnly informed me that he wanted to buy his dream house. Darn it! This would be a huge undertaking: we would have to sell our current home to buy it. I thank my family, especially my older daughter and her friend L, who packed up all of our belongings before going back to school and also found a home stager (a professional who lays out a home for facilitate its sale). I thank LG for his constant “do it my way” style: in particular, the turkey he roasted at our old home for Thanksgiving received unanimous praise, so I hope that he will continue his efforts and I eagerly await Thanksgiving this year. Shortly before Christmas 2012, I reluctantly sold the old house, and the whole family leapt to move into LG's dream house. I’d like to report that my sister-in-law has fully recovered and was too bored staying at home, so she has now returned to being a working woman. Thanks for the concern of all my online friends.