As I started writing this I was waiting for results from my bronchoscopy. In the meantime I was contemplating what is a major milestone in my cancer journey. To some extent I have withdrawn to think about this on my own. I was expecting results on the 12th but a mixup in a changed appointment resulted in the oncologist not having the results to give us the information that we needed.
I got a lot of little bits and pieces in an early conversation. It is not breast cancer. Nor is it SCLC (small cell lung cancer.) It is lung cancer but if this were a clinical trial the amount of growth would not classify as progression. So while I'm glad the oncologist is on top of it, I'm left with time to ponder what the next moves might be. The obvious ones are the move to chemo or osimertinib (Tagrisso).
But in the back of my mind I have always held out some kind of thought that my best bet would be a clinical trial. I have always made my openness to that clear. One of the things that I was thinking about was making sure that my treatment choices didn't preclude a trial by virtue of a previous treatment.
So, when in the brief conversation, I wondered out loud about that, my oncologist popped open an email that he had received the previous day of clinical trials underway in Vancouver. He mentioned one I was familiar with and began to examine the qualifications required. There was silence as he read. Then I heard an intake of breath.
"Angus you will not qualify for any clinical trial. Your breast cancer is a confounding factor that will disqualify you."
And that has left me stunned. One of my friends uses the metaphor of Tarzan swinging from vine to vine in the jungle. It describes the anticipation that when one treatment fails, another one will be there. I've been thinking about that next vine. I didn't assume that it would be there but I kind of thought it would be. It isn't the end of the line. There are still options. There are drugs out there that I would like to try. I've had compassionate access to a new drug already. And there are phase 1 trials which tend to be much more accepting of comorbidities and challenges. There is even a possibility of some sort of rare disease argument for a trial of one. It's a lot of work to get it approved but not impossible.
So that leaves me thoughtful and reflective. I am confronted at the same time with the stark reality that this disease kills. I'm thinking a lot about that end game. How do I make my last years valuable? And then I think back over my life as one is inclined to do at such moments and realize that I have never really lived quietly.
I've been asked if the colored skies in my watercolor landscapes represent a sunset or a sunrise. That is a more difficult question to answer than you might expect. The implication is that it reflects how i see life in some fashion. I enjoy color in the sky. It is a thing of beauty and therein lies a fascinating realm for discovery.
PS. The news was good. I qualify for osimertinib and after a brief washout period with no drugs, will begin to take it on Boxing Day. But that is another blog post.