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As you probably heard, sports anchor Stuart Scott died of cancer over the weekend. The immensity of Scott's love for his daughters is palpable in this ESPY award speech. He calls his girls his "heartbeat." Like almost every parent, I can relate. And watching this (just fair warning), I cried big, ugly tears. A reminder that even though cancer research has come so far, we still have miles to go before we sleep.

 

Here is some of the research I've seen over the past few weeks. If I've missed anything over the holidays that you think should be included, please send me an email and I'll add it next week. Now that I'm done stuffing myself with gingerbread and dark chocolate candy cane bark, I have time again for sifting through articles online. Because, ahem, THAT CANDY CANE BARK WASN'T GOING TO EAT ITSELF.

Zinc Test for Early Breast Cancer Looks Promising

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"For the first time, a study shows that breast cancer cells process zinc isotopes differently to normal cells - leading researchers to suggest this might be a way to detect the cancer early."

No Surprise: Herceptin Improves Long-Term Survival for Her-2+ Patients

"The results show that the 10-year survival for HER2-positive breast cancer patients who received chemotherapy without Herceptin was 75%, whereas for those who also had Herceptin, it was 84%."

Two Pre-Surgical Drugs Improve Survival for Triple-Negative Breast Cancer Patients

"We found that adding either carboplatin or bevacizumab to standard preoperative chemotherapy increased pathologic complete response rates for women with basal-like cancers -- that is, it increased the proportion of women who had no residual cancer detected at surgery."

Disease Progression Delayed by a New Drug Combination in Some Advanced Patients

"A new combination of cancer drugs delayed disease progression for patients with hormone-receptor-positive metastatic breast cancer, according to a multi-center phase II trial.

'Because the study showed a statistically significant benefit among patients whose disease progressed on an aromatase inhibitor, a larger phase III study comparing this combination to other approved therapies used after initial therapies fail, like exemestane and everolimus, should be done.'"

Updated Results of MARIANNE Study for Advanced Her-2+ Patients

"The study assessed the feasibility of three different regimens targetting HER2 in people with previously untreated (first-line) advanced HER2-positive breast cancer. Patients enrolled in the study received one of the three composites: Kadcyla (ado-trastuzumab emtansine) plus Perjeta (pertuzumab), Kadcyla alone, and Herceptin (trastuzumab) plus either docetaxel or paclitaxel chemotherapy.

Results from MARIANNE trial showed that all the three regimens were feasible in progression-free survival (PFS) for a similar amount of time."

Development of Most Cancers Is Beyond Our Control, Study Finds

Notably, breast and prostate cancer were NOT included in this particular study. So the jury's still out as to whether those might be controlled by environmental factors.

"In a groundbreaking paper published in Science, the duo describe a new factor, a tissue’s stem cells, that may explain as much as two-thirds of the difference in cancer risk among different tissues."

What's Blowing Up the Breast Cancer Blogosphere This Week

In case it's not obvious, I'm in total agreement with Ms. Schattner on this one. No amount of whisky could ease the pain I would feel if treatment wasn't an option for me. There were other great articles countering Mr. Smith's blog post -- if you're interested, here are a couple that resonated with me.

"The image of a person retching or in pain, afraid to ask questions of his doctor and not being offered palliative care is outdated by several decades.

Today, cancer surgery and medicines can extend and improve the lives of people who live for years and decades after treatment. Malignancies that were notoriously hard-to-treat just a few years ago, like some forms of lung cancer, melanoma, T-cell lymphomas, Her2+ breast cancer and other conditions have become, in many cases, manageable." (emphasis mine)

Miracles Do Happen (What I Was Thinking About Over the Holidays)

We know very little about spontaneous remission except that it's extremely rare. Most doctors refrain from mentioning it to avoid giving false hope to patients. But the allure is undeniable.

An Update

After chemo yesterday, I'm feeling pretty queasy today. I don't usually take Quinn to daycare on Tuesdays, but the option was available today so I took advantage of it. And even though our trip to Portland alleviated much of my anxiety going into this week, I still cried into Quinn's pillow in the dark as I laid down to tuck him in last night. Some of it was the slight stress I was feeling over my scan results -- UPDATE: as I was writing this, my doctor called to tell me MY SCANS WERE CLEAN!

There's no easy transition here, and mostly, my tears last night had to do with a friend, Brigid, who was admitted to the hospital yesterday for the third time in the last couple of weeks. It is really tough to celebrate my good news at the same time that my friend suffers. The tumors that have been plaguing her lungs for nearly eight years with nary a symptom are now growing so fast they are causing her lungs to repeatedly fill with fluid despite procedures to drain them; Brigid can no longer breathe very well unassisted. 

{Brigid and me, December 2013}

On paper, Brigid's cancer is very similar to my own: Stage 4, Her-2 and ER/PR+. But the drug that has held me in remission for nine months now had almost no effect on Brigid's cancer. Killing cancer is not yet a perfect science. 

When I first met her, I was in awe of how long Brigid had lived with this disease -- about five years at the time. As I approach the three-year anniversary of my diagnosis, though, I realize five years isn't close to enough time; neither is eight years. Is there ever enough? Are we ever ready to throw in the towel? Does it matter what we want?

Who knows why I respond to drugs that haven't stopped Brigid's disease from progressing? Who knows how long my luck will hold? For now, I am feeling an odd mix of relief and fear for my friend. My stomach is doing flip-flops, and this time I can't entirely blame chemo.

Six Months

I wanted to write this post before my meeting with my oncologist Friday, thought about how I'd construct it, whether it would include a photo of clinking champagne glasses (or, possibly, God forbid, a slew of obscenities), but I didn't want to jinx myself. I mean, sure, I felt great, but what if he came into the exam room and told me it was time to change chemo? After all, he'd done it before. Spoiler alert: this time he didn't.

What if I'd written--in black and white, where things become real--a whole scene of how I wanted the day to unfold, only to have my heart broken? So I held off on writing until I was certain, until I'd heard the words straight from my doctor's mouth: "No cancer." At which point, I hugged the poor man.

My scan was clean! My scan was clean! My scan was clean! 

Also, no destructive bone lesions, which is good.

Then I had a celebratory lunch with my dear friend Sandi who went with me to my appointment (because Chris couldn't make it this time) and tried to will my frazzled nerves to calm the heck down. I think it took about six hours until I didn't still feel like I was going to vomit from the stress of this appointment. Mental note: I have got to figure out a way to not do this panicked, angst-y routine every three months. If you have suggestions that go beyond Xanax, please let me know.

Nothing changes in my routine: I'll still go in for blood work every week, still have infusions of this chemo every three weeks, indefinitely. I've been on Kadcyla a year now; my blood counts look relatively normal and the other side effects are mostly manageable. And my oncologist is of the "if it ain't broke, don't fix it" camp. As much as I'd love to not have to have chemo interrupting my life every third week, it is huge safety net for me. Which is a good thing to have when you're walking a cancer tightrope. 

This scan is my third clean one in a row (holy smokes!) and marks six months of no evidence of disease  (NED) for me. I was asked the other day how long I'd been in remission, and I didn't really know how to answer. Based on the National Cancer Institute's definition, I'd say NED equals remission, so the answer is six months, although nobody in my cancer world seems to use the term remission anymore. Is that unique to me? To breast cancer? Either way, I'll take it. 

Counting Time

As a cancer patient, I mark the passing of time in three week increments between infusions (a phenomenon described eerily by Susan Gubar for the NY Times here). These last three weeks - with the winding down of the holidays, Chris gone to the field for eight days, a huge work deadline for me, and Quinn's bronchitis and sleeping troubles - time flew by. It didn't seem like enough downtime between treatments. Usually, I'm feeling back to normal and exercising regularly by the time my next infusion rolls around, but out of sheer exhaustion, that didn't happen this round.

It feels like I've barely had time to come up for air, and the next wave is knocking me over again, dragging me under and spinning me around while I hold my breath and wait to be spit onto shore.

I had chemo this morning, and if you count the six rounds of chemo I had last fall, today was my fifteenth infusion over a total of thirty-nine weeks, which is coincidentally the exact amount of time I was pregnant with Quinn. This seems like a nice stopping point - just the right amount of time to produce a healthy new life. And as with pregnancy, my body is achy and tired, I'm having trouble sleeping through the night, and I'm totally ready to be done and on to the next phase.

When I finished up chemo last December, the nurses showered me with confetti and made a big deal of it being my last round; it's a tradition they do for all their patients. The few of these celebrations I've witnessed over the last six months were bittersweet for me, not having a definite end date or specific number of treatments to complete before I could say "I'm done!" this time. In the beginning of this cycle, all my oncologist would commit to was, "At least six months," and "We'll see."

As I think I've mentioned, I have a PET/CT scan this Friday. If it's clean, my doctor will drop the Taxotere (the chemo component), and I'll just be on maintenance drugs long-term, or as long as there is no evidence of disease. If it's clean, today will have been my LAST CHEMO, possibly ever, but there was no confetti this morning. My nurse didn't want to jinx anything; she didn't even mention it until she was giving me my flu shot at the end of the day, just before I headed home.

I'm trying not to get my hopes up, but after October's clean scan, I'm cautiously optimistic. And I don't know about you all, but as much as it makes for exciting cliffhangers and quirky plot twists, I'm ready to focus on something other than three week infusion cycles, how many steroid pills I still have to take, how few eyebrow hairs are still holding on (about a dozen per side, if you're interested). I'm ready for what's next: time to focus on my growing boy, time to write a book about this crazy journey, time to reconnect with my husband, time, time, and more time.

Scanxiety

The period leading up to a PET scan and the time spent waiting for results are often fraught with what people in cancer-land dub "scanxiety." I don't really know how to describe the feeling except to say you try really hard not to get your hopes up, but there they go, imagining your future - one in which you have hair again and that new house you've been shopping for. One in which you've sat at a sidewalk cafe sipping red wine and fattening yourself up on freshly made pasta in Italy itself, maybe as the Mediterranean breeze blows through that new hair of yours. It's a future in which you teach your little boy how to tie his shoes and cheer him on at his first baseball game. Your hopes take on a mind of their own during this period, and you panic at every thought in which the outcome might not be what you want. I can go on and on about how none of us really knows our future and how important it is to live in the present, but when it's time again for my scans every third month, all those platitudes fly straight out the window.

Last week, as I drove to pick Quinn up from daycare the afternoon after my PET scan, I got a call from my oncologist's office confirming my appointment for the following day. No word about scan results, just a matter-of-fact, all-business call to confirm an appointment. Routine, I'm sure. But it set me off--my heart started racing, my palms got all sweaty on the steering wheel, and I convinced myself that it must mean bad news, since last December, when it had been good news, they'd called and told me over the phone. 

I immediately called Chris to see if he could calm me down. "They probably don't even have the results yet," he tried to comfort me. My throat was closing up and I was contemplating how I would pull over on the exit ramp leading from one freeway to another since I was not sure I could safely drive. "Worst case scenario, they've got lots of other drugs they can try," he said. He was right--as usual when it comes to these things--but rational thought isn't at the forefront of my head in the midst of a panic attack. 

So when we hung up, I called my oldest friend, Alana, who was in the middle of her own craze trying to pack for a weekend trip with twenty minutes until she had to leave for her flight. Her frenzy took my mind off my own stress and she even made me laugh a bit. I promised her I'd call as soon as I had any news. 

Less than a minute after our call ended, my phone rang. It was my oncologist, calling to tell me that my PET scan was completely clear. "They don't see anything," he said.

"Totally clear?" I asked. "There's nothing at all?" I checked again. I wanted to make absolutely certain I'd heard him correctly before I told anyone.

I hugged Quinn extra hard at pick-up that day. "We did it again," I whispered in his ear.

I still have another three months of this chemo cocktail, as my oncologist wants to be absolutely certain this time we knock out each and every one of these cells. But assuming another clean scan mid-January, he'll take me off the chemo component and leave me on the other two maintenance drugs. If our luck continues, this will put me into long-term remission. On the other hand, I'll continue to have scans every three months, so if anything does come up, we'll catch it early again and I'm confident I'll continue to respond well to treatment.

Chris and I celebrated our four-year wedding anniversary and my clean scan this weekend. And I feel like I have another lease on life, even if I have to renegotiate this contract every three months. Turns out, I'm a pretty good negotiator.