At the moment that Dr. Andrew Pippas, morphed from being my friend to becoming my medical oncologist, I already knew several things about him. I first met him in his cramped little office across the street from Doctors Hospital, well in advance of the construction of the John B. Amos Cancer Center.
I was there to welcome him to town. Our conversation drifted to men’s clothing. I recommended Chancellor’s as a good place to go. We talked about his family and that he had just arrived here from Lakeland, Fla. I found him to be quick-witted, very intelligent and he seemed to always order his thoughts before he opened his mouth to speak. Over the years I’ve know him, he’d occasionally disappear from the small space his body occupies and appears to be lost in thought, pondering some angle, some formula or another way to get at something on which he’s been working. Like a well-dressed mad scientist in a bow tie, he leaves no stone unturned in his quest to heal those of us sick people who are glad to be in his care.
These few days since my last posting on this blog have found me on a soul-wrenching journey. Our lives have gone on: doctor visits, dinners with family and friends, quiet conversations with family, the business of running two print magazines while launching three digital versions of both of them, church (although I skipped today to have some quiet time just for myself), board work, tractor time, an event with my parents — all against the ever present backdrop of cancer and a big decision that needs to be made.
As you know, Jill and I just returned from an 11-day journey out to Houston, Tex. to the M. D. Anderson Cancer Center. Out there we found out a couple of things we already knew and one thing we were surprised to hear. The cancer that has invaded my body is trying to kill me, but thankfully it has brought a slingshot to the gun fight. But instead of the one tumor that we knew I had on my left adrenal gland, we found out that I have two more small ones in the upper pole of Strainer, my right and only kidney.
There is a surgical option that should be exercised after a period of systemic treatment. I have always been told by Dr. Pippas and other medical oncologists whose opinions we’ve sought: “Treat a local problem with a local treatment. Treat a systemic problem with systemic therapy.” We’ve got a systemic situation now, and although surgery is still on the table, we need to blast my system with cancer-killing therapy to beat down what is there and destroy any cells that may be trying to get a toe hold someplace else.
TKIs and anti-angoiogenic drugs are the chosen systemic route these days for clear cell kidney cancer because they can shrink tumors and lessen a patient’s tumor burden in advance of surgery. I believe there are 7 of them: sunitinib (Sutent), pazopanib (Votrient), everolimus (Affinitor), axitinib (Inlyta), sorafinib (Nexavar), temsirolimus (Torisel) and bevasizumab (Avastin). These drugs have two things in common: their toxicities are legendary and they cannot cure kidney cancer. The 8th approved therapy is called Aldesleukin (IL-2). It has one thing in common with the other seven: its toxicities are legendary. AND, +/- 7% to 10% of the time, it can also cure (provide a durable, lasting remission from) kidney cancer.
If you search HDIL-2 on this blog, I’m sure you’ll find a double handful of references and the discussion that if this cancer forces me to a systemic therapy, high-dose interleukin-2 will be the one I choose. I know that I’ll be walking unarmed and naked into a wall of flames, but I’ll be walking toward the only thing that can give me my life back and provide a tiny hope for my greatest wishes: to live to be old with Jill Tigner, to see our sons happily married and to hold a lapful of grandchildren.
Andy Pippas called me this afternoon and we talked about things. The bottom line: I am not going to dick around with a drug that has not got a chance to cure me. Not now, anyway. I may have to take one of these 7 drugs some day in advance of another surgery. But, I may be one of the 7 percenters, who can get enough remaining life out of HDIL-2 to ether be done with this shit or to live long enough for something more profound to come along.
So, I sent Dr. Dan George an email today and asked him to make a place for us at Duke University Hospital in his world-class HDIL-2 treatment program. My hair is on fire, my eyes are red, I’m locked and loaded and I’m going in. Unless something in my scans or labs makes me ineligible for this treatment, we’re choosing to ride the only horse that can take us all the way to the finish line.
This decision had been difficult to make and has taken days of discussion with Jill and many emails with the doctors who are involved with my case. I am tired of thinking about it now. We know what we’re going to do and we’re ready to get about it. Here is some information on Aldesleukin if you need some specific things to pray for on our behalf. This is going to be worse than 100 miles of cobblestones in a Belgian bike race. But, with enough people cheering us on, we’ll get through it.
I’ll post here when I hear from Dr. George. Please keep us in your prayers.