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Five-Year Plan

Six months have passed since I started the Pazopanib trial at Stanford. Last week I had my latest milestone appointment with Dr. Kunz. I’m very happy and relieved to report that all of my tumors are still stable, with no signs of new tumor activity. Another very boring report/visit which makes me ecstatic! So again the plan is to stay the course. Kathy asked some good questions this time out, and the answers were very interesting. I knew there were over 150 patients enrolled in this trial nationwide (we found out the actual number is 165), but what we didn’t know is that apparently I’m the only one enrolled in the study through Stanford. We’d also been told that I can stay in the study so long as the results are favorable, but this time Dr. Kunz let us know that the outer limit is five years. To maintain my current quality of life I’ll gladly do this for five years.

I have been experiencing a little breakthrough syndrome, but certainly nothing out of the ordinary for me. While I’m on 40mg LAR every 28 days, I haven’t been using rescue injections for several years. It was suggested that I go back to using them on an as-needed basis so I stocked up on some of the pre-loaded octreotide syringes. We also discussed Telotristat, an oral med that hopefully will be coming to market later this year, and can supplement LAR injections to help manage syndrome. Let’s hear it for oral meds!

Pazopanib Trial Update

I’m three months into the Pazopanib trial at Stanford with Dr. Kunz, and today was my first scan-review visit. Last week I had my usual MRIs of abdomen and pelvis, plus CT of chest. I was very pleased to learn that the scans showed no new tumors, no tumor growth, and even some minimal shrinkage (2.4%) of a couple of the larger “index” tumors in my liver. Woohoo! A very boring report, and as anyone with NETs can tell you: boring is good! I’m feeling pretty good on a regular basis, and my quality of life is good, so this really is welcome news. The only recent hiccup was over-eating on Thanksgiving which caused a lot of pain and made me feel awful, but that was self-inflicted so all is good.

The plan moving forward is to stay on the blinded trial for three more months. Given the promising results the presumption, or at least the hope, is that I’m actually on the med and not a placebo. I’ll continue with follow-up visits every four weeks, and then another round of scans in three months.

We’ll also be seeing Dr. Kunz and several other NETs specialists on January 24 at the 2016 Neuroendocrine Tumor Patient Conference at the UCSF Mission Bay Conference Center. This is an excellent event with lots of good information. Kathy and I have attended annually and are always glad we did. If you’re in the Bay Area that weekend I strongly encourage you to attend. Admission is free, but you need to register online in advance. Hope to see you there. Happy Holidays!

Time for a Change

For the last few years following my PRRT in Houston I’ve been getting my maintenance labs, imaging and meds at Kaiser. That was fine so long as my tumors were stable and nothing new was cropping up. Unfortunately my tumors have started to grow incrementally and a couple new tumors have developed in my liver. I’ve also had more nagging discomfort along my diaphragm on the right side where I have a cluster of mets. Kaiser didn’t have any new or different tools in their bag so it was time to move on.

Since Dr. Wolin, my go-to NETs expert at Cedars, has moved his practice to Kentucky I wanted to find a new team on the west coast. What’s exciting is that in the last few years the NETs team at Stanford has, in my opinion, really grown and is on the cutting edge of advancements in neuroendocrine tumor studies and therapies. After attending a symposium at Stanford earlier this year and having an introductory appointment in April, Kathy and I decided we’d transfer my full-time care to Dr. Pamela Kunz at Stanford.

Dr. Kunz discussed a few different courses of treatment available to me, including:

  • Afinitor – a daily tablet – this mTOR inhibitor interferes with the growth of cancer cells and slows their spread in the body.
  • Pazopanib – a daily tablet – this angiogenesis inhibitor, in a Phase II clinical trial, is designed to slow the growth of new blood vessels to the tumors.
  • Fosbretabulin – a weekly IV therapy – this vascular disrupting agent is also in a Phase II clinical trial, but we quickly ruled out this therapy as the weekly time demands would be too taxing on my schedule.
  • Immunotherapy trial – this trial is not yet open but should be soon and is something I’m definitely interested in pursuing if and when I can.

After much discussion and advice from Dr. Kunz, we decided that the best course of treatment would be for me to enroll in the Pazopanib trial. I’ve completed the enrollment paperwork, had my prescreening labs, echocardiogram, MRIs, CT and will next week have my official trial prescreening visit with Dr. Kunz. If all goes well and I’m approved for the study I’ll be starting the new meds after a return visit on September 4. I should point out that this is a randomized clinical trial with the possibility of crossover. What that means is that there is a 50% chance that I’ll be given a placebo. I will be closely monitored every month, and have the full gamut of labs, scans, etc. after three months. At that time the trial team will evaluate my progress and a few different things could happen: if my condition is stable or improving I could continue on the drug; if my condition is worsening (tumor growth or spread) they could break the seal to determine if I’ve been on the drug or a placebo. If I’ve been on the placebo I could then crossover to the drug and the process restarts.

If however I’ve been on the drug and things are worsening then I can move off of the trial drug and begin one of the other treatment options like the Afinitor or perhaps enroll in the immunotherapy trial. The good news is that there are options and regardless of the outcome of any one course of treatment there will be others for me to try. If the Pazopanib does end up working for me then I will be allowed to continue taking that. I should also mention that throughout all of this I will continue with my monthly maintenance dose of Sandostatin LAR at 40mg (2-20mg injections).

I will keep you posted here on my progress during the trial. Here’s to options!