Familiar Territory

I sometimes feel like I'm living a very slow-motion version of Groundhog Day, the movie. I have (again) a PET scan that shows a spot on my liver. I will now switch to some heavy-hitter drugs that I've done before, plus a new one. I know what to expect and I know how to handle it. I don't have to like it.

Last Friday I had a PET scan done. Since my CEA has remained elevated none of us were surprised to see that there's new activity. This time there's a spot on my liver (a new one - not one of the spots recently zapped by Charlie). According to the PET scan it may appear to be in my lung but the radiologist and the oncologist believe that it's actually behind the lung and in the liver. If I read the report correctly, there's a "5 mm nodular density" that shows no metabolic activity on the PET scan that's also in my lung. I believe that's a different spot. It was seen before and has grown from 2 mm to 5 mm, so they will be watching that one to see what it does.

What's the plan, you might ask? Well, I go on a familiar regimen that I've had before. This week I'll take a break from the drugs and next week the week after next (Feb 11) I will start on the "FOLFIRI + Zaltrap" plan. FOLFIRI is the acronym that indicates a standard chemotherapy drug combination of Leucovorin, Fluorouracil (also called 5-FU), and Irinotecan (also called CPT-11). A new drug similar to Avastin will be used in conjunction with these called Zaltrap. More information about FOLFIRI can be found here. More information about Zaltrap can be found here.The 5-FU will (again) be delivered over a 48-day period using the dreaded pump. Definitely not my favorite part of this experience.

From my experience before I know that I'll be gone from the world for several days after the infusion and will hope to emerge by the weekend. My infusions will be on every other Monday starting next week in two weeks. These drugs usually cause my brain to get very tired, so much so that regular conversation is difficult and draining. I know that I will struggle a lot to find the simplest of words. Therefore for a few days every two weeks my communication will likely be limited to email. That's not as draining to me because I can pause as often as needed to find the right words and don't have to worry about sounding conversational.

After four treatments I'll get a new PET scan to see what effect the drugs are having on the lesions. We will of course continue to monitor the CEA level. The goal is to knock it all the way back down to a normal level and to make the spots disappear. The number of treatments will depend on how quickly and effectively that happens. I may be going through this for four to six months, most likely.

When the treatment cycle is over, I think the oncologist will recommend a liver-directed therapy that involves injecting Irinotecan-saturated beads into the liver to deliver a strong dose of the drug directly to the liver. When and if that happens I'll have more details on that.

For those who like to see the PET scan report, here it is: