Thursday, March 24, 2016

can you go 10 rounds?

We spent much of yesterday at the hospital, and had the distinct pleasure of seeing how a very large hospital with dozens of doctors, nurses, and support staff, and hundreds of patients that has also fully transitioned to digital records manages care when the computer system shuts down.  Fun times! Lucky for us, actually, not much changed, though we did get to skip one step of check-in, so actually maybe for us it worked better. Ha!

We met with Dr. Einhorn and got the results. James does not have the rare genetic mutation, which means he qualifies for the immunotherapy drug pembrolizumab. (Say that three times fast!) The idea behind immunotherapy is based on the fact that cancer cells have "immune inhibitors" which act like a barrier, preventing your white blood cells from responding to your cancer. They are unable to attack the cancer cells, even though they recognize it as a foreign body that needs killed off. Immunotherapy drugs break down the immune inhibitors, while boosting your body's immune response, which allows your body to attack the cancer cells, and in many cases, kill off the cancer. It is the newest advance in cancer care, and pretty state of the art stuff.

The Plan
James had his first dose of "pembro" (as the insiders call it) yesterday afternoon. It is an IV infusion that takes about 30 minutes...or 2 hours if a nurse can't find a vein. Not that we're speaking from experience or anything. (Ouch.) James will receive these infusions every 3 weeks for one year, which translates to 17-18 doses...a few more than 10 rounds, but not bad! Throughout the year, Dr. Einhorn will be monitoring James through blood work, x-rays, and (hopefully, if insurance doesn't hate us) PET scans.

The Hope
Dr. Einhorn used the word "remission" yesterday, which was really encouraging! We had no idea this was possible apart from a miracle. But yes, over the past few years doctors have seen patients with other cancers use immunotherapy drugs, experience remission, and be effectively cured of their cancer. Unfortunately (or fortunately, however you want to look at it) - this drug is so new in the world of lung cancer that they don't know yet if the remission will "hold." That is, does lung cancer go away only as long as you use the drug, or can you actually be cured of lung cancer? Is remission of even a few years possible after a year of immunotherapy? They don't know, and they know that thus far, nothing has really been that effective for most lung cancer patients. But based on what they've seen with other cancers, they are tentatively hopeful.

Additionally, doctors have seen that patients who have the PDL-1 biomarker respond the best. That is, the higher your percentage of PDL-1, the more likely pembrolizumab is to reduce/eliminate tumors, and the more likely it is to allow you to live longer without progression of disease. With James being a 90% percent match - one of the highest they've ever had - this is all very good news. Needless to say, Dr. Einhorn expects this to be very effective for James, and is expecting he'll experience remission.

The Needs
Okay, so I know this is what you wait so patiently wade through all my mind-numbing (quasi) medical mumbo jumbo to find out how to pray. Thank you! You are so kind. And here you go.

*There is a small risk that James's immune system will be over stimulated, resulting in any kind of "itis" you can imagine (hepatitis, colitis, gastritis, our old friend pneumonitis, etc.). Pray that this does not happen. They have medical ways around it, but better if we don't have to endure that, IMHO.

*James broke out in a rash today. Apparently not too itchy, but it is a direct (common) result of the pembro. Fun times! Pray that it goes away, and that it isn't something he has to deal with every time.

*James's hip is causing a significant amount of pain these days. Dr. Einhorn expects James to feel the positive effects of the pembro in 4-6 weeks, which would mean a reduction of pain. May this drug be a means of God's grace, effectually working in his body, graciously bringing health, healing, and life. And if God would show James mercy in allowing the drug to work faster than it's "supposed" to, well, we would not be surprised...but we would be very grateful.

*Dr. Einhorn has been so kind to be mindful of the fact that we would rather be back home in China. He brings it up just about every time we see him. He has offered to go above and beyond in some ways if it meant that we could return. While we don't currently have plans to return to China long term (we are far from out of the woods), we are hopeful that we might be able to have an extended visit over the summer. To me, sitting where I am right now, this is little more than a dream. But you can pray for that, and we'll see what God does.

God is at work. God is good. And this is far from the end of the story.

But you knew that already, didn't you?
Thanks for hanging in there with us for the long haul. We'll get to the end of all this one day, dear friends, and not only will our joy be that much deeper for all the hardship and sorrows we've endured, but we'll all be better for it.

To God be the glory.

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