Last Option

Yesterday, as previously scheduled, I had more blood tests, and Susan and I met first with Dr. Jarnagin, the surgeon who operated both times on my liver, and then with with Dr. Saltz. Dr. Jarnagin told us that last week's CAT scan showed that the chemotherapy was having "at best" no effect on the tumors. In response to a question of mine, he also said that, although there was no surgical intervention that would be efficacious against the tumor progression, drains could be inserted into my abdominal cavity to drain some of the fluid that keeps accumulating in my belly.

When we met with Dr.Saltz a few hours later, he confirmed that he was discontinuing my treatment with FOLFOX. He thinks that I now have tumors both in my abdominal cavity and in my stomach and that the fluid is cancer-related.

Dr. Saltz indicated that he has only one other chemotherapeutic option for me to consider: Erbitux combined with irinotecan. I was previously exposed to irinotecan, as it is an ingredient in the FOLFIRI cocktail with which I was infused soon after my initial diagnosis. Although FOLFIRI set off a bewildering Kaleidoscope of adverse reactions in my body, Dr. Saltz thought that I tolerated FOLFIRI relatively well. The more I think about my previous experience with irinotecan and study the literature on the irinotecan/Erbitux combination's probable and possible side effects, the more I marvel at its users' willingness to endure sufferings worthy of Job to try to stave off death .

If the irinotecan/Erbitux combination were to prove efficacious for me and its side effects were not life-threatening, I would receive it for about six months. Then, once-- and if-- I recovered sufficiently from the side effects, I might have one last period in which I could go out into the world again. 

On Sunday, I will undergo an invasive procedure under local anesthesia during which a drain will be inserted in my belly for some two hours. Dr. Saltz says that the chances of my getting another infection from the procedure-- I got a total of four infections last year from four procedures (two from one, none from another)-- are minimal and that the reduction in pressure should temporarily relieve some of the pain in my midsection. The fluid will rebuild-- perhaps over 48 hours, perhaps over three or four weeks. As the abdominal pain is starting to wake me up at night (I intend to avoid taking pain medication for as long as possible), the potential benefit of the procedure seems to me to justify its purportedly minimal risk.

Until forced to make a decision sometime in the near future, I will continue to mull whether the irinotecan/Erbitux regimen would be compatible with my goal of maximizing the quality of my remaining days. Meanwhile, Susan and I will meet tomorrow for the first time with MSKCC's palliative-care specialists.