Dr. Glare volunteered to talk about my life expectancy. Previously, I have had to rely on the literature and conversations with non-MSKCC scientists to estimate how long I may have to live. According to Dr. Glare, if I wanted to enroll in hospice at this time, I would qualify. In other words, in the absence of more chemotherapy, it would be reasonable to assume that I would die within the next six months. Most of the colon-cancer patients sent to Dr. Glare die within two to 12 months-- including patients who continue chemotherapy and those who do not-- with a few outliers dying within two months or after 12 months.
From Dr. Glare's specific examination of me and my records, his guess is that if I were to forego additional chemotherapy, I would probably make it through this summer and die this fall. If I were to undergo additional chemotherapy, and it were to prove efficacious, I would probably die later, but probably still within 12 months. He noted that third- and fourth-line therapies tend to be less efficacious than first- and second-line therapies. (In my case, the first-line therapy, FOLFIRI, was moderately efficacious; the second-line therapy, FOLFOX, was not at all efficacious.)
I am still studying the probable and possible side effects of embarking on the irinotecan/Erbitux chemotherapy and trying to decide if a six-month course of it, followed by a recovery period of a month or so, would make sense for me, given my values and expected longevity. Here are some excerpts from Erbitux's package literature per se (irinotecan causes its own adverse reactions): "The most common adverse reactions with Erbitux (incidence > 25%) are cutaneous adverse reactions (including rash, pruritus, and nail changes), headache, diarrhea, and infection. The most serious adverse reactions with Erbitux are infusion reactions, cardiopulmonary arrest, dermatologic toxicity and radiation dermatitis, sepsis, renal failure, interstitial lung disease, and pulmonary embolus.... As with all therapeutic proteins, there is potential for immunogenicity."
Dr.Saltz told me that when Erbitux is efficacious, patients always get a rash, and that patients for whom Erbitux is not efficacious may get the same rash. This rash looks like acne, may itch, and may extend from head to toe. While this rash is present, the skin has to be kept covered in ointments and cannot be exposed directly to sunlight. When Erbitux is discontinued, this rash usually, but not always, disappears, typically within a month.
Dr. Glare noticed that Susan was carrying a cloth bag from Coolmore Stud in Australia. He is Australian and said that he has kept his membership in the Australian Jockey Club. He asked if we have horses. I replied that we do and in fact had a runner, Hot Money, entered at Belmont Park for the next day. He asked if I fancied Hot Money's chances. I said that I did, but only at high enough odds to compensate for the risk that his disappointing previous race indicated some undetected problem.
In Hot Money's race today, he was bet down to 5-1 odds. He ran well, closing fast at the end to gain third place. Before placing any bet, one should always weigh the odds.
