The meeting with the medical oncologist late yesterday wasn't as potentially uplifting. In a nutshell, he said that Lisa's cancer is now classed as Stage 3b T4N2M0 (it had been staged as 3a T2N2M0 when first diagnosed), and with any live cancer showing at this time and surgery not being an option, "your cancer isn't curable" and we need to "move to a maintenance type of treatment." He did clarify that's the textbook talking, and that there are always exceptions. Further, there are patients who have been living with a maintenance type of therapy for years.
For now, he suggests taking a month off and doing nothing medically and recover from all of the aggressive chemo and radiation that Lisa has had along with the recent biopsy surgery. He's not particularly keen on Lisa going to MD Anderson in Houston, because he doesn't think they're geared for giving advice on radiation and primary treatments, but are instead focused on experimental trials and research. He's going to discuss this with Dr. Childs, but the decision to coordinate with the MD Anderson group will ultimately be ours, if they agree to review the case.
There are two types of first-line maintenance medication the medical oncologist would consider. The first is ALIMTA, an infusion type chemo. The second, Tarceva, is a pill-type drug that would only be used if Lisa's tumor biopsies test positive for what's called EGFR mutation. EGFR is a protein called the Epidermal Growth Factor Receptor. EGFR, which helps cells to divide, is found at abnormally high levels on the surface of many types of cancer cells, including many cases of non-small cell lung cancer. Based on studies in 2004 and later, Tarceva interferes with certain EGFR mutations and keeps tumors from growing. A portion of Lisa's biopsied tumor is being sent off for the EGFR test, and results should be known in two or three weeks.
The radiation oncologist suggested that we do a PET scan in 90 days from when the biopsy surgery was done. The medical oncologist said he'd like to see one sooner, though waiting longer would certainly make the results more definitive.
We'll be hashing this all out over the next week or two... or longer.
