It's been beneficial that we went to MD Anderson back in July. It's allowed us to coordinate with them quickly regarding the new findings. One thing they stated is that the mere fact that the cancer has spread with bone "mets" (metastases) doesn't necessarily imply anything about how fast (or slow) the cancer is progressing. The spots that we're seeing on the scans almost certainly were "seeded" long before Lisa was diagnosed nine months ago and were just too small to detect definitively until recently. MDACC has seen the MRI report, though not the images yet, but based on what they know, their initial recommendations include:
1) See an orthopedic surgeon to evaluate if right femur-to-hip needs stabilization (potentially a rod insert or hip replacement).
2) See the radiation oncologist to get radiation to the spots of disease on bone to help slow progression of disease and help with pain.
3) Get an injection-infusion (15 minutes) of the osteoporosis drug Zometa that is also useful in rebuilding and strengthening bone compromised by cancer. Zometa is given every 4-6 weeks after radiation, and can be given concurrent with chemo. Continue to take Zometa until bone shows signs of healing on scans.
4) Two to three weeks after finishing radiation, recommend chemo combination of Carboplatin and ALIMTA, two treatments three to four weeks apart, then rescan to see if it's working. Typical side effects are fatigue, decreased blood counts. PET/CT would be best type of followup scan since we also need to monitor the chest in addition to bones; PET/CT can be done after every two cycles of chemo.
5) If it appears to be working, continue on Carboplatin and ALIMTA via IV every three to four weeks.
We will meet with the new local medical oncologist on Monday afternoon at 4pm, and we'll talk with him about MDACC's Zometa, Carboplatin and ALIMTA recommendations. For #1 above, we have a referral/consult with an orthopedic doctor on Thursday (there is probably no urgency to do this at this time based on the radiation oncologist's review of the actual MRI and CT images, but he wants us to play it safe before he starts radiation in #2 above).
