Six of one, half a dozen of the other

Whew! Dave here. What a long trip...we hit all the popular hotspots in the Pacific Northwest on this trip; Portland, Seattle, Enumclaw...

We got into Portland on Wednesday evening, got a CT scan, then went out for Indian food with Cheryl's friends, Blair and Noel - very tasty! You just can't get good ethnic cuisine up here. Hell, a bratwurst is considered ethnic in this neck of the woods, but that's beside the point. I waaay overate, and felt like a python that had swallowed a goat and needed to go digest under a tree for a week or so.

Sadly, Cheryl ended up puking around midnight, which has been a common occurrence lately, so we weren't surprised when Dr. Crocenzi informed us that the tumors had grown a bit, so no more Plan C. Phooey. We weren't terribly upset about this, as being a double-blind study, we had no clue that we were getting the good stuff or the placebo.

However, the following news was somewhat better. While Cheryl got an IV of fluids and a little anti-nauseals, Chris Fountain came by with the paperwork for Plan D, an anti-CTLA4 drug called ipilumimab (say that five times fast and it sounds like you're calling the legal offices of Bob Loblaw).

So what's this drug do? As mentioned previously, melanomas are something the immune system should recognize and destroy, but doesn't. This is partly because melanomas have a "shield" of an animo acid (CTLA-4, duh), which blocks the killer T-cells. Basically, the T-cells come up to the melanoma cells, John Cleese pops out and taunts them, and the T-cells go away to plot some other way to get into the castle.

Ipilumimab, according to this study, will strip the CTLA-4 shield from the melanoma cells, enabling the T-cells to sneak inside the cells using a giant rabbit...or maybe a badger.

However, since CTLA-4 protects many other things in the body from indiscriminate immune responses, there's a possibility of many other autoimmune side effects, similar to what happened when Cheryl underwent IL-2 therapy, most commonly a nasty skin rash.

But it gets more interesting! The paperwork we had says that, on average, about 10-15% of all patients see some kind of response - about the same as IL-2. However, Chris told us that 20 people have undergone ipilumimab therapy at the Oregon Clinic so far, and 16 of them have been in the program long enough to undergo further CT scans. Of those 16 people, a whopping 14 have seen some kind of response, varying from no further growth to, in at least one case, complete remission. Apparently, if you have seen some kind of response in IL-2 therapy (which we have), the odds are much greater that you will see a response in ipilumimab therapy.

And, this isn't chemo, so there'll be no nasty chemotherapy side effects, and it's only one treatment every three weeks, not three weeks/one off.

So Plan D sounds like a winner in our book (which is good, as we're not sure what Plan E might be as yet).

Heartened by the possible good news, we ventured up to Seattle to visit my friend Scott Rudi and catch a Mariners game, which was sadly unexciting save for a unexpected bench-clearing brawl (but, I mean, Sexson is all of six feet thirteen, and you throw a helmet? Come on!), topped by a fantasy-league-killing performance by Felix Hernandez. Thanks for nothing, Felix.

(Cheryl here)... Just wanted to report that we stopped by to see our friend Vanessa at her parents home outside of Enumclaw. Three weeks out from major brain surgery, and she is walking, talking, and overall doing really well. So well, that she and I are going to plan a trip to New Mexico in the fall, baring health ickies. Whoopee! Balloon Fiesta, here we come!