Mostly Silence…

Mostly silence… the gentle hum of a sound machine drowns out any noise of a not-so sleeping city. The deep, rhythmic breaths of my wife now long asleep. The whimpers, growls and paddling feet of two puppies chasing down their enemy squirrel in playful dreams. Yet here I lay, so desperately wanting to join that other realm, to escape the physical and mental pains of my tormentors hidden deep within, to drift off to another land and let my brain ...

begin its ritualistic waves of healing.

As if self-aware of… the enemy engages in tactical warfare, it uses sleep deprivation to combat my resilience, it will fail. On one of many fronts, malignant cells located in the sternum attempt to escape from their bony confines, expanding in whatever direction gives first. Untouched, their growth finds a way like a sprouting weed through pavement, digging, pushing, and eventually cracking through to the sunlight above. Ironic, like many aspects of this world, one must die for the other to survive. The battle in-between either side succeeding I can assure you is not one of comfort and relaxation.

The adult musculoskeletal system no longer adapts well to forced change. Growth plates long closed leave little room for expansion, swelling bones anger connecting cartilage, ligaments, tendons and muscles. The manubrium bulges, forcing the collar bone into the shoulder blade and the dominos continue to fall. Eventually the pain can be all encompassing. The pain so debilitating that it inspires action through fear. I must act because if don’t I am unsure if I will ever be able to perform that action ever again. So the cycle begins. Continuously forcing oneself to endure extreme pain as some of your lifes favorite, simplistic, little moments hang in the balance: Throwing a tennis ball half the distance I once could for two slack tongued, wiggling tailed behinds as they look up at me with wide eyed anticipation. Fighting off the agony of the invisible knife dug deep within my shoulder blade upon release, and when they dutifully complete their end of the bargain in the game of fetch I without question reward them once again by reaching back and proudly launching another joyful slobber ball wrought with pain sailing through the Boston common air;  Scooping a deep-sleeping bride off the couch, she nuzzles her head into the dip of my shoulder and I marvel, deeply satisfied at how her body molds perfectly to my own. Still half asleep she murmurs loving protests in a language that only dreams may bring, objecting to her ferried ride to the waiting warmth of a turned down bed, yet, I lie soothingly through a clenched jaw and gritted teeth that “the pain doesn’t affect me that way,” and continue to enjoy the moment meandering from one room to the next as slowly as my dwindling structural strength allows. I collapse into bed and start to read because I am exhausted to the point that sleep seems like something I once dreamt about.

The rules have changed… about two years ago, after some exciting published scientific documents and news reports on immunotherapies and their effectiveness against some cancers, I asked my oncologist how colorectal cancers were responding. Specifically, the conversation was about a class of immunotherapies called checkpoint inhibitors, among them were drugs from multiple pharmaceuticals companies but alli variants of Anti-PD-1 and/or Anti-PD-L1. He said something along the lines of  “while some Melanomas and Lung Cancers are responding extremely well, the response rate of colorectal cancers is marginal, around 5-8%. Although, those who are responding are doing so very well. Flash two years later to the current, after 4 years of aggressive cancer treatment and multiple chemotherapy regimens my cancer has grown to resist most standardizes treatments. At the time of diagnosis my cancer was your run of the mill unmutated colorectal adenocarcinoma. As of my last biopsy and genetic snapshot of one liver tumor it was determined that my cancer is now classified in an extremely rare subset of colorectal cancers known as Microsatellite Instability or MSI-H. MSI-H means the cancer is prone to rapid mutation of which I have four known mutation variances: K-ras, APC, EGFR, TP53. Historically, mutated colorectal cancers is a bad thing, they have been more difficult to treat. MSI-H allows the cancer to adapt and resist standard treatments faster and they are often far more aggressive. The MSI-H subset of colorectal cancers makes up about 15% of colorectal cancers and only half of that population for some reason or another ever enter into clinical trials, about 7.5-8%.  Well, remember that marginal response rate of 5-8% of colorectal patients to checkpoint inhibitors, guess what population they are from. There seems to be a very promising correlation between the patients responding and that rare subset of colorectal patients with MSI-H that I just so happen to be in! The data is so strong that some on-going clinical trials that are testing these potentially curative immunotherapy drugs known as checkpoint inhibitors are adding MSI-H cohorts (a group of people) to their studies to further the theory and hopefully bolster their data. In fact, they are creating entirely new clinical trials based on this premise alone!

So let me tell you something cancer, you piece of shit: Today the rules have changed. Today, we no longer fight to slow things down, we no longer try to stabilize or delay. Today, we fight to kill, we fight to win. Today, at 1:00 pm EST I start a clinical trial: A Phase 1b Study of MPDL3280A (an Engineered Anti-PDL1 Antibody) in Combination With Avastin (Bevacizumab), and I will tell you what. I know you’re scared, because as if self-aware of your own demise, like a rat backed into a corner you have been lashing out with everything you have left. I told you, you will fail. One must die for the other to survive, you’ve thrown your cards down on the table and it’s time for you to see mine.  You can rant, rave and scream all you want because after today I expect … Mostly silence.

I Love you All – Teej =P

p.s. as I said from the start #FUCKCANCER