“We Beat You Up Pretty Good”

Chemo is done. 

Chemo is done. 

Chemo is done.

We (family team) have pushed hard for a fast CAT scan & team-read of the films. The  intention is that the immunologic treatment would begin the same day as the CAT scan reading. The caveat is that the scans must show no spread of disease anywhere. If there is any evidence to the contrary, we pivot. 

Dr. Radiology is very precise: in the Pacific study, patients who started immunology within two weeks of radiation ending showed benefits. Dr. Oncology takes a more nuanced approach. Remember how I was trying to decide about being part of a clinical study before treatment began, and one of the reasons I opted not to enroll was because of time lags? Dr. Oncology reads the ideal timeline derived from the Pacific study, which has set new standard of care I am receiving, with this fluidity in mind. 

Some of the standards of the Pacific study were created after the study was rolling along. This is legit, as long as you account for it in your data analysis. For example, originally, the enrollment period for the Pacific Study was 40 days, then it was extended. So a person could have ended radiation, enrolled after that, and had a lag while all the enrollment labs and tests were completed, which would have created a gap between immunology and radiation longer than the-supposedly-ideal Pacific Study set of protocols for the new treatment standard. 

There were also other factors in individual study participants that make a timeline less definitive. As a result, Dr. Oncology reads the optimal timeline as 2-3 weeks, give or take a bit. Dr. Radiology has said that she is going to “talk with Evelyn [Dr. Oncology]” and press to have it the start date for immunology be as close to two weeks from tomorrow, the LAST DAY OF RADIATION, as possible.  

“We beat you up pretty good; we need to give your body some time to bounce back,” she said. I appreciate her gentle perspective; it’s a good balance to my terrier of a radiologist, who seems to grab hold of data and shake it until the facts we need fall out for perusal. 

Please note: Dr. Radiology has revealed a lovely snarky streak that makes me want to be a fly on the wall (or email chain) for her exchange with “Evelyn.” We were talking about Covid and vaccines and different people’s reactions to them. Her daughter had received a second dose, as had the daughter’s boyfriend. Boyfriend wanted to come over to hang out, but his mother was all NONONONO he’d just had a second Moderna dose and young people were known to be susceptible to more extreme reactions. So, “of course he wasn’t allowed to come over.” Dr. Radiology said, rolling her eyes behind her masks and face protector, “Of course he couldn’t come,” she repeated, “not to a doctor’s house, two blocks from the hospital. Makes perfect sense.” Needless to say, her daughter announced this was not a perspective that would be shared with Boyfriend nor his mother. 

Remember how Dr. Radiology said the radiation effects will be continuing two weeks after treatment 

Here’s something to aim for.

ended? She reminded me that it will be as though I am still being dosed. So I will feel progressively worse. Then, in about two weeks, I will start to feel less awful. About two weeks after that, I’ll start to feel better. Then we will be watching like hawks for any side effects for the Durvalumab that would preclude continuing the full course of treatment. 

Dr. Oncology reassured me that not everyone has the full regimen– 2x per month for 12 months– and even six months brings a good benefit. The big side effect is not nausea or vomiting, thank God. But a form of lung inflammation called pneumonitis is a “rare but serious complication…triggered by an autoimmune reaction where the immune system goes after normal cells in the body. This can happen at any time while taking, and/or stopping Durvalumab.”

10-29% of patients experience muscle and/or bone pain (she underlined bone pain), constipation, decreased appetite, rash (she circled this one), nausea, swelling, urinary tract infections, abdominal pain, fever, colitis, diarrhea, decreased sodium level, decreased white blood cells. 

Greater than 30% of patients experience fatigue and infection.