Four new drugs approved for metastatic bladder cancer!

In the past month, the FDA has approved four new immunotherapy drugs for treatment of locally advanced or metastatic bladder cancer. On April 17, FDA granted accelerated approval to Genentech/Roche’s Tecentriq (atezolizumab). On May 1, AstraZeneca’s MedImmune division earned FDA’s approval to Imfinzi (durvalumab). On May 9, FDA approved Bavencio (avelumab), a drug from EMD Serono, a partnership of Merck and Pfizer. And on May 19, FDA approved another Merck drug named Keytruda (pembrolizumab). All 4 drugs are approved for bladder cancer patients who either have failed chemotherapy (second line therapy), or first line therapy for patients who are chemo ineligible, usually due to kidney problems or other co-morbidities.

This is great news. One of the press releases quoted on of my doctors, Andrea Apolo of the NCI, as saying that "until recently, there had been limited innovation in urothelial carcinoma, and this approval gives us another treatment to help battle this aggressive disease." She added: "Once urothelial carcinoma progresses after treatment with chemotherapy, the five-year survival rate is alarmingly low."

At last Friday's Hopkins presentation regarding bladder cancer, the panelists were encouraged by these recent approvals. They noted how studies are ongoing to determine if immunotherapy is more effective than chemotherapy, which would make these drugs a first line therapy for everyone with metastatic bladder cancer. Other trials are evaluating whether immunotherapy might be able to reduce the number of radical cystectomies. Although those results are several years away, the breakthrough of these new therapies is very hopeful.

Other targeted therapies are also being studied. This week a new article was published evaluating a drug that regains control of cell cycle deregulation, which is a key driver of bladder cancer disease progression. The article provides an overview of the current status of those CDK4/6 inhibitors in cancer therapy, their potential use in muscle-invasive bladder cancer, and the challenges for their clinical use.

Big pharma has invested billions of dollars in developing these new drugs, and they are saving lives. Keep it up, people!

My son is thru-hiking the AT in honor of his fallen best friend

Earlier this week our hometown newspaper published an article about my son Spencer who is thru-hiking the 2200 mile Appalachian Trail. Earlier this week I met him on the trail between Roanoke and Lexington Virginia. It was the first time I'd seen him since March 11, when I dropped him off at the southern terminus of the AT in Georgia. He's hiked about 900 miles so far, and plans to finish by mid-August. I am in awe of my son's energy, enthusiasm, dedication, and ongoing efforts to help fight drug addiction.

Following is the text of the article; clink on the link to see the photos.

Great Falls Resident Hiking Appalachian Trail

Spencer Brothers is hiking the thousands of miles of historic trail in honor of his fallen best friend.

By Ashley Simpson

The Appalachian Mountain Scenic Trail (AT), the longest path in the world exclusively for hikers, stretches 2,190 miles across 14 states in the eastern part of the United States – from Georgia up to Maine. Great Falls resident Spencer Brothers is currently hiking the thousands of miles of this historic trail in honor of his fallen best friend, who lost a long, fatal battle with drugs four years ago. As a recovering addict himself, Brothers is in the midst of a challenge that years ago, he never would have imagined himself taking on.

“I started hiking the trail on March 11, so, I’m about a month and a half into it,” Brothers said. “It’s been going great so far. I knew before I started that it would be hard, but it’s even more physically challenging than I ever thought it would be. Nonetheless, I’m really enjoying it.”

It should take Brothers about five and a half months to hike the entire trail. His first time hiking the AT, he planned his maiden voyage in memory of his late friend, Chris Atwood, who died in 2013. As Brothers ploughs ahead, he’s also raising money for The Chris Atwood Foundation, a local organization founded by the Atwood family to provide resources for substance disorders and to combat the stigma surrounding such dependency.

“The biggest source of inspiration for me to take this on is to honor my friend Chris Atwood who died of a heroin overdose four years ago, in February 2014,” Brothers said. “I’ve done some marathons and other races to honor him and to raise money for the charity that his family founded. This is bigger than that. It took a lot more preparation, and a lot more time obviously, being that I’ll be hiking for more than five months. It’s to honor Chris and to raise $21,000 or more for this awesome, important foundation that his family created. I set the goal of $21,000 because Chris lived until the age of 21, so I’m hoping to raise a thousand dollars for every year he was alive.”

Ginny Atwood Lovitt, Executive Director of The Chris Atwood Foundation, said that people like Brothers are the backbone of this organization that her family started.

“Spencer’s bravery and compassion for this cause are unbelievable,” Lovitt said. “Most of the time it just leaves me speechless. The Chris Atwood Foundation is entirely funded by private donors so it's only through the efforts of people like Spencer and our compassionate donors that we are able to do this work. What he is doing is not just helping people that otherwise might die, but it's in a way keeping my brother's memory alive and honoring the lives of all those we have lost to overdose.”

The dollars that Brothers accumulates for The Chris Atwood Foundation are nowhere near the most important outcome of the mission, either.

“Spencer is not just raising much needed funds to help people with addiction, he's showing them just how incredible life can be after addiction,” Atwood said. “He's showing them that day by day and step by step recovery can help you achieve things you never thought you were capable of. It's our hope that Spencer's journey will defeat some of the stigma that people have about addiction and recovery. We want his journey to bring this issue out into the open and show people in our community and beyond that people can be really proud and open about their recovery if they want to and that they can use that to accomplish great things.”

Despite Brothers taking the first step of his Appalachian Trail hike less than 10 days before the official start of spring, he has encountered snowstorms and several instances of hypothermia-inducing temperatures. Through both the expected and unforeseen hardships, Brothers said that he is confident that his resolve to conquer the trail will continue to overpower any notions of quitting – as long as he keeps his focus on the bigger picture.

“Early on, I was just carrying too much for the sheer number of miles that I was doing day in and day out,” Brothers said. “The pack that I carry everywhere started out really heavy. I was wondering if I was cut out for this, if I could actually do this. I was seriously considering giving up, but, I had been planning this for too long and I was doing this for The Chris Atwood Foundation and for people other than myself. In the beginning, leaving the comforts of home was hard to adjust to but then it became the new normal. There’s just no way that I’m going to give up unless I become physically unable to – and that would take something completely out of my control.”

IN ORDER TO STOP BROTHERS, the world would have to present him with something truly catastrophic. He’s already found a way to put one foot in front of the other through physical conditions that many would consider insufferable, including early stages of hypothermia and an injury that has been known to prevent even professional athletes from accomplishing their goals.

“I started out doing some pretty decent mileage,” he said. “Then, within a couple of weeks, I injured myself trying to do more than I was ready for. I strained my IT band, but I took a day of rest and I called my sister who is a physician to get her advice, and I ordered a support wrap. I decreased my mileage for a while to let the band heal. Since I’ve gotten the wrap and I’ve given my leg some time to heal, I now average about 20 miles a day consistently. The longest mile I’ve done is 26 miles, which was just a few days ago.”

Since Brothers struggled with drug dependency early on in his life, he is no stranger to overcoming challenges. In this sense, perhaps this part of his background gives him an edge on the AT.

While many people may find it difficult to be alone, with just the sounds of nature and their thoughts to remind them that they are indeed still alive on Earth, Brothers said he appreciates this component of his extended solo hiking experience.

“I get a lot of time for thinking,” he said. “But, thinking in a wilderness setting allows things to bubble to the surface that I wouldn’t ordinarily think about. There is something really healing about being out in the woods for a long period of time. I’m really growing from this.”

While he spends the majority of his time on the trail alone, he said he does regularly encounter other people.

“I haven’t gone a single day without seeing people yet,” he said. “During the day, since I’m hiking at my own pace, I’ll be alone, but, at the same time, I run into and meet tons of people in spurts, at different points on the trail.”

In fact, during Brothers’ first weekend on the AT, fellow hikers literally helped lighten his load.

“I stayed at a hostel my first weekend on the trail and found people who helped me figure out which gear I could get rid of to lighten my back a little bit,” he said. “My pack started out at 47 pounds, and now it weighs around 35 pounds – or less.”

Although this is Brothers’ first extended hiking endeavor, it is nowhere near his first exposure to survival in the great outdoors. His first steps toward recovery years ago were actually at a program that he went to as a teenager that first exposed him to trekking through the wilderness.

He said his background with addiction, treatment programs – and thus, the woods – is likely the reason the idea of the AT was so intriguing to him.

“I struggled with drug addiction myself as a teenager, along a myriad of other issues like low self-esteem and anger,” Brothers said. “My family sent me to two different treatment programs that did outdoor adventure therapy. While my challenges didn’t end with these wilderness programs, the programs help put me on the road to recovery. My experience with them – exposure to the woods, and hiking and camping for long periods of time – planted the seeds for the inspiration to do a really significant hike like the Appalachian Trail.”

Still, Brothers said the hiking he did through wilderness programs really cannot even compare to what he’s doing now.

“With the wilderness programs I did, we hiked and camped every day, but we averaged more like 6 or 7 miles a day,” he said. “Now, overall, I’m averaging 15 to 20 miles every day. It’s really difficult to stay motivated to keep up with that progress day in and day out, especially with the physical damage that comes with it.”

Now that he’s accustomed to the rigor, Brothers said the majority of his every day really is hiking. Other than willing himself to push onward through varying elevations and, oftentimes fickle weather, he spends the remainder of each day preparing basic meals, and then sleeping as much as possible to recharge for the following day. There are designated campsites, hostels and other shelters along the way specifically intended for AT hikers.

He added that he typically resupplies at grocery stores in towns surrounding the AT. He’ll either get to the towns by getting off the trail and walking an extra mile or two, taking a shuttle, or he will hitchhike. Recently, he actually accepted a ride into a Southern Virginia town from a woman who happened to be a fellow Great Falls native.

LATER THIS MONTH, Brothers will reach a point close enough to home so that his parents can pick him up and usher him back to their house so that he can enjoy the comforts of home for a few days. Really, though, Brothers has planned this respite from the trail is so that he can submit graduate school applications. And, when he gets back on the trail, his girlfriend will join him for the remainder of the hike, which will make his hike even more meaningful, and even symbolic.

“I’m so excited to have her on this journey with me,” he said. “It’s actually been her dream to hike the AT since before I met her, so it’s wonderfully serendipitous that our journeys and dreams literally walk alongside each other.”

In the meantime, Brothers said he’s learning a lot about himself, and about life, as he treks onward on his own.

“I definitely am learning patience on the trail,” he said. “I’m also learning to trust myself. I see so many different hikers approaching the trail and pacing themselves in different ways. You have to learn to be confident in following through with a plan that is best for you. Also, if I didn’t know it before, I certainly know now that nothing worth doing is easy. Looking back on this experience, when it’s all done, I’m going to be glad that it was hard. It’ll make future struggles seem more surmountable.”

As of now, Brothers has raised about a third of his $21,000 goal for The Chris Atwood Foundation. A few people have pledged a dollar for every mile he completes, including Chris Atwood’s father.

Brothers is hoping for more donations – both big and small – as he puts himself closer to his finish line at Maine’s Mount Katahdin. Even though he has limited access to the World Wide Web and all of its convenient means for the mass communication of information on his mission, he’s still spreading the word.

“At every shelter, there is a log book for AT hikers to sign and to look at the words of hikers that reached that point before them. I’ve been writing the fundraising information in there. Hopefully it will resonate with people, and they will pass it on.”

TO DONATE to Spencer Brothers and The Chris Atwood Foundation, visit www.crowdrise.com/blazing-the-trail-to-recovery.

To read updates to his journey, visit his blog at https://spencersatblog.wordpress.com.

CR 675: BCAN Walk and a Hopkins Bladder Cancer Workshop on May 19

Last Saturday was the Washington DC annual BCAN walk for bladder cancer awareness. It’s one of BCAN’s primary fundraisers. Participants are asked to form teams with contributions going to fund bladder cancer research. (If you want to donate to my team, there’s still time. I’m looking at you, extended family members!) The participants gathered at the Jefferson Memorial and walked around the Tidal Basin.

It was good to see Dr. Andrea Apolo, who heads NIH’s bladder cancer work; Dr. David McConkey, head of Hopkins' Greenberg Bladder Cancer Institute, LizRaymond, Hopkins’ Senior Associate Director of Development, Diane Zipursky Quale, co-founder of BCAN, my family and friends, as well as hundreds of other people from the DC area who were walking to raise awareness and funds. 

It’s still amazing to me that the fifth most common cancer in the US still has such a low profile, both in public awareness (who has heard of bladder cancer unless a family member or close friend is diagnosed?) and funding (20^th). BCAN has awarded more than $4 million in grants to researchers devoted to advancing the fight against this pernicious disease, but so much more is needed. C’mon, if you haven’t donated a few bucks, hit this link and do it now. Please.

Speaking of leading the fight against bladder cancer, on Friday May 19 from 12-1:30 pm, the Johns Hopkins Greenberg Bladder Cancer Institute is sponsoring a program regarding promising updates in bladder cancer treatment for patients and caregivers. Several Hopkins faculty members (including Drs. Noah Hahn and Trinity Bivalaqua, who have treated me) will discuss the cutting edge of bladder cancer therapies, and David McConkey will be discussing how the Institute is changing how bladder cancer is treated. I’ll also be on the panel to provide a patient point of view. The speakers will take questions both during their talks as well as a general Q&A at the end. Feel free to attend – just make sure you RSVP by May 12 so enough rubber chickens are ordered!

CR 658: Another good CT scan

Last week I had another CT scan and Hopkins visit. Ever since I was diagnosed in late 2011, I’ve had CT scans every three months (and sometimes more often). When I scheduled the scan for 8:30 am, I forgot that Kaiser wanted me to drink one bottle of barium contrast 4 hours in advance, and another 2 hours in advance. So I set alarm for 4:30 am, stumbled downstairs and chugged a radioactive banana smoothie. I couldn’t get back to sleep, so I climbed into the hot tub and watched the sky grow lighter with the sunrise. I was struck with a sense of gratitude for the day, and gave thanks to God for being alive.

The scan was routine – no blown veins or exploding connections – and I following the advice of the tech to drink lots of fluids to wash out the contrast, I went to McDonalds for breakfast and 4 liters of Diet Coke. In the afternoon, an oncologist nurse called to tell me that the scan showed no changes from my last scan in January, and no evidence of metastatic activity. Another prayer of thanks.

Early in my cancer journey, I found myself thinking more about a scan in the couple of weeks before it happened. Some patients get so worked up about scans that they have a hard time thinking of anything else. “Scanxiety” is a real thing. I learned to get over it by accepting that I had no control over the course of my cancer, and putting my trust in God. It also helped to realize that scans are imprecise and retrospective: to the extent that they show anything, it’s what has already happened in your body. Getting worried about what’s already happened is silly.

These days, I go into my scans with zero expectations. I have no idea if it will show that my cancer is inert, or growing, or doing the polka. There is no data that I can reference to develop a set of expectations of how long (or short) my current remission will last. In the absence of data, I refuse to speculate, so I mostly don’t think about it. In that sense, my cancer journey currently is an abstraction; a thought exercise. At some point in the future, it is almost certain to smash back into the forefront, grab me by the throat and shake me around. When that time comes, there likely will be nothing I can do about it. But until then, I’m living my life as best I can, grateful for each day.

On Thursday, I went up to Hopkins to check in with Dr. Hahn. I brought a copy of my scans, and we looked at them together. The supraclavicular node where my distant mets first showed up was visible on the scan, but inert. Dr. Hahn said that the scan seemed to slice through it just right to make it show up on the screen, but there was nothing going on with it that he could see. The sites of all of my other tumors were normal.

I asked whether there was any new data on durability. He said that aside from the Bristol Myers release that accompanied the formal approval of Opdivo for metastatic bladder cancer in February (which I had previously blogged about), nothing else had been published in the past 3 months. Bristol Myers continues to follow patients who have had partial or complete responses and stop taking the drug. The company will typically release additional data in conjunction with meetings of oncologists in the US or Europe, such as the Spring ASCO meeting in late May. I’ll be watching for those data, since I’ll be included in the data set. 

I told Dr. Hahn how I still had occasional itching to the scalp, and sometimes around the neck and backs of my calves. I knew that itching was a sign of dermal toxicity, a known side effect of Opdivo in some patients. I asked what the data showed for how long that lasted after patients stopped taking the drug. Dr. Hahn replied that the data was sketchy and incomplete. Some patients saw the itching resolve soon after stopping the drug. Others had it last longer. In a few patients, it had yet to resolve, suggesting that it might be permanent. In my case, it’s very minor – grade 1 at most – and it comes and goes. Sometimes I’ll find myself absently scratching my head or neck. When I get into the hot tub, sometimes the backs of my lower legs sometimes itch. And my forehead and cheeks sometimes show a mild rash. Dr. Hahn suggested that if I find the itching to be problematic, I should consult a dermatologist for a topical cream. Alternatively, I might try Benadryl or Claritin. I’ll monitor it and see how it goes.

After meeting with Dr. Hahn, I chatted with Liz Raymond, a Hopkins employee who is helping launch the Greenberg Bladder Cancer Institute. She invited me to a luncheon at Hopkins on Friday May 19 where Dr. Hahn, Dr. Bivilaqua, Dr. McConkey, and others will be talking about new developments in bladder cancer treatment and the GBCI. Liz said that I might be asked to take a few minutes and share some of my experiences. If you’re in the area and interested, come on by.

Join me for the 2017 BCAN Walk: May 6, 2017

The 2017 fundraising walk sponsored by the Bladder Cancer Awareness Network is on Saturday, May 6, at 9 am, starting at the Jefferson Memorial. Here is a link to the Team KBros fundraising page. Please make a donation and, if you are in the DC area, consider joining me and my family and friends for the walk. See you there!

A history of our home

Early in my cancer journey, Jennifer and I had seriously considered downsizing, bluntly asking ourselves whether it would be better to get that done before my likely death in a few months or maybe a year or two. We decided to stay put, minimizing the disruption to our family and focusing on spending time with each other.

In the past year, we tentatively reconciled ourselves to the unexpected fact that I am in an immunotherapy-induced remission. With no scientific basis to know or even guess how long this remission might last, we've continued to focus on our family. Last summer Garrett graduated from high school, then accepted a two-year missionary commitment from our church. After that is done, he'll likely attend Brigham Young University. In December, Spencer graduated from George Mason University with a multidisciplinary degree in biology, psychology, and social work. While he considers his options for further studies, in early March he set out to thru-hike all 2200 miles of the Appalachian Trail. This May, Kirsten will graduate from Mason with a degree in Social Work, and has committed to attend the Masters of Social Work program at the University of Denver. And Chelsea has accepted an offer to join the staff of McKay Dee Hospital in Ogden, Utah.

Now that our nest is empty, we have returned to the idea of downsizing. Our family home now is too large for our needs. The center of gravity of our children (and grandchildren) is in the West. There is no economic need for us to stay in the DC area. Taxes continue to rise, traffic continues to get worse, and we're growing weary of maintaining such a large place. After our return from our recent trip to Machu Picchu and the Galapagos, we decided to begin preparing our family home to be put on the market.

Last week, our house was listed in the MLS. More photos and a video is located here. As we have cleaned and cleared out house, I have reflected on our history in our family home. In 1997, after I was made a partner at my law firm and had a bit more job security, Jennifer and I considered whether we should build our dream house. We decided to do so, and spent more than a year looking for a lot that met our criteria: two or more acres bordering parkland or protected area, sloping down to a stream, not on a busy road, less than 30 minutes from downtown DC, in a good school district, and in our price range. Finding nothing in Montgomery County Maryland where we then lived, we crossed the Potomac and looked for land in the Old Dominion.

Eventually, we found Lot 11A of the Offutt Home Tract. We learned that it shares in the story of the colonization of northern Virginia. In 1608, Captain John Smith of Jamestown explored the Potomac River to Little Falls above the mouth of Pimmit Run. By the end of the 1600s, a few English settlers had ventured into what is current-day Great Falls and made land claims, even though it was then was considered the hostile frontier due to raids from the Iroquois. In 1722, Spottiswood’s Treaty in Albany caused the Iroquois to withdraw beyond the Blue Ridge, and lands adjacent to the upper Potomac above Little Falls were open for settlement and immigration.  By then, the English Crown had issued large grants of thousands of acres along the Upper Potomac between Great and Little Falls.

The land on which our home sits was surveyed in 1730 for Lewis Ellzey, Fairfax County’s first Sherriff, a Captain in the Virginia Militia, a county justice, and church vestryman. That survey covered a 544-acre tract in Great Falls on the north side of Difficult Run near the first large branch. Ellzey acquired the parcel for investment; the only house that was shown on the 1730 plat was a residence built by a planter named Thomas Simmons that eventually became known as “Four Stairs”, and still stands at 840 Leigh Mill Road. In 1742 Ellzey deeded the lower 300 acres of his grant to Simmons. Simmons cleared the land around Captain Hickory Run and built a grist mill near the confluence with Difficult Run. The foundations of the mill are visible below the house at 991 Millwood Lane. The remains of the mill race can be seen around Captain Hickory Run, including at the bottom of our property.

Simmons worked the land until around the time of the American Revolution. The tract changed hands several times until it was purchased by Captain John Jackson in 1796. Captain Jackson was a Revolutionary War militia leader, and held a lifetime appointment as a Fairfax County Justice of the Peace. The Jacksons renovated and added to Four Stairs, and the 300 acres eventually was subdivided between the Jackson descendants. One of Jackson’s granddaughters married Joshua Offutt, and eventually their portion of the land became the Offutt Home Tract. One of Offutt’s descendants was Judge Oliver Gasch, who owned Lot 11A, which is 4.6 acres at the end of a private road backing to a Virginia Resource Protected Area. Judge Gasch was born in 1906, and served as a federal judge in the District of Columbia for more than 30 years. He sold lot 11A to Jennifer and me in February 1999, just a few months before he passed away.

We designed our family home with respect for the history of the area. Taking the lay of the land into account, I prepared the floor plans and elevations using a computer assisted design program. Once we were satisfied with our plans, we commissioned Woodhouse Post & Beam in Mansfield Pennsylvania to create a timber frame structure, using native Eastern White Pine. Woodhouse's crew assembled the frame using historic post and beam, mortise and tenon construction, with oak connecting pegs. No nails were used in building the frame. The wood was “green” when built, and the slight shrinkage during the drying process causes the frame to be tight, while developing natural “checking” in in the timbers. Woodhouse enclosed the frame in SIPs - Structural Insulated Panels - on all exterior walls and ceilings. 

Jennifer selected all of the interior finishings and paint colors. Our family home has 7 bedrooms, 5 full baths and two half baths, and nearly 9000 square feet. It has a large covered front porch and rear deck. We added a large in-ground heated swimming pool with built-in spa, screened post and beam gazebo, large patio and fire pit. The exterior features local stone and durable concrete fiber James Hardie shingle siding. We included hot water radiant heat in all three floors, using concrete as a thermal mass to hold and distribute the heat. Six different zones ensure that the warmth slowly rises from the floors in desired locations. We have a private spa located adjacent to master bedroom that we use daily. The four kids bedroom each have large lofts. The fully finished basement has a second master suite, full kitchen, as well as a rec room, art studio/craft room, and work shop. We recently replaced both HVAC systems, the dishwashers, and had the entire house repainted. According to our agent, it shows like a model home. 

The most time consuming task was sorting and purging our stuff. We have not had a long distance move in nearly 30 years, and inertia is a powerful force when if comes to stuff. We found that I am far less sentimental about stuff than Jennifer. If something has no current use and I am unlikely to use it in the future, then I'm happy to get rid of it. Jennifer imbues objects with sentimental value, and found it harder to separate the emotions from the object. We ended up selling (on Craigslist), giving away (to friends and church members), or donating lots of stuff to charities. The pictures show a minimal amount of furnishings that we kept for showing. Jennifer applied her artistic eye to stage the house, getting a couple of bedspreads and throw pillows for splashes of colors.

We now have the joy of keeping our home as immaculate as possible until a buyer is found. I don't like fearing my own house, not able to use the towels or leave my clothes on the floor or the bed unmade. I'm glad I'm still alive to suffer through this.

CR 589: Opdivo approved for mets BC

Today Bristol-Myers Squibb issued a press release announcing that Opdivo (nivolumab) has been approved by the FDA for patients with metastatic bladder cancer who have had their cancer progress after having chemotherapy. I was in the clinical trial that accrued data that led to this approval. I'm glad to hear that Opdivo is now available to mets BC patients in the clinical setting and outside of clinical trials. I hope that others have as good a response and I did.

Speaking of which, the data reveal just how fortunate I am to have had a complete response. Bristol Myers reported a 20% response rate, meaning that 1 out of 5 patients who had post-chemo stage 4 tumor growth not only had the growth stop, but reversed. Of the 270 mets BC patients enrolled in the clinical trial, 53 had clinically significant tumor shrinkage. But only 7 of the 270 had a complete response. I'm one of those seven. I am humbled and feel most fortunate. I am grateful to all the scientists and health care professionals that contributed to the development of this immunotherapy.

Unlike other drug makers who are developing checkpoint inhibitors, Bristol Myers did not limit participation in the clinical trial to those patients who showed high levels of PD-L1. Patients who had more than 1% of PD-L1 markers had a 10% better chance of having an overall response, but because PD-L1 can come and go, 15% of patients who did not test positive for PD-L1 still had an overall response.

A 20% overall response rate may seem low. But every one of those 270 patients was headed for almost certain death with active growth of metastatic tumors. I know that was the case with me. So managing to reverse the cancer in 20% of people who otherwise were on death's door is a pretty good result. The press release quotes Dr. Jonathan E. Rosenberg, MD, Memorial Sloan Kettering Cancer Center: “As an oncologist, a nearly twenty-percent response rate in advanced and metastatic bladder cancer is extremely encouraging and clinically meaningful in this patient population.” For me, it's very meaningful.

For those like me who have responded, the next question is how long the remission will last. "Among responders, the median duration of response was 10.3 months (range: 1.9⁺-12.0⁺ months)" says Bristol Myers. I'm not too worried about the median of 10.3 months, because I understand that was (and still is) an artificially shortened amount of time. Bristol Myers collected the data used for this approval in late 2015, which was about six months into my complete response. I'm now in the "12+ month" category, and the data set continues to expand for the durability data. But I also recognize that I am the data. Others will look to my experience (and many others) to help gauge how long the effect of Opdivo can last. For me, every day is a blessing.

This month, one of my term life insurance policies (a 15 year term for $500,000 in coverage) expires. I bought it back in 2002, along with a 20 year term policy and a couple of whole life policies that I was required to take by my law firm. I have the option of converting the expiring policy into a 15 year Universal Life policy with no medical underwriting, but with an annual policy cost jumping from $800 to $6200. If I was to live to age 69, my total cost for this policy would be $93,000, which is crazy expensive. But I'm thinking that it's probably a good idea to pay the $6200 a year, since the odds of my living for another 15 years are unlikely. But what do I know? When my cancer went metastatic five years ago, the odds of my surviving 5 years was less than 10%. And I'm still kicking!