Mets Day 525: I've decided to have ddMVAC chemo

For the past ten days I've collected a lot of information about the treatment options for my spreading cancer.  I've spoken with three different oncologists about whether I should have salvage chemotherapy, and they have in turn consulted with four other doctors.  Yesterday Dr. Apolo said that she had consulted with two additional doctors, who agreed that ddMVAC was appropriate, so the final tally is 5 doctors support dose dense MVAC, and two advise against it.  In addition, I have extensively discussed whether to proceed with Jennifer and Chelsea.  I have prayed for guidance in, or at least comfort with, my decision.  Yesterday afternoon I decided to go forward with ddMVAC.

The things that swung my decision to go forward with treatment were as follows:  First, I trust the judgment of Drs. Apolo and Aragon-Ching.  Although I also trust the judgment of Drs. Plimack and Steinberg, who were advising against treatment, I was ultimately persuaded by review of the literature, and as a result of my phone conference with Dr. Apolo yesterday. 

Second, the fact that Dr. Apolo said that she had examined the cancer cells take from me during the biopsy a couple of weeks ago, and concluded that my metastatic cancer was undifferentiated and more aggressive, caused me discount the hope expressed by Dr. Plimack that my cancer might move slowly through my body.  It appears to be the type of cancer that, if unchecked, will move quickly through my body.  Doing nothing likely would ensure that I would form secondary tumors in a few months.

Third, Drs. Apolo and Aragon-Ching strongly believe that they can manage ddMVAC without the toxicities that were common 10 years ago, when 70% of patients ended up being hospitalized during chemo.  Dr. Apolo said how she had been treating a number of patients who continued to work, or garden, or otherwise keep ambulatory. This helped persuade me that the three months of chemo probably would not be lost months, but that I would be able to keep a relatively normal schedule. Whiel I don't expect the ddMVAC to be a cakewalk, I'm persuaded that I should be able to avoid hospitalization as a result of the chemo. 

Fourth, the upside of ddMVAC outweighs the downsides.  The average time for progression to full-blown tumors with no treatment is 4-5 months.  With ddMVAC, it's over 9 months, and 35% hit the two-year mark.  While there will be no way to prove whether ddMVAC bought more time, should that occur, it likely won't cause long-term damage, especially since I'm relatively young and otherwise healthy.

I've let Drs. Aragon-Ching and Apolo know of my decision.  Dr. Aragon-Ching has obtained the approval of my insurance company to proceed.  I'll have a baseline CT scan through NIH on Monday afternoon, since the insurance company balked at approving that.  I am scheduled to have my first dose (the "M") starting on Wednesday, September 25.  On Thursday, Sept. 26, I'll have the "VAC" doses.  On Friday, Sept. 27, I'll have the Neulasta growth hormone booster shot.  Then I'll repeat the cycle for six times, or until I have too many side effects (most likely mouth sores that prevent me from swallowing).  After I end the cycle, I'll have another CT scan to see what changes there are from my baseline CT scan.

For now, I feel as I am headed back into the toxic mire, poisoning myself to save myself.  To (mis)quote young Henry:

Once more unto the breach, dear friends, once more;
Or close the cells up, make our cancer dead!
In peace, there ’s nothing so becomes a man,
As modest stillness and humility:
But when the blast of chemo blows in our ears,
Then imitate the action of the tiger;
Stiffen the sinews, summon up the blood
Disguise fair nature with hard-favour'd rage;
Then lend the eye a terrible aspect;
Let pry through the portage of the head
Like a brass cannon; let the brow o'erwhelm it
As fearfully as doth a galled rock
O'erhang and jutty his confounded base
Swill'd with the wild and wasteful ocean
Now set the teeth and stretch the nostril wide
Hold hard the breath and bend up every spirit
To his full height.