Mets Day 1007: Nothing unexpected from last week's scans

Dr. Apolo and I had been trading calls since last Friday. Today she got hold of me to pass along the highlights from last week's scans. It's the classic good news/bad news that is consistent with the story line for the past six months:

• The size of the metastatic lymph nodes under my left clavicle have continued to slowly increase in size. They have now passed the threshold of 1.5 cm in the short axis, which means that I now am eligible to participate in NIH's clinical trials. More on that later. 
• The scans showed that there were some slightly enlarged nodes in my abdomen. Those nodes are not pathologically significant, which means that they are under 1.0 cm in size. Those nodes were also noted in the last couple of scans. We don't now if they are growing because of metastatic activity or some other reason, since they did not show up as "hot" in my last PET scan in September 2014. But it's more likely than not that the growth is related to metastatic activity.
• There was no evidence of tumors in my liver, lungs, bones, or any other organs.
• The CT urogram showed no evidence of kidney cancer.
• The pulmonary embolisms and clots in my main hepatic portal have been completely resolved.

There is nothing unexpected from these results. I've known since September that my superclavicular nodes have metastatic activity. Each scan since then has shown a slow increase in size, of about 1 mm per month. In November 2014, the node was measured to be 1.42 cm on the short axis. Now it's over 1.5 cm. No surprise there. The good news is the absence of tumors elsewhere, as well as ruling out that the recent blood in my urine was due to kidney cancer.

Dr. Apolo said that, now that my nodes were of sufficient size to enter clinical trials, we should consider whether I should enter a trial, and if so, which one. NIH is currently running five clinical trials for patients with stage 4 bladder cancer. One is a Phase I trial of an AdHER2 vaccination. This is the clinical trial that I was being evaluated for in October when my PE was discovered. Another is a Phase II study of cabozantinib, a new chemical entity that inhibits multiple receptor tyrosine kinases with growth-promoting and angiogenic properties. The primary targets of cabozantinib are MET, VEGFR2, and RET. Dr. Apolo is the principal investigator of this trial, so I think she has a bias towards having me participate in it.

In addition, there are also clinical trials outside of NIH that I could consider. The most compelling choice is a Hoffman-Laroche sponsored study of MPDL3280a.  I've previously blogged about this drug; initial results have shown great promise, helping slow or stop tumor growth in 50% of patients. The drug was designated a "breakthrough therapy" by the FDA last summer. I'll be meeting with Dr. Apolo on Tuesday after my cytoscopy, and will be questioning her in detail about my clinical trial options.