Mets Day 1040: I'm in the nivolumab-only cohort

I received an email from the clinical trial nurse at Johns Hopkins, advising me that, for the clinical trial in which I am enrolled (A Phase 1/2, Open-label Study of Nivolumab Monotherapy or Nivolumab Combined With Ipilimumab in Subjects With Advanced or Metastatic Solid Tumors), I have been randomized into Arm N. This means that I will only receive the Nivolumab (Opdivo) anti-PD-1 drug, and will not get ipilimumab. The infusions will be every other week. I will get 3mg of nivolumab per kilogram of my body weight. I get my first infusion tomorrow morning.

I'm very pleased about this news. I very much wanted to get a PD-1 or PD-L1 drug and was not that eager to get ipilimumab along with it. Ipilimumab has more side effects, and has not been shown to have a great impact on metastatic bladder cancer. I'm hopeful that there will be very few side effects from nivolumab only. 

I will need to juggle some of my travel plans around the schedule, however. In early March, Spencer and I are going to Utah to visit Rose and her parents, and depending upon how I feel, maybe do some skiing. I won't have to make any changes to that trip, it appears. But in late March, Jennifer, Kirsten, and Garrett and I are booked to fly to Florida to visit my folks over spring break. I'll have to push back my departure by two days to get my infusion. And in May, I am planning to fly out to Utah for my niece's wedding, and the birth of grandbaby #2. I'll have to shorten that trip. That's why I fly on Southwest - no cancellation fees and easy rebooking. It turns out that the new flight dates are even cheaper than the tickets I had already purchased, so happy day!

Today I saw an abstract of a recent article about the management of metastatic bladder cancer from a French medical journal, La Revue du Praticien. The abstract bluntly summarizes the current status of treatment of metastatic bladder cancer:

The management of patients with metastatic bladder cancer is mainly based on cytotoxic chemotherapy. The reference molecule is cisplatin. In 2014, first-line regimens include gemcitabine and cisplatin (GC protocol) or methotrexate, vinblastine, and cisplatin doxorubicin (MVAC protocol). When cisplatin is contra-indicated, another platinum salt, carboplatin, is used in combination with gemcitabine. Vinflunine is the only molecule to have obtained a marketing approval for patients who failed first-line chemotherapy including a platinum salt. The overall prognosis of patients remains dismal, since the median overall survival is 12 to 14 months for patients being treated with cisplatin, whereas it is less than 1 year for patients receiving carboplatin. The identification of new effective drugs is a major challenge for the coming years.

I'm two months away from my third anniversary of the discovery that my bladder cancer had metastasized, so I am well past the median survival point. I'm aware than it has been more than 20 years since the FDA has approved a new drug for the treatment of bladder cancer, and I'm hopeful that nivolumab is one of the "effective new drugs" that the article says will be a "major challenge" to identify.