Mets Day 1083: More on the good results; fourth Opdivo infusion

Yesterday I returned to Hopkins for my fourth nivolumab infusion. We moved it to Monday instead of my usual Tuesday so I could fly to Florida for spring break. Jennifer and Garrett had flown down on Saturday, and Kirsten and I were planning on joining them after my infusion. I found that Mondays at Hopkins' cancer center was much busier than Tuesdays. My blood was drawn an hour late, which meant that my labs were an hour late, which meant that the pharmacy was delayed in preparing the custom-made nivolumab dose. All this would have been fine, but I had a plane to catch!

While I was waiting, I met with Dr. Dung Thi Le, the principal investigator at Hopkins for this trial. I asked her about the math in the supplemental reading of my CT scan, which showed that the size of two of my targeted tumors had decreased from 32 mm to 16 mm. She explained that 32 mm was the sum of the short axis measurements of those two tumors as shown in the baseline scan on 2/10/15. 16 mm was the sum of the the short axis measurements of those same two tumors from my 3/24/15 scan.

I knew that Dr. Le did not specialize in bladder cancer -- she's a GI oncologist -- so I asked if she was surprised at the 50% reduction in size of my tumors after just three infusions. Although I was her first bladder cancer patient in this trial, she said that she had received favorable reports from other trial locations regarding the effect of nivolumab on metastatic bladder cancer. As a result, she said that she was not surprised by the reduction in my tumors, because "we know it works on bladder cancer." Then she smiled and said that she was still very pleased to see the results.

She added that the trial had originally sought about 400 patients, and more than 800 have enrolled. There has been very high demand for this immunotherapy drug. And in seeing my results, one can understand why.

Dr. Le pulled up the side-by-side images of the before and after CT scans of my tumors on the computer screen, and showed how the nodes had reduced in size. Her researchers previously had carefully made the measurements and saved them on the scanned images. I asked about the size of my supraclavicular node -- the original metastatic site -- but she was unable to pull up that image. It was apparently not one of my target nodes, so I'm not sure how much that has changed in size.

We discussed how long I would keep going on the trial. She said that their goal was for me to have a "complete response" (or CR) on all of my tumors. CR is defined as the tumors shrinking to less than 10 mm on the short axis. CR is not the same as being "cured" of cancer, however -- the traditional definition of a "cure" is five years with no detectible disease. If and when I achieve CR, then we will discuss with the oncologists how much longer I will stay on the nivolumab. That decision will be influenced by the guidelines for the clinical trial. One of the things that Bristol Myers Squibb wants to find out is how long the drug works to keep the metastatic cancer suppressed. There is insufficient data on how long nivolumab works on mets BC after CR has been achieved, and the trial can last as long as two years, as long as the drug appears to be working and the patient is willing.

But we're getting ahead of ourselves. My new goal is to get to CR first. So I made my way over to the infusion area and waited. I was supposed to start my infusion at 12:30, and my flight from BWI to Florida was at 4:20. Infusion takes at least an hour. I was still waiting at 1:30. My nurse said that the nivolumab had still not arrived from the pharmacy. I told my nurse about my flight, and so he got me set up in a chair and went to bug the pharmacy. Finally, at 2 pm the drug arrived and I was hooked up. I was calculating times in my head - how long to drive from Hopkins to the airport, how long to park and get to the terminal, how long security would take, etc. It would be tight.

At 3:02 pm, the infusion was done, and I bolted out of the hospital. Kirsten was waiting in the car, and we took off for the airport. Traffic was light, parking was easy, the shuttle was waiting, no one was in the security line, our flight was at the closest gate to security, and we arrived just before boarding started. Another faith promoting rumor is born.