Treatment Decision Time

[CourtneyL]

You ladies and gentleman have always been such an incredibly helpful sounding board. I'm hoping you can offer some guidance/thoughts about my latest predicament.

I am currently enrolled in the t-cell vaccine trial at the University of Washington. So far I have received the 3 vaccine injections and the leukapheresis whereby they extracted my T-cells (which have hopefully developed an immune response from the vaccine). The t-cells are currently frozen and awaiting defrosting where they will then grow additional t-cells and infuse them back into me. The trial finishes with another 3 rounds of vaccine booster shots. The idea is that the t-cells infusions will super charge my immune system to identify and destroy the remaining cancer cells.

The wrinkle is that over the past few weeks I have been experiencing some back pain and my tumor markers have been slowly climbing. My CA 15-3 in February was 35 and it is now at 48.4 - suggesting some disease progression. I panicked a little and called up the folks at U of W for advice. Dr. Salazar said that the vaccine could cause the spike and inflammation (hence the pain) but that I should get a PET in the interim to see what is going on. Onc called today with the PET results and the results are mixed. Lungs and liver are NED (Thank GOD for small miracles!) but bones are a mixed bag. There was some regression but also some progression as well as "a new focus". Huh?

I optimistically suggested to my onc that perhaps this was bone healing or active bone marrow producing magic t-cells. He said "no, its probably a new met." He said we could try a systemic treatment but that would push back the t-cells for months. He favors switching to Denosumab instead of Zometa (see my other post on this issue) and proceeding with the t-cells. I asked about targeted radiation and he doesn't think it would get them all.

My concern is that if the t-cell therapy is not robust enough we would have to do more systemic therapy down the road and that might compromise the immune response by destroying all of my supercharged t-cells. Do I proceed with the t-cells now (which will also involve one dose of Cytoxan) and hope for the best? Or do I do a systemic treatment now (probably Navelbine) in hopes of lowering the tumor burden as much as possible and then get the t-cells in a few months?

Decisions, decisions.

Congratulations if you actually made it to the end of this long-winded post. And thank you in advance for any thoughts/input that you may have on this scenario.