David had a brain MRI on 3/15 and met with Dr. Brooks on 3/16 to discuss David's options. We won't know for sure until David meets with Dr. Frye (the radiology oncologist) on 3/18, but Dr. Brooks said it appears that a new brain tumor is developing in the right cerebellum. That's the area of the brain where David's first and largest tumor developed, and it was the one that caused all the balance issues and dizziness. We're hoping Dr. Frye says it's small and can be eradicated with a single dose of targeted radiation.
If there is indeed a brain tumor, that will need to be treated before David starts any other new treatment to address his lymph nodes. After talking with Dr. Brooks and reading all the literature he gave us for the phase 2 clinical trial his group at Arizona Oncology (AZO) is doing and for another option, a chemo pill called Lonsurf, David is inclined to sign up for the clinical trial. There are pros and cons for each, but in a nutshell, Lonsurf is not particularly effective and the IV chemo that will be used in the trial (Enfortumab-vedotin) has been effective for people with advanced bladder cancer that has progressed despite treatment with two previous therapies—so much so that the FDA accelerated its approved. This phase 2 trial will test whether it's effective against other types of cancer. There is no placebo group in this trial, so we're sure David will be getting the Enfortumab vedotin.
There are 10–12 other clinical trials going on in Tucson or Phoenix for gastric cancer, but David wouldn't qualify for some, and Dr. Brooks didn't think any of the others would clearly be better than the phase 2 trial he is running. By definition, all trials test unproven treatments, so there is no guarantee that any of them will succeed, which explains why they are a last resort for cancer patients whose cancer is not responding to standard protocols. A benefit of doing Dr. Brooks' trial is that David can get the treatment at AZO and Dr. Brooks will remain his primary contact. If David signed up for a different trial, he would have to go wherever that trial is being run and change doctors. We like and respect Dr. Brooks a lot, so it'd be nice to stick with him.
We asked if there were any other options, and the short answer is no. Since the previous chemo and now the Keytruda have not stopped the cancer from growing, those aren't viable treatments, the cancer will likely grow and spread if we don't do something different, and those drugs probably wouldn't be covered by insurance any longer.
In addition to possibly needing to have brain radiation, Dr. Brook's research nurse needs to contact Oro Valley hospital to see if they still have some tissue from the liver biopsy that was performed when David's cancer was diagnosed. Dr. Brooks thinks they should have that, but if they don't, David wouldn't qualify to join the trail because biopsy tissue is needed so the researchers can characterize the cancer. We asked whether a biopsy could be taken of the lymph nodes if the liver biopsy is not available, but Dr. Brooks said it would not be advisable to do that. The research nurse will call the hospital and report back to us as soon as she hears from the hospital.
Assuming the hospital has the biopsy and David can get radiation, he will sign up for the trail. Some preliminary tests would need to be run first, so the first dose of Enfortumab vedotin likely wouldn't occur for several weeks. In the meantime, he'll get Keytruda again on 3/25. We'll keep you posted as we learn more.