Andrew didn’t get chemo today. About 18 hours before the appointment, he found out that there are THREE trials with open slots at Hackensack Hospital in New Jersey. This is incredible and unexpected, and we are grateful and happy.

Now we try to make a vitally important decision with a lot of complex and possibly conflicting variables in just a few days. And ultimately we won’t have all the info we wish we had to feel confident we chose right. 

The first decision is easy: Two of the trials are testing a treatment targeting the KRAS gene mutation. This is what we wanted because both Sloan and NYU oncologists think KRAS treatments show promise. The third trial is the most similar to the first trial that Andrew failed, so it doesn’t make sense to do that.

The two KRAS trials are for drugs made by the same company. One is currently offered at Sloan, but spots are full. NYU doesn’t have patients in either one. The NYU oncologist wonders why the same drug company would have two drugs targeting a specific type of KRAS mutation (G12D). Is it because the first one has known issues with safety/toxicity or efficacy? Being in a phase 1 trial could mean you’re getting a drug only ever given to mice, so monitoring for safety is a big part of it. (Generally speaking, phase 2s are for maximizing effectiveness and dosage; phase 3 is about comparing an investigational drug to standard-of-care options, such as chemo.)

If the two trial options were from different drug makers, we might more readily opt for the trial that’s been around longer. That’s also the one Sloan offers. The newer trial also has dose escalations built into the protocol, and we don’t want to risk Andrew getting the lowest dose.

We are waiting to hear back from NYU on their recommendation, and will most likely go with that. Andrew is scheduled to go to Hackensack on Monday to consent to his trial of choice, so the decision must be made by then. Time is of the essence because we delayed chemo, and Andrew’s cancer needs to be controlled somehow. But trials have “washout” periods where you can’t have taken any treatment for a certain time before enrolling. Andrew is likely within that range now but doing a round of chemo would reset the clock. 

We are looking for prayers that we pick well and of course that this trial would be effective.