Yesterday, I met with my oncologists at Memorial Sloan Kettering. We went over a lot of information in the meeting, so I’ll try to break things down in simple terms. I’ve had to learn a lot about this disease, so apologies if this still full of jargon. We have covered a lot of these concepts in previous blog posts, but have more clarity on a path forward that I am happy with. 

 

Chemotherapy Plan 

At one point, the plan was to stop chemotherapy after round eight, which is this coming Monday, September 30. However, now it’s more likely that I’ll stay on my current chemotherapy treatment for up to a few more months. My chemotherapy cocktail of four drugs, known as FOLFIRINOX, targets and kills fast-growing cells, including cancer cells. But it can also affect healthy cells, which is why side effects—like neuropathy, or numbness and tingling in the hands and feet—have to be monitored closely. We also have to make sure my blood counts stay at safe levels because the drugs can harm my bone marrow. If needed, we could reduce or stop certain drugs, including oxaliplatin, which is thought to be most effective. The MSK oncologist said that as long as we continue to see improvement on CT scans, it’s reasonable to stay on the other chemotherapy drugs until we hit a point of diminishing returns and it’s time to transition to the maintenance phase. 

 

After chemotherapy, I’ll be joining a clinical trial at NYU. In this trial, they’re testing whether a combination treatment of a PARP inhibitor (olaparib) and an immunotherapy drug (pembrolizumab) work better than olparib alone. 

 

Science lesson: All cells are meant to die. A tumor is a clump of cells that were supposed to die, but bad DNA turned off the die switch. So they stay alive, hanging out and taking up valuable space in your organs. PARP is a protein that helps cells fix DNA damage, so its job is to help fuel healthy cell replication. With cancer, you want to block damaged cells’ ability to make copies of themselves because that’s how cancer grows. Enter: a PARP inhibitor, like olaparib, which is a standard maintenance therapy for people with the BRCA mutation and pancreas cancer. Taking it (as a pill) can offer months to even years of chemo-free stability, hopefully improving quality of life and allowing for side effects like neuropathy to subside. 

 

Pembrolizumab is a type of immunotherapy, which means it helps the immune system recognize and attack cancer cells. Cancer cells often hide from the immune system by turning off certain signals that tell the immune cells to attack. Pembrolizumab blocks this "off" signal, helping the immune system do its job more effectively. 

 

Early results of this combination look promising. I’ll have a 50% chance of getting both drugs, and a 50% chance of just getting the PARP inhibitor. The MSK oncologist said this is not a blinded study, which means there’s no placebo and I’ll know if I’m getting one or both. 

 

The doctors gave me three possible outcomes based on the trial data for olaparib so far: 

1. A 50% chance the treatment could keep the cancer under control for roughly 6-8 months. 

2. A 20% chance the cancer won’t respond as well, and I’ll need to go back to chemotherapy quickly and likely remain on it forever. 

3. A 30% chance the treatment could work for several years. 

 

As for treating the tumors directly (called local therapy), we’ve decided to wait for about 9-12 months before discussing any surgical or focused treatment options. By that time, we’ll have a better sense of how well the treatments are working. The MSK oncologist explained that the longer pancreas cancer is under control, the more effective local therapies may be. 

 

One option could be histotripsy, a procedure that uses focused sound waves to break up the tumors in my liver. Another option is the Whipple procedure, a major surgery that removes parts of several organs. Specifically, they would take out the head of the pancreas, part of the small intestine, the gallbladder, and sometimes part of the stomach. It’s a very complex and invasive surgery. Because the body needs time to recover, I wouldn’t be able to continue chemotherapy for about two months afterward, which is why we want to be cautious about when and if we proceed with that option. 

 

There is a lot on the table, but for now I’m staying focused on the next step and taking things one day at a time.