The Journey Continues - a choice to make -- 8/7/2025

 If you have been following my posts you'll know I have been diagnosed with lung cancer and I've had an operation to obtain a biopsy sample from my spine to see if the cancer had spread.

This week I learned that indeed, the cancer has spread to my T7 vertebra and so I have Stage 4 Lung Cancer. My doctors explained that they don't think of Stage 4 Lung Cancer as being curable because even though there are treatments that can eliminate all evidence of cancer in many cases, it is quite likely that the cancer will return and treatment must then be resumed.

Luckily, there have been some amazing advances in the treatment of lung cancer and it may eventually become a treatable chronic disease like AIDS or Diabetes or other Endocrine disorders.

One of those advances is immunotherapy in which drugs are given through infusions every three weeks for up to 2 years and these drugs stimulate the immune system to attack the cancer cells. The effectiveness of this approach depends on precisely which genes in the cancer have mutated to cause it to divide and grow uncontrollably. I don't know how these drugs work, but I'm excited about reading up on these new approaches to cancer treatment.

Luckily for me, about 90% of my cancer cells have the right mutation and so I can be treated with a new drug Keytruda (Pembrolizumab) that has been shown to effectively shrink lung cancer lesions. Such treatments are not without risk though. Because the immune system is being highly stimulated it can begin to attack normal cells too, and so there is a whole list of possible adverse effects, but in the most recent Phase III trials Keytruda was shown to be tolerated generally well by many patients, and a good number of patients were able to have the cancer completely disappear and were cancer free after five years. I am 100% committed to doing everything I can to be in that group.

Now, the choice!

It looks like I am a good candidate for a Phase III clinical trial of a new treatment that would combine my immunotherapy, Keytruda, with a new drug that delivers toxic chemotherapy agents directly to cancer cells and is designed to kill just those cancer cell and not all fast growing cells. This new drug Dato-DXd combines a monoclonal antibody (like a white blood cell) with a chemotherapy agent. The antibody seeks out cancer cells and gets absorbed along with its chemotherapy agent, and boom, the cancer cell and some of the surrounding cells are killed. If I am accepted into the study then they will randomly decide if I continue with my Keytruda treatment by itself or if I also get a Dato-DXd infusion.

I will probably apply to join the clinical study for a few reasons. The main reason is that, although there is an increase risk of treatment related adverse effects, there is a possibility that this new drug will be significantly more effective at treating lung cancer. If I am in the group getting that new drug, this would benefit me personally, if I am in the control group then I will at least be contributing to medical science. If however it turns out to be much more effective than Keytruda alone, they will switch all of the control group to the new treatment.

It is also possible that the new drug will not be more effective at treating lung cancer and that it may actually be significantly worse. If it is dramatically worse, then the treatment group will all switch to just Keytruda alone, and the trial will have failed.

Another risk to joining the trial is that I need to apply and go through a battery of tests that could take several weeks, during which time my cancer will continue to spread, but I judge that to be an acceptable risk since the benefit could be a potentially much more effective treatment for me, or for other lung cancer patients in the future.

I will keep everyone posted on this journey. I won't be talking about the survival statistics for these treatments because they deal with population averages, and for many reasons I think I am exceptional since I caught it early in a scan, I have no symptoms, and I'm quite healthy otherwise, I have an excellent support system, and thanks to my secular buddhist beliefs a very positive and joyful attitude, even knowing the seriousness of this disease.

If you want to dive deeper into lung cancer treatments, continue to follow me, but if you've had enough, feel free to unfollow me, or just delete my posts that start with "The Journey Continues"

Namaste, and thank you for all of the support you've offered!