The Beginning of the End

Since my last entry I have been in a holding pattern with regards to my mesothelioma. In the interim, I had cataract surgery on my right eye which went very well. It was pain free and except for my astigmatism, I now have clear distance vision for the first time since I was in the third grade. The thing that impressed me the most was how much brighter and more colorful the world appears now through my right eye. i had no idea I was looking through a yellow-brown haze. I gather that this is a common revelation to others who've had the surgery. I'll have my other eye done on Thursday.

Back to mesothelioma. On Monday I had my first CT since January, and on Wednesday we saw my oncologist for the results.  They were not good.  My mesothelioma has grown through the diaphragm into my abdomen. 

The abdomen is lined with the same kind of tissue as the chest cavity, so the cancer seem very happy to be in the abdomen and is flourishing. It is forming a crust across the top of my liver and down the sides.  However, the lungs seem pretty stable.  Dr. Camidge offered a new chemotherapy and a monoclonal antibody that works against the formation of new blood vessels (thereby starving the cancer).  I asked the prognosis if I did not do anything, and he said probably less than a year.  I told him that I didn't have much faith in the chemo helping, and I didn't want to spend the time I have left under the effects of both the chemo and the cancer.  He understood, and we agreed to give the antibody (minus the chemo) a six week trial and regroup then. 

The monoclonal antibody is called Avastin (bevaciizumab). Monoclonal antibody drugs (generic name ends in ..mab) are man-made antibodies that work through the immune system. Avastin is a member of the class of drugs that are designed to combat angiogenesis, the creation of new blood vessels. The idea is that the cancer needs new blood vessel to grow, and if the drug prevents the creation of the blood vessels, the cancer will stop growing. Avastin is not as effective as some of the newer immuno drugs, and as my doctor recommended is usually given with a chemotherapy agent, so I don't expect much, if any, improvement; however, I'll give it a try. I get my first infusion on Wednesday and then again three week later, assuming that insurance will pay for it. Avastin is not licensed for mesothelioma.

It looks like I'm entering the beginning of the end, and it's time to get my affairs in order. When I was first diagnosed seven years ago, I thought I had six months to live. I realized intellectually that I had an incurable disease, but it never seemed real or my death imminent. After a couple of years when my cancer showed itself to be rather indolent, I realized that I had a longer life expectancy than that. Now it seems clear that my time is getting short, and for the first time i feel my mortality emotionally, a feeling that meso going to take my life.

PS. I knew something had changed because my belly looks like it's inflated. Even our five-year-old granddaughter noticed and remarked on it. When examining me, my doctor said I look like I'm pregnant. He quickly said that I was one of only a few patient that he could say that to. I appreciated the fact that we have gotten to know one another well enough for him to understand that I would not be offended. 

 David