Day 294, Year 11: Happy, Happy
Date: Thursday, August 11, 2016
Weather: More Hot and Humid; High Temp in the upper 80’s F
Location: At Home in The Studio #8, Falmouth, MA

Tonight we are happy, happy. Even when you think you have prepared yourself for all possibly alternatives, evidently you just never really know what comes next. Mark and I have discussed the next steps in his cancer treatment program with each other and with Dr. Kwak at Mass General. We thought he had only three options—one of two different oral pills, a heavy duty infusion drug called Folfox, or no treatment at all. Mark had decided to go with the aggressive Folfox, but he was dreading the side effects so much that he sometimes thought again about ending all cancer treatment. But today when we met with his Cape oncologist, Dr. Aviles, we were presented with yet another alternative. This was a total surprise, but Mark liked what he heard. Dr. Aviles presented the possibility of a different type of immunotherapy. Mark has had treatment with cetuximab and panitumumab which are both monoclonal antibody immunotherapies. Both worked for a time, but then the cancer outsmarted them. The new alternative is a different type of immunotherapy that is a checkpoint inhibitor called pembrolizumab (brand name Keytruda by Merck). In plain English, I think that means it simply does something to let your own immune system work against the cancer. Dr. Aviles has a number of patients who are trying Keytruda and he is seeing great results. The trick is that Keytruda is not yet an approved treatment for colon cancer so we would have to pay out of pocket for the treatments. Dr. Aviles estimated the cost to be somewhere in the $100,000 range. And as he said, no one can afford that. But Dr. Aviles thinks he can get Mark approved as a compassionate care case with Merck which means Merck pays the bill through December. If the therapy is effective for Mark, we would just have to hope that Merck would approve this for another calendar year. We were given the opportunity to go away and think about this option, but Mark opted to sign the papers to apply immediately. We should hear from Merck in no more than ten days, but possibly as soon as the middle of next week. This regimen is given as an infusion every three weeks and there are no side effects. Woohoo!!! Of course, there is also no guarantee that it will work, but neither is there any guarantee that Folfox would work the second time around and we know all too well the side effects that chemotherapy regimen. So with Merck’s approval, we will launch into a new chapter in Mark’s battle against cancer. Maybe he really is a cat that has nine lives!

Day 295, Year 11: The End of a Chapter
Day 293, Year 11: Day Trip to Boston