E-mail update from July 14, 2007

Just wanted to pass along the latest news from my recent CT scan and blood work. As I mentioned in the last e-mail, we were expecting good news -- the near-the-surface tumors were clearly smaller, I was cutting back on my pain killers (suggesting improvement in the bones), and had the experience of this treatment working previously. I was feeling pretty good, too, for the most part.

Anyways, I had a CT scan a week ago, and got the results on Wednesday, when I went in for what should have been a treatment. In something of a surprise, given how good things were looking, it turns out the tumors in my liver have been growing. I guess they've adapted to and are no longer responding to the treatment. These are, of course, the dangerous ones...the ones that really dictate when a change is in order.

So, what's next? We've got one (maybe 1.5...depending on what kinds of drugs we can add to the supplement one) more standard and approved treatment option to try. It's a pill form of a drug I'd taken back in the Spring of '04 at Northwestern. We have no way of really guessing how well that regimen worked -- we weren't yet checking my one good tumor marker (that showed up as a good marker with the first Sugarbaker surgery), though we can say that there wasn't great growth during the months I took it (nothing was popping up bigger on the CT scans during those months). I suppose taking it orally allows it to be absorbed into the system in a different way...not sure how that might make it more effective, but I suppose it could.

Beyond that, we're looking at clinical trials. Given that my cancer is pretty rare, I'm not gonna qualify for many of the experimental options out there -- at the "trials" stage they're looking to accumulate data on how well a given treatment may take out a particular kind of cancer. There just aren't enough folks with appendix cancer to warrant a full scale study of treatment options specific to it. This means that my "experimental" options are mostly going to be limited to very early trials...where they're still looking to establish the dose levels and things like that they'll use for a bigger and more specific trial. I've called the folks at Vanderbilt University, in Nashville, and they said they've got 5 or 6 such trials happening right now that I'd qualify for. We're not running there next week -- we'll give this last "approved" option every opportunity first -- but it's worthwhile to start asking around and seeing what's available.

We've actually decided to take a short break from treatment. Dr. Grapski (my guy here in Knoxville) is going to call Dr. Marshall (my guy at Georgetown) and see if he's got other ideas besides Xeloda (that pill treatment I'd mentioned). In the meantime, we'll take a couple of weeks and see if we can't do something about those cryptic "issues" I'd mentioned...problems in the lining of my digestive tract and bladder that have arisen since the surgery in Munich last August. If we can do something to get this to heal up, we open up one possible option to add to the Xeloda (a drug called Avastin, which I'd taken a bit at Northwestern. It gets in the way of the cancer cell's ability to create new avenues of blood supply. One possible side effect is the creation of or making worse of such problems as I've already got -- the issues I'm having would potentially go from mild nuisance to a big deal).

I'll probably be starting up on Xeloda (and whatever else) come the start of August.

No sugar coating this, folks -- this is bad. But we'll do what we always do when we get punched in the gut. We'll get back up, catch our breath, and resume the fight. And we'll pray. Lots.

Thanks as always for all your prayers and support.