UPDATE FROM NUCLEAR MEDICINE BUNKER IN THE SKY - 6 JUNE 2023

 The PET-MRI scan from the end of last month did show active malignancy. I had suspected as much - the rising Ca125 and the feeling of having something going on in my butt were clues - so I was disappointed but not really surprised. 

Dr M. was back in heels, feet fully recovered, when I saw her for the bad news. We talked a bit about options - Carboplatin still seems the obvious choice as it's worked before and it seems I could have it with paclitaxel again, same as the first regime. I'm not keen on this as my hair would fall out again (I know, trivial) but of more concern, the peripheral neuropathy might get worse. 

Then, for carboplatin alone, there's a trial - one arm gets the standard carboplatin-only treatment - 6 cycles at three-weekly intervals (15 weeks). The other arm gets an 'adaptive' carboplatin regime - once the first cycle is over, the dose of carboplatin depends on your Ca125 level just before the next one is due. This may have a bonus of reducing side effects if you only need lower, or no, doses for some of the cycles. But this isn't the main advantage being sought, and indeed, the trial could last for 36 weeks, a lot longer than the standard. The main effect being investigated is to manage the ecology of the cancer cells.

The idea starts with the understanding that cancers are made up of a mix of cell types. This is why treatments are often made up of more than one agent - if one doesn't get all the cells, the other agents have a chance of mopping up the rest. Then, it seems that the carboplatin-sensitive cancer cells are robust thugs while the carboplatin insensitive cells are weedier. Perhaps in gaining resistance to carboplatin, they have lost some level of overall fitness. The carboplatin-sensitive cells, by being more generally robust, may exert a brake on the growth of the others. This leads to the expectation that a carboplatin-only treatment could result in a population explosion in the carboplatin-insensitive cancer cells. As carboplatin is cheap, being out of patent, 'relatively' well-tolerated (apparently), and still very useful for this and some other cancers, it makes sense to find ways to use it that are most effective.

The idea moves on to something analagous to integrated pest/weed management in agriculture. Not aiming at eradication but at control, closely adapted to what's going on with the cancer activity, which is monitored three-weekly using the blood Ca125. If it works, it'll be like a sort of maintenance treatment.

I said yes to the trial. I think I saw something on the Ovacome website once that said to always accept a trial. This is the reason for being back in Nuclear Med on the 5th floor - I have to have a full-on kidney function test again - the GFR. Definitely feel like I'm spending too much time in WC1E.


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