The second cycle of chemotherapy was much more challenging than the first. She received the infusion 2 weeks ago on 9/17/18, and the following 4 days, she was dealing with fatigue, intermittent nausea and vomiting, no appetite, and pain in multiple locations for which she was taking pain meds. Her blood counts dipped lower after this cycle, but she’s been holding up well and we have just been more cautious with infectious precautions. She was still experiencing the nagging cough, which has been intermittent throughout the day and night. This past week she began perking up and has been feeling much more herself. The cough is still there, but her appetite has returned and she is currently not experiencing pain.
In fact, we took a short trip up the coast to Monterrey the past few days stopping at beaches and hikes along the way. Our favorite was Garrapata State Park, where Grace hiked up a mountain that equated to 43 floors(!) on our phones without getting too winded. Grace is now back up to hiking 2-4 miles per day. She even jogged a little bit on the beach tonight.
Now let’s discuss her management. After our visit to MD Anderson a few weeks ago to discuss enrollment in their drug trial (HDAC + PI3K inhibitors), we decided to sign the paperwork and save a spot in case we need to enroll in the near future. The current plan is for Grace to get a CT scan this Tuesday 10/3/18, which will be 2 weeks after the second cycle of chemotherapy (Insurance would not cover a repeat PET). The results of the CT will dictate how we will proceed with her treatment, and we will discuss with our oncologist after the CT to go over treatment options. I speculate that if we see improvement on the CT, which I hope is the case given her clinical improvement, then we will likely continue the current regimen for a couple more cycles of chemotherapy/immunotherapy. The door could also be opened to discuss surgery or radiation. However, if the CT shows disease progression, there is a very real possibility that we would need to relocate to Houston and enroll in the clinical trial at MD Anderson. Grace and I would both like to avoid this for obvious reasons. In addition, there are a couple other trials opening in the near future, which would allow us to enroll locally at City of Hope. Regardless, Grace and I are hoping we can get on a targeted therapy as opposed to chemotherapy simply because of the side effects associated with chemotherapy. But if we find that chemotherapy is working well, I don’t know if we will switch to a trial just yet. This will be a discussion we will have with the oncologists in a few days.