Sunday, September 28, 2008

More Kidney Cancer...



Today I spent my first day using the cancer drug, Sutent. To detail the story of how I got here, look back in this blog to posts here and here. To shorten the story… after finding a lump on my right kidney a year ago, I have undergone a nephrectomy, and while the initial scans found no signs of metastasis, a follow-up exam four months ago has led me to my diagnosis of advanced renal cell carcinoma.

Dr. John Karod was given the unpleasant task of calling me on August 6, and informing me of the second biopsy results - the presence of kidney cancer cells in my lungs. That led to further full body CT scans, brain MRI scans, and bone scans which were done on the 11th and 18th of August at PenBay hospital and a visit with Dr. Nadia Ramden, an Oncologist in the cancer care unit at PenBay on August 12th. After  reviewing my case, she advised me that the bone scan and brain scans were clean of any current cancer, but that there were several cancerous growths, mostly 1-2 cm in size in both of my lungs and that there was also 5-6 cm growth in my abdomen. She suggested that I start taking the drug Sutent but we decided to wait to start that until I met with Dr. Glen Kroog at Memorial Sloan Kettering Cancer Care Center in New York City.

I made a quick trip down to New York for that appointment on August the 28th. I am so lucky to have one of the world’s greatest sisters who lives in Manhattan and she was indispensible through this process. Dr. Kroog suggested that I would be a candidate to join a clinical trial comparing Pfizer’s Sutent to an unreleased anti-angiogenesis drug, but I would need new baseline scans, so we scheduled those for September 8th through the 11th, and I returned to Maine for Labor Day Week with my daughter and son-in-law, before going back to New York for the tests.

With some very minor growth evident, those scans were essentially the same as the PenBay results, but the Kidney Cancer Group did not think that the benefits of participating in the clinical trial were worth the inevitable stress of the bi-weekly travel involved so I decided to not participate in the trial, and to have Dr. Ramden be my primary oncologist, but I also fully expect to consult regularly with Dr Kroog at MSKCC.

The technology involved in this process has been amazing.  The Radiology, MRI, and Nuclear Medicine departments at both institutions have wonderful Doctors and technicians using world class state of the art equipment. I was pleasantly surprised by the quality of the technology used at PenBay, but was equally impressed with the quality of the human interaction in New York which was much more down home friendly than what I anticipated from big city hospital.

So here I am, on day one of chemotherapy. Pfizer is supplying me with the drugs under their First Resource plan in conjunction with my Medicare Part D coverage for no out of pocket cost to me beyond the $271 per month I presently pay under my various Medicare plans. I am told that were I not insured, the cost of the drugs, and the number co-pays would be figured on, would be over $80,000 per year ($350 per pill).

I have yet to have the first symptom or pain, but am preparing for a battle. The Sutent is supposed to stop the process of making the new blood vessels necessary for the cancer to grow. This process is called anti-angiogenesis, and I sure hope it works. It clearly does for some folks, sometimes with few side effects, but a whole long possible list of bad things for others. My life has been interesting to me so far, and I don’t expect it to change any time soon. Here’s hoping for the easy path this time.