Trials

Zach has exhausted all the standard options for treating metastatic prostate cancer. And his oncologist said they didn’t have any clinical trials that Zach would qualify for either. He did say they’d keep Zach's name in the hat, which is doctor-speak for “Don't hold your breath.”

But last week, they called about an immunotherapy trial. This is what we’d been waiting for: A new therapy–something to give us hope!

Zach didn’t share my enthusiasm. 

Zach: I don’t believe in Santa Claus. 

Zelda: What do you mean?

Zach: It’s a pipe dream. They have no clue if this will work for me.

Still, he agreed to at least look into it, and we read the details of the trial together. 

At first, it sounded good. They're attempting to use the patient's own immune system to destroy tumors. But it's early days. They’re figuring out what levels of the drug are safe and effective, and if combinations of drugs increase effectiveness. It's a phase 1/2 trial.

Or as Zach so aptly put it, “they have no clue if this will work for me.”

We read on, and learned that certain factors, like PSA over 5,000, and peripheral neuropathy, which Zach has, “significantly increases the risk profile” for participants. Also, there’s something called systemic “cytokine release syndrome” or CRS, which could cause an intense immune response with rapid widespread inflammation. And Zach would need mandatory pre-study meds, including steroids, antihistamines, and antipyretics to lower the risk. Whee! 

But wait, there’s more! The treatments would be administered every week. And Zach would have to be hospitalized for observation for 2-4 days each time, in case of life-threatening reactions. Plus, there’d be frequent blood draws as well as CT, MRI, and bone scans. 

In the best case scenario, the hospital stays, scans, and symptoms would be manageable, and the tumors and pain would decrease. But we had to consider the worst case too. The treatments could trigger a serious immune system reaction. Zach could be in the ICU and intubated, and spend the rest of his life dealing with severe neurological disability and uncontrolled pain. Yikes over YIKES!

Zach: I might as well move into the hospital and let them put me in a cage with all the other mice.

Zelda: You can’t think like that.

Zach: Can too.

Zelda: I mean it’s not helpful. Can you think differently? What if it works?

Zach: Chemo didn’t work. Pluvicto didn’t work. No reason to think this will work. They just need bodies. They don’t care about me.

Zelda: But you’d be helping them figure it out. 

Zach: I’ll be dead before they figure it out.

Needless to say, Zach is not participating in this immunotherapy trial.