Years ago I joked to a friend that when it comes to humanity’s survival of the fittest, there’s a thing I named “The McDonald’s Factor”.
I said at some point in the future we will only begin to understand just how complex human survival is, and medicine will soon be about that – the minutia in our lives, and how it aids in survival – or doesn’t.
I think we will soon question (and find) why some fat kids who indulge in video games and bad food choices will mysteriously grow up to outlive others who appeared healthier. Or why some old folks can smoke and drink a little whiskey every day and live to be 90-something, and why others who did everything they were supposed to, must deal with lung cancer at 30-something.
I predicted that after many years of rigorous data management and eventual following of the lifestyles and choices of kids to adulthood, science will discover it’s the idiotic, random combination of consistently using a minimum of 2 Heinz ketchup packets with a Happy Meal at Mc Donald’s combined with consistent acidity of a Coke with ice that creates a seemingly magical chemical combination that extends life, even in the unhealthiest of people.
In other words, cancer is not predictive because it is so incredibly unique to each person’s biochemistry, and choices. Perhaps it’s as random as using toothpaste and using a certain shampoo each day, coupled with eating lots of steak, which causes a chain reaction to wake up a mutant gene. The only thing we do know, is that we don’t know why. But there must be a reason.
I feel one of the biggest missteps in cancer treatment is not treating cancer as individualized as each person who has it. While it helps to know averages and generally what to expect, to treat people with blanketed, FDA approved, one-size-fits all approach is missing something. (Not to say that some treatments aren’t tailored to the patient, but that our entire tool box is too generalized).
If we don’t know why some people survive and others don’t, clearly the mundane minutia in our lives (like eating ketchup with our fries) may create the lucky, critical, uncharted things which that aid survival. What else is there? I think this goes much farther than dietary choices, excercise and positive outlooks. I think the chemical reactions we create can be so subtle and numerous – from the complex chemistry of moisturizing lotions we slather on, to the toothpaste we use, to the packaging they arrive in – and perhaps – in what order we use these daily products as well. We do not track the long list of chemicals we absorb, or how these are metabolized and what they do with each other. Tracking vitamins and calories is daunting enough for most. If we poured the contents of what we ingest, breathe and apply daily into a bucket it would be pretty disgusting, and probably even flammable.
I have a hard time just dealing with what’s in our garbage disposal.
The point is, that we’re all unique. And we mix stuff up a lot without paying attention as we live in a super-fast-paced world.
Introducing Dr. Sosman
We met with Dr. Jeffrey Sosman and another oncologist doing a fellowship at Vanderbilt. Both were great to speak to. Sosman is a soft spoken, earnest man who is both an oncologist and scientist. His humble demeanor was striking to me, especially for such an important man. He seemed familiar and we both instantly loved him. He was gentle, genuine, and humanitarian. We both immediately felt right at home.
This melanoma expert gave us some hope then brought us back down again. He reminded us that Kevin has a very severe case. His meds are working remarkably, which we know is temporary. However, Dr. Sosman said 20% or so of his patients live several years or more with these meds. He has not been able to figure out why some survive longer and others don’t. He said, with a lot of admirable frustration in his voice, “I just can’t figure that part of it out. You simply never know.” He told us that one guy had more melanoma tumors in his brain than Kevin, yet is still alive 15 years later. He said there’s really no way to predict yet who will do well and who will not. It was a little like a roller coaster – we’d feel hopeful, then in the next minute back into reality, then up again, and down. Oncology is a field for the greatest of optimistis. I don’t know how people in this field can stay in it, yet if I were younger I would get into it for the sake of doing what I could to help people win the war on cancer.
We were enthused at first, yet right back to not knowing anything. The main difference is that Vanderbilt’s oncology unit seems to be massive and bubbling with new treatments. Dr. Sosman knows Kevin’s current oncologist. They were colleagues at the University of Chicago. He assured us we’re in good hands in Iowa too. I told him it’s not the staff, but the clinical trials we’re after.
While we didn’t receive a triumphant cure that day, as I reminded Kevin, our goal was to better his odds by getting him in line for clinical trials by having him listed as a patient at Nashville Vanderbilt as well, and we met that objective. In this digital age it seems ridiculous to travel so far to “show” Kevin and get him enlisted as a patient, but this is still how it’s done.
Two more places to go: wash U and Chicago. This gives Kevin a fighting chance to give him access to the precious and difficult-to-find, Anti-PD-1 drugs, which unmask cancer cell’s ability to hide from the immune system, allowing your body’s t-cells to fight cancer.
We learned during our trip that these are extremely close to FDA approvals. We can only hope Kevin will survive to receive the meds. If so he has a 44 percent, to 88 percent (if he can tolerate high dosages) of a cure. Personally, I’m skeptical of a permanent cure from melanoma, but even if it buys years of cancer-free living, that’s a pretty amazing feat with this disease.
We’re in a race against the clock. Dr. Sosman said he’s usually in the know about when a drug will be FDA approved, but said no one is saying anything when it comes to anti-PD-1. Personally, I think this is because several major big pharma companies are rushing to the finish line, and stocks will soar with those companies. He suspects a year or possibly two before it’s on the market.
Kevin is now on Vanderbilt’s list of urgent patients, and will hopefully be on the same when we go to Chicago and Wash U in St. Louis – both much easier and cheaper trips than Tennessee. However, to get the treatment (whether in clinical trial or accelerated wide use before FDA approvals) he must be at the point where his current meds are not working. This is why having several options for clinical trials is critical – it’s not just getting in. It’s getting in at precisely the right time, being both sick enough to receive treatment and well enough to handle it.
Since several anti-PD-1 treatments will be on an accelerated approvals list with the FDA, Kevin might also receive treatments through the different research hospitals in an extended use list, due to the deadly nature of the disease. So, we’re doing everything possible.
When it comes to cancer, leave no stone unturned. Cures are just around the corner – it’s now a matter of surviving long enough to get them, and remaining healthy enough to tolerate the meds.
For now, we are on our way back to our comfortable bed and copious pillows, heavy blankets and happy dog. At least we learned one important thing while we were here – that is that some people go on for years with the meds that Kevin is currently on. That is a new hope, and as it has been our motto from the beginning: we’ll work with that.