This could be the making of me

William Blake - Ancient of Days

One of the things about cancer is that there really are no (or at least very few) absolutes in treatment.  They have things that "usually" work or "often" help, but there's no real guarantee that it will work for me.

This is one of the hardest things for me to deal with.  I don't like to take chances and I'm very, very fond of sure things.

People who work with cancer do, of course, absolutely know what works a lot of the time.  They know if something has been proven to work better than other things, plus they understand the reasons certain things should be effective (for instance, my cancer, both in the original tumor and now in the bone, has been tested and found to have estrogen receptors, so depriving it of estrogen is considered a good approach because it both fits the science and has worked in controlled trials for others with similar cancer characteristics).

But, with cancer (like, unfortunately, with so many things) there is still a chance it won't work. Kind of like how I had the "most likely to cure this" treatments last time and yet....

Basically, there are still a lot of unknowns.

In the next week, I'll have been off the tamoxifen (no longer my best friend) long enough to "officially" have it out of my system and be ready to start the next treatment plan (the Xgeva I started a few weeks ago is intended to help prevent further bone damage from the cancer, but it's not supposed to kill the beast).  The plan is to move on to a different kind of anti-hormonal drug (probably an estrogen downregulator, possibly with or instead an aromatase inhibitor, both of which are different than an estrogen blocker like tamoxifen was, for those keeping track or playing cancer treatment bingo).  If that works, then great!  And hopefully it will work and work for a long time.  But, if not, I will probably be on to chemo fairly soon (then, hopefully that will work and work for a long time).

But, of course, we won't know what will happen to the cancer until it actually happens.

For now, with this next treatment plan, the question is which particular estrogen treatment (there are seveal out there for post-menopausal/post-chemopausal women to choose from) and what else goes with it.  And, for now, the non-answer answer is, "it depends."

As I mentioned in an earlier post, my oncologist is recommending a clinical trial for me.  I'm hoping it pans out.  There are a lot of pieces that have to fall into place for it.  Things that do look likely to fall into place, but it's not a sure thing.

The trial is just opening up--in a way that feels very cool because if I was diagnosed even a month before I was, I would have already been on an aromatase inhibitor or estrogen downregulator and not eligible for the trial, so that feels like a good sign--but, because it's just opening up, my hospital's institutional review board still needs to approve it for their patients.  They were meeting at the end of last week, so hopefully that's done with, but if they were to put off making a decision, we wouldn't put off treatment (because cancer) so that would mean I'm out of the trial.

If it is now approved by the IRB, there are still some tests I need to "pass" to meet the requirements.  I should pass them, no problem, but there's a chance that I won't.  Wouldn't be the worst thing ever, of course, because I'd still go on one of the standard treatments, but it would be disappointing.

And if it's approved and I'm approved, there's still a chance the institution coordinating the trial will have delays in opening it on their end.  Which would also mean I'd be out of it.

But, even if all of that works like a clockwork (and I hope it does), there's still the fact that it's a double-blind clinical trial.  This particular one is, I believe (and my oncologist believes), a pretty good bet for someone like me who's not in dire straights and who's not already run through multiple treatments: it's testing 3 different currently on the market drugs to see if they work better together, so it's not testing a new product yet to be used in the larger world and, therefore, not testing things without long track records.  Also, it's a phase III trial, which means it's passed tests for dosing and safety already.  And, most importantly, no matter which "arm" of the trial I end up in (between drug plus 2 placebos, 2 drugs plus placebo, or 3 real drugs), I'll still be receiving the drug that is an accepted standard of care for someone in my situation in any of the 3 arms.  So that part, of course, is not at risk.

But it's kind of a gamble, even if I'm in the trial, as to which arm I'm in and which arm I should want be in.

I'm relying on faith (ok, faith combined with the knowledge that I'll still be getting good treatment no matter what else goes with it) that whatever I'm on will be "right".  I'm hoping for the best, and hoping it brings me to NED (no evidence of disease) and keeps me there for a very long time.

I try to remember that God has a plan for me even when I don't know what it is.  But, unfortunately, God doesn't promise eternal life on earth and doesn't promise there will be no trials in this life, either (trial/trial? I guess it works either way, right?), so there is that.

In the end, this trial could be one of many things that I'm not doing in life, it could be just another treatment that does or doesn't work for me against my cancer.  Or, you never know, it could just be the thing that saves me.

Here's hoping for that last one.  Whichever meaning of "trial" and "save" you want to apply to that, let's just put our hope in that one.