On The Cusp

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(This is Part III in an everlasting-we-can-hope series on Heidi's journey to a cure for her cancer. Read Part 1 here and Part 2.)

Heidi and I had the privilege of listening to—and asking questions of!—an amazingly talented and smart group of Enormous Brains at Massachusetts General Boston Hospital. Drs. Justin Gainor, Lecia Sequist, Ibiayi Dagogo-Jack, Jessica Lin and Zosia Piotrowska were empaneled for a webinar called, New Strategies in Lung Cancer: Innovations in Clinical Trials, Treatments, and Patient Care and spoke on some of their recent research activities and positive steps they’ve made in the treatment of lung cancer.

I was pleasantly flabbergasted to see a panel composed of 80% women! STEM women ROCK. It should be noted that we have encountered nothing BUT Enormous Brains in our experience at Dana-Farber and its next-door neighbor, Mass General, and these women are four of the superstars in the thoracic cancer treatment department. As Heidi pointed out, these are women who are doing amazing, super-smart thinking and research and clinical work—and they’re also probably making peanut butter and jelly sandwiches and trying to get the kids to do their homework, too. Quite the impressive group.

We learned some interesting facts about lung cancer along the way. I hadn’t realized the progress that lung cancer treatment has made in the past decade, but Dr. Gainor introduced the talk as moderator by showing a three-step treatment graph for lung cancer as it existed then. Before about a decade ago, the graph was shorter: “Diagnosis -> Die.” That progression became “Diagnosis -> Chemo -> something-I-couldn’t-read -> Die.” Naturally, his graph didn’t show “die.” I’ve added that step because it’s what happened next—rather rapidly, too.

Then he showed a graph which showed today’s treatment options based on various biogenetic markers and it’s quite complicated. Yes, each of the paths ends in a not-so-great terminal condition, but the length of time in between steps is getting longer, progressing from months (days, really) to years. And tonight and in a few papers I’ve read, we’re learning that there are loops in the treatment protocols which may extend life, with good quality, even longer.

Their work is amazing, certainly! All are working on the treatment of cancers in new and amazing ways, but I think it was Dr. Sequist who is leading the charge in that group for early detection using such never-heard-of-by-me techniques as AI applied to CT scans, inhaled biomarkers which would be detectible in urine, and other sci-fi level testing. I was also intrigued by their predictions for the next five years. I can’t remember who said what, exactly, but there were two predictions that stuck most in my mind. One doctor-cum-scientist said she was most hopeful about the ability to use testing to construct custom treatment plans for each patient’s cancer progression. Using such tests as “liquid biopsies” (which is a neat way of saying “detecting cancers by using blood and other bodily fluids”), being able to track the progression or regression of the disease would allow on-the-fly tailoring.

The other prediction that stuck in my mind was COVID-19-driven, and I apologize to the four panelists because I can’t remember who said it. We are blessed to live within 90 minutes of at least two world-class cancer treatment centers. With the advent of telemedicine and testing at a distance, labs that can be done via FedEx, and so forth, the reach of their care and, importantly for their research needs, their ability to get data from across the globe gives them the ability to help millions more people. We’re looking forward to our next face-to-face visit with Dr. Kehl, but we’re also very thankful that others will have the ability to reach that level of care as well.

In any case, I feel very much like we are on The Cusp of an enormous breakthrough in the treatment of lung cancer, and cancers in general, with the advances in technology that we have at our disposal. I was particularly pleased to hear that these and other researchers are working to do what are known as investigator-led trials. These are trials that are led by independent, institutional investigators, such as the panel we heard this evening. They’re able to work on combination therapies which cross drugmakers’ boundaries, such as the studies led by Dr. Dagogo-Jack who is using multiple drugmakers’ treatments in patients at the same time or in sequence. The other kind of trial (that I’m aware of, anyway) is the drugmaker-led trial, where the corporation is most interested in learning how its own drug works. Now, don’t get all mad at them, that’s the right thing for them to do, and their trials enable studies like Dr. Dagogo-Jack’s... and life-extensions for my wife…

And so every time we read about someone on the ROS1ders Facebook group who didn’t make it to The Cusp, we are saddened and again reality reaches up and slaps us in the face. Our ultimate goal is a long and healthy life for Heidi, of course, but I feel like the short term goal is to get her to The Cusp where some major change in cancer treatments will make a step change in her life expectancy.

This evening’s talk gave us hope that she will one day be able to make it to The Cusp. The Enormous Brains are working on it.

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