Here We Go Again

It has been about a month since my last post, almost 2 months since my scan, and by this point I’m sure you are assuming one of three things: life threw me another cancer-related curveball and the spots were not cancer, my treatment plan is now: wait and let it fester…really give this cancer a chance to live to its full potential, or I’m finally fulfilling my dream of moving to a beach in Mexico…apparently without internet. Well, none of those three is the case. It just takes a while to make appointments, order tests, get results, and then make new appointments.  I was able to get the suspicious spot on my liver successfully biopsied and it is confirmed to be breast cancer that has maintained its original characteristics of being estrogen receptor positive (meaning estrogen is one of the things that helps this cancer grow) and HER2 negative.  Estrogen receptor positive cancer is generally considered less aggressive and many anti-estrogen treatments are available to fight the cancer on the hormone front. 

As I mentioned previously, the cancerous cells from my biopsy were submitted for genetic sequencing and while I was definitely excited and on board with this plan, I have mixed emotions about the results. First of all, it took about 3 weeks for us to receive the results, so it definitely delayed getting a new treatment started. Second, it turns out I have the same genetic mutations I did the last time my cells were sequenced in 2018. This leads me to wonder what the actual chances were that the genetic makeup (at least the genes that are identifiable at this point in time) would have changed and thus, was this test (and biopsy) even warranted? My evidence-based health professional brain says the chances were likely high enough to warrant the testing, but my singular patient, emotionally charged and frustrated-by-delays brain questions this. I will say the nifty feature of the genetic sequencing was that all of the FDA approved treatments and clinical trials for my specific treatment history, biomarkers, and mutations were listed in the results. This enabled me to compare what I had researched and the possibilities that my oncologist had mentioned with a meta analysis of treatments and evidence curated for the genetic fingerprint of my cancer.

The identifiable mutation my cancer cells continue to express is PIK3CA. I asked my oncologist what percentage of breast cancer patients expressed this mutation and he indicated that it was definitely over 50% initially, but many lose this mutation as the cancer progresses. He felt it was a good sign that I still carried this mutation. This mutation also means that I am eligible for many treatments. The plan is to start a new targeted therapy called capivasertib. Similar to the drug I have been taking for the past 6 years, palbociclib, this drug targets growth factors specific to breast cancer. Capivasertib targets something called serine/threonine kinase (AKT), a critical component in the signaling pathway that helps the cancer grow. Because my cancer is still fueled by estrogen, I will also change up my estrogen-blocking attack. I will take a drug called fulvestrant. We will evaluate how well this regimen is working with another scan in 3-4 months. We are hopeful that the tumor growth will stop at the very least, but hopefully even shrink.   

I feel well at this point. Changing medications is never without obstacles and I would not be surprised if I stumbled a little bit healthwise just adjusting. When I started my current medication, palbociclib 6 years ago, my immune system took quite a hit. For the first couple of years I would routinely have to take an extra week break from the medication because my white cell counts (and specifically my absolute neutrophil count, the cells most important to fighting infection) dropped too low. I also got a pretty intense respiratory infection and then the rib infection all within a couple years of starting the palbociclib. Things improved after time and it seemed my immune system developed some type of resistance to the medication as my white counts have been close to normal for the past 3-4 years. My hypothesis is that as my immune system was becoming resistant, so was the cancer. Probably a valid statement, but it makes me wonder if there is a legitimate link. Trademark that: testing whether white blood cell counts can be used as a surrogate marker for palbociclib effectiveness. You heard it here first. Anyhoo….long story short, I’m guessing my immune system and overall energy level will take a hit with a new regimen. 

I have been able to continue jogging, for the most part, and I’m hoping to complete the last 5 states of my race in all 50 states goal in 2025. I can’t predict how much longer I’ll be able to run and while I would still consider walking a race a success, it would be more enjoyable and feel like more of an accomplishment to be able to run (or slowly jog) them.  

More to come in 2025 as new treatments and hopefully adventures begin.