Of Guinea Pigs, Romance and Financial Advice

The Providence Cancer Tower in Portland

We had a busy two weeks. During the chemo-vacation, we were on two-weekly oncology visits because cancer can grow fast and unexpectedly. And so it did.  Our oncologist worried about the chest pain that seemed to be getting worse and the pain in my back and butt that did not go away. She went into full panic mode and when she does, things happen. A CT scan and MRI was scheduled for the next day and we came back two days later to discuss the result. The news was not exactly what we wanted to hear: the bone cancer had spread to the right hip and the damage in the lung had enlarged and is now diagnosed as cancer as well.  That was a bit of a bummer, but amazingly there are still a few choices left: we could switch to a pill based cancer drug called Tarceva which can delay cancer growth and add some time to the good life we are having without too many side effects. Alternatively we could participate in a clinical trial of an immunotherapy drug that is in development.

Our Oncologist

I had read about immunotherapy drugs and knew that every major pharmaceutical company is racing to get these kinds of drugs approved. We are fortunate to have an oncologist who is a leading scientist in the field of Lung Cancer Research and supervises one of the three test legs for Bristol Myers Squibb. She thought I could qualify for the clinical trial and we started the paperwork immediately. The test protocol requires a number of tests that had to be completed before acceptance and that included another MRI in the afternoon; a biopsy of lung tissue on Monday; a CT scan and a bone scan (that requires an infusion of radioactive material – our toilet now glows in the dark) as well as an X ray on Tuesday and too many blood samples to remember. On Wednesday we went to the hospital to check if any of the tests had disqualified my participation, and when that was not the case, the first infusion started right then and there. 7 hours later we walked out of the hospital as an official Guinea Pig with the new drugs infused and hopefully they are now killing some cancer cells.

Portland and Mt Hood

Hilton Portland

In the middle of all that medical ado, romance was flourishing. On a beautiful Saturday, March 22, Bonnie and I celebrated 45 years of marital bliss with a romantic date in Portland. The afternoon started with an exquisite lunch in restaurant Andina, according to Urban Spoon one of the top 5 restaurants in the city. For the Philadelphians: this is the Peruvian equivalent of restaurant Amada: it cannot get any better than that. This was followed by a white wine tasting in the Hilton, and a classical concert in the Arlene Schnitzer Center. Bonnie was a little disappointed she was not called on stage this time but other than that the concert was perfect. Afterwards there was, of course, a tasting of the regional red wines and snacks before stumbling into our room at the Hilton.

Ferry Street, Eugene Oregon.
Bert Versteege, Eva Ouwehand, Phocas Savenije,
Larry Lissman, Lydia Simoneau and the
gorgeous bride

45 years of marital bliss: March 22, 1969 and March 22, 2014

About the new cancer drugs:
Immunotherapy is probably the future of cancer treatment. Whereas traditional cancer drugs target and kill all kinds of fast growing cancer cells (and hair is one of these fast growing cells, that is why you lose it), immunotherapy enables the patient’s own immune system to selectively kill cancer cells.  The system would always do that, were it not for the fact that cancer cells bind certain proteins, which make them appear as normal cells. Pharmaceutical research is now focused on removing the proteins from cancer cells so that the immune system’s T cells can - chomp, chomp - eat the cancer cells. It was first discovered in Melanoma (the deadly form of skin cancer) treatment and Bristol Myers Squibb has an immunotherapy drug on the market that shows a spectacular improvement in 3 year Melanoma survival rate. At $120,000 for 4 injections there better be some improvement. Lung Cancer is the most common form of cancer (over 200,000 cases in the US every year) and that is where the real money is. It is no surprise that the immunotherapy concept is now being applied to lung cancer and Bristol Meyer Squibb (BMY), Merck (MRK) and Roche are apparently the front runners. The Phase 1 test in which I participate is a combination of two drugs that are given intravenously every two weeks (Nivolumab) and four weeks (Lirilumab) to remove 2 different proteins from cancer cells (PDL1 and KIR). The Wall Street Journal estimates the price of this drug, when approved, to be $ 220,000 per year and that times 200,000 new cases per year translates to $ 40 billion in sales. Ka-Ching..! With the many uninsured people in the US, it will not go that fast, but according to the WSJ, Bristol Meyer Squibb could add another 6 billion sales in three years, which is a significant increase compared to the 30 Billion Sales they have now.  In my hospital, 8 patients were already in the clinical trial when I started. The wife of one of the patients wrote in a web forum that her husband had a 41% reduction in tumor size after 8 weeks. Wow.  I don’t know about the other 7 and the medical staff will not discuss patients. However, as long as you see new installments of this blog, BMY shares look like a winner. If the blog suddenly stops, it may be time to sell.

Since this is a public blog, the above is not investment advice, we do not currently own BMY and you better do your own DD.

Spring is arriving

Medical Update

The medical situation is good but a little confusing. The last chemo infusion took place on January 21 2014. Four weeks later I had my usual CT scan and visited the oncologist one day thereafter to hear the results. The good news was that the tumors had not grown and some previously found cancerous lymph node in the abdomen was apparently cancer free. The CT scan also showed that a large part of the right lung was dysfunctional, which is noticeable because climbing a flight of stairs leads to heavy breathing, and not for the reasons one likes to. The oncologist could not tell whether the damage was due to delayed scarring from radiation, or a reaction to the docetaxel, the chemical compound that was infused. She decided to withhold any treatment for the time being and I have been on a chemo-vacation for the past 3 weeks. That certainly improved life: Hardly any coughing, a little more air, and no annoying side effects such skin rash or itching. My hair is starting to grow again and I had to be retrained in the art of shaving. I have been to the oncologist’s office for a checkup meanwhile and I will stay off medication, probably for another 4 weeks.  This is good. Spring has arrived, the temperature of the rain is increasing and I will not be house bound as I was during the winter.

Snow travel

Since the last blog, we had our week vacation in Maui. Leaving for Maui turned out to be a challenge. The first three days of snow and sleet this year happened exactly at the time we had to leave. We took one snow shovel when we moved from Pennsylvania and that is the only snow equipment in the entire neighborhood. Bonnie’s water aerobics training was put to good use when she managed to clean the driveway to the top of the road, only to find out that the homeowners association decided to save some money by not clearing the roads in the development itself. The next day we had another dump of snow and even our all-wheel drive car would not have made it up the steep driveway. Josh saved the day. He bought two extra snow chains for Sara’s all-wheel drive swagger wagon, which now had snow chains on all four wheels, and was able to rescue us. We left the night before the flight and we all stayed at a Portland airport hotel because there was an ice storm forecast for the day of departure. The fact that the plane was completely full is a miracle: there was indeed a thick layer of ice on the ground and travelling was not easy.

Maui

The week in Maui was, of course, fantastic. Sara and Josh had arranged a nice apartment with a studio attached. Nice sunny weather, palm trees, beaches, swimming pools and beers in lounge chairs: what else does one need in life? This was perfect. The grand kids had a ball and kept parents and grandparents to a lesser extent, busy in swimming pools and on beaches.

Grand-kids waiting to feed Koi fish

The kids participated in feeding fish in the koi pond at the end of the day. Other activities included snuba diving in the ocean, surfing, football in the pool, spa visits by the adult women and very little shopping: I call that a successful vacation.

dinner and umbrella drinks

Surfer Babe

Valentines Day was celebrated in style. Bonnie and I drove to the other side of the island and had lunch at "Mama's Fish House", probably the most famous fish restaurant on the entire island and romantically situated on a palm beach.

grinning on a selfie

The food was exquisite. Fish caught around the island was freshly served the same day but to my dismay that included Opa or Opah as it spelled in Hawaii. The kids were quite amused that Opa was served pan-fried or grilled.




Spring and visitors are coming

The fear for a drought in Oregon was premature. The precipitation we lacked early in the rain season came down in buckets in February and March. The reservoirs are full to capacity and the snow level is back to normal. The temperature is increasing and most days we get to 50F or higher, but often with rain or showers. Plants like that, people not so much. The signs of spring approaching are everywhere and we enjoy seeing the first flowers but we especially enjoyed the first visitors this year. Jacqueline visited us the first weekend in March. It was an enjoyable and relaxing couple of days with few excursions. Tammo and Aafke arrived the next weekend for what I thought was going to be a weekend of strenuous projects around the yard. The rain however provided an excuse for a lazier visit but in between showers a big pile of firewood got transported to the garage.

A star is born

Tammo, Aafke, Bonnie and I went to the Keller Auditorium, the biggest stage in Portland, to see the Blue Man Group, who were touring the pacific Northwest. The show was humorous and spectacular and we enjoyed the performance. As professional and talented as they are, their performance paled in comparison to Bonnie's on stage performance. Out of a total audience just shy of 3000, the group needed one member of the audience to help their skit. They of course looked for the best dressed and most elegant spectator and zeroed in on Bonnie. She was helped on stage, asked to wear a blue bib, and take a seat at the on-stage dining table with the three blue men. In the skit they were supposed to eat Twinkies, a gooey sweet concoction, guaranteed not to contain any natural ingredients. This is of course not on Bonnie's diet plan, and that added to the length and fun of the skit. She later ate some of the banana that was on stage and her bib magically started spouting some kind of goo. After about 15 minutes, Bonnie was still having way too much fun and the blue men had to gently push her off stage and back in her seat. Everybody liked it and she got a big applause and credits at the end of the performance.

Finally:

Yesterday I had a health visit with the Pulmonologist, the poor guy who drew the short match and had to give me the "you have cancer speech" when it was first discovered. He remarked that it has been close to a year and he considered that "quite a feat". Good. I like to know which superlatives he will use when we meet one year from today.