Moving Forward

First I should mention that after Mark's Gamma Knife procedure, he returned to work the very next day (we all saw the pictures of what the procedure entails). Even though he should have taken the day off to give his body some much needed rest and healing time, he was thinking long-term and knew that there was a good chance he will need each and every one of his vacation days with future treatment options. While he wasn't feeling like himself for most of the day on Saturday, by Saturday night he was up and at 'em and they went to Applebee's to watch the Browns preseason game.

Today's Appointment

Mark and my mom met with Dr. Kendra and her intern today, as planned to discuss his treatment options for the remaining six tumors in his lungs and one in his brain. The intern, with whom they were impressed, explained that his frontal lobe tumor, the one he hasn't addressed yet, is an active tumor and has a blood supply. It is something they need to be mindful of and watch for any symptoms.

Although they left with somewhat of a different plan than I think Mark was expecting, they both agree with Dr. Kendra's assessment and reasoning and feel good about the plan in place. As I had mentioned previously, Mark was hoping to enroll in another immunotherapy clinical trial. The trial would be a combination of two drugs: Illpillmunimab (immunotherapy) and Temodar (chemotherapy by pill). Dr. Kendra explained several things regarding this clinical trial. First she explained that Mark would not be eligible for the trial since he has already taken Temodar before and this is one of the stipulations for the trial (there are always a lot of criteria that need to be met in order to be eligible for clinical trials). Dr. Kendra also explained that it is only a phase 2 clinical trial, meaning there isn't any evidence yet that these two drugs work together. There is, however, evidence that they both work when taken alone and somewhere down the road, Mark might need to try the Illpillmunimab alone.

For these reasons, and the fact that Mark has already had success with Temodar, Dr. Kendra recommends that Mark start taking this chemotherapy pill Temodar for three months to try to decrease the size of his lung and brain tumors. Mark hopes to start taking the drug in a week or two, once he settles things with his insurance company and makes sure they will cover the drug. If not, he's looking at over $10,000 for three months of the drug which just isn't feasible for them. So fingers crossed that insurance will cover it! After a preliminary discussion with his insurance company, it looks like Mark will have to pay the first $650 out of pocket for the Temodar and then insurance should cover the rest but nothing is finalized at this point.

Once Mark starts the chemotherapy, he will take the pills for 5 days, every four weeks. After three months of taking the chemotherapy pill, Mark will get re-scanned. Dr. Kendra will be looking at the results of the scans to see if the tumors are stable (meaning they haven't changed at all) or have reduced in size. If she sees either of those results, Mark will continue on the Temodar. If the tumors have changed at all for the worse, she will take him off the drug and will probably recommend that he tries another drug in combination with Temodar.

The Temodar will not only impact the tumors in his lungs, but will also fight the lingering tumor in his brain. As for the spot under Mark's arm, the reason he initially pushed to get those scans in July because he felt it increasing in size and causing him pain, Dr. Kendra believes it is just fluid and nothing to be concerned about. Thank goodness for that fluid, though, because otherwise Mark's scans wouldn't have taken place until today and who knows whether or not that tumor in his brain would be worse by now. I think the fluid in his arm was his body's way of saying..."Hey buddy, something's going on in here and you better get it checked out!"

Neither Mark or my mom really remember how Mark's body reacted to the Temodar drug the last time. I thought I remember him being extremely nauseous the 5 days he takes the drug and then a few days after. I guess time will tell for sure. In addition to the Temodar, he will need to take an anti-nausea medication (which wasn't covered by insurance the last time). He tried several different kinds and the only one that actually helped the nausea was the one insurance doesn't cover. Go figure.

I will keep you updated as Mark battles the insurance company about the Temodar and when he will officially start taking the drug.

Thanks again for the thoughts and prayers!