May 20, 2023. Stable. That’s my excuse for the long gap since my last post about a month ago. The most recent CT scans were good. The radiologist’s impression was:

“Compared to 4/5/2023, stable burden of multiple irregular pulmonary nodules, consistent with stable intrathoracic metastasis.”

In other words, there are no growing nodules. And (this is a BIG “and”) “previously described lingular nodule is not seen.” Which means the nodule in my left lung is undetectable. The nodules in my right lung have not changed in size since my CTs on February 22. They aren’t getting smaller, but they aren’t growing either. Stable.

So, in the grand scheme of it all, I’m doing great. That’s not so say that there have not been any hiccups.

When you are being treated for cancer (or any disease, I imagine) that involves infusions, there is more to it than sitting in a chair, having your port accessed, and getting the prescribed medicines infused. It also involves getting medications prior to the immunotherapy/chemotherapy. Some are taken orally, some are pushed or injected through the port, and others are infused. Until my most recent visit on May 10, I was given the antihistamine Benadryl (orally) to help relieve potential allergic reactions to the therapy, the steroid Decadron (pushed) for nausea, the antacid Pepcid (injected) to decrease stomach acid, and nausea blockers Zofran and Cinvanti (the first blocks the action of serotonin while the second blocks the action of neurokinin, both natural substances which cause nausea and vomiting).

Once all the premeds are given, they have to precolate in my body for half an hour. They are like the appetizer before the main course. The expectation is that after your infusion you shouldn’t feel nauseous for at least a couple of days. And, if take you take your prescribed anti-nausea medications prophylactically you can usually stay ahead of any nausea until the next treatment.

In my case, I feel slightly nauseous most of the time. That is the reason I’ve been given Cinvanti since nearly the beginning of the study. The theory is that it will keep nausea at bay for a couple of days at least. It worked pretty well, until it didn’t. Cycle 5, Day 8 was the first time I suspected it wasn’t preforming as expected. Within minutes of having the Cinvanti push, I felt somewhat nauseous. Honestly, I just didn’t feel good at all. I attributed it to the fact that I hadn’t eaten anything prior. So I didn’t say anything to my care team. I made a point of eating some carbs prior to getting any premeds on Cycle 6, Day 1. But again, after the Cinvanti, I felt yucky. The yucky feeling lasted for several days. At this point, I let my UCSF care team know that I wanted to discontinue the Cinvanti and explained why. Silly me, I thought it would be as simple as that. Continue getting what I was getting at each treatment sans Cinvanti.

Instead, after a care team powwow, they asked that I consider replacing the Cinvanti with Emend (also a neurokinin action blocker) and rather than getting the premed Zofran replace it with Aloxi (a longer acting anti-nausea medication). Also for five nights I was to substitute my nighttime anti-nausea med Lorazepam with Olanzapine (typically prescribed as an anti-psychotic, but in low doses is effective in treating nausea). I agreed.

The Emend and Aloxi worked great for me. Since my last treatment on May 10, I have not felt any nausea. The Olanzapine, on the other hand, made me feel jittery, off balance, a bit buzzy and gave me insomnia. On night three I took a half dose, and I still did not feel right the next day. So I simply switched back to lorazepam and feel so much better. Good energy. Good sleep. Just plain good.

This Wednesday will be Cycle 7, Day 1. On my last visit, I asked how many cycles there are in this study. The surprising answer is at least 20. That’s right. Twenty. That takes care of 2023. But, if I continue to feel good, and I continue to respond well to treatment, this old lab rat will be content to be stable.