Game Plan

It felt like today would never come. Today Bow got into the oncologist at UTSouthwestern. The doctor was very helpful and hopeful. He was very positive. Here are the notes taken from today's appointment in bullet point. What we know today... 

• Melanoma is a mimicker of other diseases 
• More than a dozen spots on his lungs 
• Possibility (small chance) lungs is melanoma and abdomen area is renal cell 
• PET scan recommended
• After consulting with the tumor team (can they come up with a better name? maybe fight team?!) they have decided to biopsy mass in abdomen area to confirm that cancer- doesn’t need this done before starting treatment 
• If abdomen mass is renal cell it may be a potential to remove 
• Immuno therapy, approval from insurance and then can start (maybe by the end of the week?!)
• Immuno Therapy: Single agent- 1 drug or combination therapy treatment which usually has a better response. Combination therapy does have higher side effects (autoimmune side effects- 90% can treat side effect effectively) After his appointment the nurse messaged and they decided he will go the combination route giving him Opdivo and Yervoy. This will be given every 3 weeks for 4 treatments through an IV. 
•  Labs before each treatment. See doctor and then infusion about 2 hours. 
• 12 week treatment willl be followed with single Opdivo every 2 weeks. No set answer for how long. Depends on side effects and response. 
• Melanoma b raf mutation. Test to see if he has this mutation. Good to know if he has that. Oral drug that will attack that mutation and help the cancer stop growing if he has that mutation. Will use tissue already taken to test. 
• Will play close attention to lymph nodes  but is just another spot but doesn’t make it worse 
• Only thing will change is if it goes to his brain- symptoms: headaches, double vision, nausea 
• Combination therapy is also used for renal cell if the other mass is renal cell 
• Stage 4 melanoma- incurable. Won’t get rid of cancer completely. Too early to tell prognosis. Treatments can give years and normal activity.
• Choose an aggressive treatment to match the aggressiveness of the cancer 
• Went over pain meds- he will call in 
• Watch swelling of right leg. 

Doctor called after talking to the tumor board: 

Will do a biopsy of the mass in his abdomen. 

Combination treatment- will “flip dose” which will help decrease some side effects.

Should have same response rate with less side effects. Same dose for renal cell so it will still cover that cancer and continue if the biopsy comes back that he has both cancers. 

Schedule for infusion as soon as insurance approves. Hopefully this week! 

Bow and Rosa continue to be overwhelmed by the kindness and love they have been shown. They know they are not alone and have a huge tribe on their side.