New old chemotherapy

The news this week of more tumor growth brought us to start treatment immediately. With the tumor growing, there’s no reason to wait. Last year’s chemo bought us only several months of stability, so Dr. Nghiemphu ruled out going back on Temodar. She recommended an older drug combination called PCV that’s coming back to use based on research published last summer. PCV chemotherapy is a series of Procarbazine, CCNU (Lomustine), and Vincristine doses that were the standard of treatment following surgery and radiation 20 years ago before Temodar was available.

A long-term study revealed that brain cancer patients with recurrent Oligodendroglioma who also have a 1p/19q chromosome deletion have fared well with PCV treatment. Since Susan’s tumor has oligo cells and her DNA is missing those chromosomes, she may respond well also. Our one reservation is whether her body can handle it after nearly 6 years of ingesting heavy-duty chemicals. We’ll need to watch for worsening blood counts and other side effects.

Meanwhile, she had one dose of oral CCNU this week, will go to UCLA next week for Vincristine IV, and then will start two weeks of oral Procarbazine. She’ll go back for Vincristine three weeks later, get labs done, and start the whole cycle again if her counts are okay. With PCV, CCNU, and UCLA for GBM, all I need to do is keep the acronyms straight.

Wednesday’s MRI also alerted us not only to tumor growth and brain swelling, but to enlarged ventricles. This indicates fluid build-up or hydrocephalus. We don’t know whether it was triggered by tumor growth or a failure of her shunt, but it we may need to have the shunt checked out. That could mean another surgery to replace the L-P shunt; but we’ll see. At any rate, between brain swelling and hydrocephalus, we need no other explanation for her present physical and cognitive weakness.

We’re so encouraged by people’s expressions of care and the many prayers lifted on our behalf. We remain secure in God’s peace and confident in his plans for us. I spent a good deal of the past month or so meditating on Psalm 50. As a writer, I’m intrigued by its verbal theme – God speaks. His word is powerful, commanding, and carefully used. But buried in there I found his valuable command. “Sacrifice thank offerings to God, fulfill your vows to the Most High, and call on me in the day of trouble; I will deliver you, and you will honor me” (Psalm 50:14-15).  

Again, it’s all about words: thankfulness, keeping vows, and crying out, which is a fascinating idea from the One who created the universe by speaking and whose Son is the Word of Life. But that’s to explore another time. God’s word to us here is simple: be thankful, obey, and cry out. His promise follows: he will deliver us. He also promises that we’ll honor him, a result that defines the right relationship with God.

We’re learning what it means to be thankful, to obey, and cry out, and we’re so glad for God’s faithfulness to deliver us. In that light, our circumstances don’t really matter.