Final Path

Nearly three weeks have gone by since surgery, and last week marked the official passage from the long winter into Spring. The daffodils have made their appearance, and the weather is noticeably warmer these days. From a surgical standpoint, it feels like my recovery is on track if not ahead of schedule. I truly believe the prayers of a thousand carried me through along with the presence and practical help of my sister, brother-in-law, best friends, and church members. I haven't had to make my own meals since January. Flowers decorate my home space, and the cats have been keeping me company on quiet days, often luring me to long naps. After attending church yesterday, I slept for three hours in the afternoon and still slept overnight.

The final path report came within a week after surgery. I was disappointed to see that it revealed a small amount of residual breast cancer in the tissue (0.3 cm) which was removed. This amount of minimal residual disease is called RCB1. After three months of tough treatment, plus an MRI report which recently showed the disappearance of the abnormalities, I had been hopeful for pathological complete response (PCR). I went back and reviewed the chart of a 48 year old patient of mine who died of breast cancer in 2021. She had similar tumor biology but more remaining cancer and positive lymph nodes after surgery. She was treated with the dual antibodies after this finding. It took only a few years for her disease to recur, and when she passed away, she left behind her husband, children, sister and parents. I felt fear and grief anew over the the loss of my patient and the 3 mm bit of cancer remaining on my pathology slides. I had a good cry and a time of prayer with my sister on the day she was leaving to go back home.

A review of medical research articles proved more hopeful, one of which showed overlapping disease-free and overall survival curves between RCB1 and PCR, survival of close to 90%. A note to my oncologist confirmed that the treatment strategy would need to switch to an antibody-drug complex called T-DM1 or Kadcylla. A study recently found T-DM1 to educe risk of recurrence or death by 50% when compared to the dual antibody approach for people like me who still had some cancer left on the final path. 

Starting at the end of next week, I will be starting every 3 week infusions of Kadcylla for a total of 14 doses. It will span into next year if I am able to continue to tolerate the medication. Main serious risks are to the liver and heart, but these side effects are rare. Digging into the detailed side effect list of this drug has been daunting; though, I am glad not to have to restart the antibodies, as that treatment caused everything to run right through me for months. Because tiredness is common, I am going to have to keep making room for this. I plan to  work at 80% of my normal schedule through the end of next year. Last time I had cancer, it took at a couple of years to recover energy after the end of chemotherapy. I am 15 years older now. 

On a spiritual level, I believe this is a season of growth for me. I have more compassion now for those who are afflicted with colitis or other forms of chronic diarrhea, for those with severe dry eye syndrome or visual loss, for those with low energy who normally have to go to sleep after work, for those unable to lift more than 5 lb, and for those who have to live with the uncertainty of cancer. For Christians, this season of Lent is a time to reflect upon the suffering of Christ and to turn away from selfish and sinful ways. It is almost three weeks in, about halfway through leave from surgery, and I am just getting to the point of being able to reflect. In God's economy, no suffering is wasted.