Last Thursday, April 5, 2012, Lisa had the first set of CT and MRI scans since her neurosurgery in January. On Monday, we met with her neurosurgeon and her oncologist at MGH to discuss the results.
Her neurosurgeon said that her brain MRI “looks perfect” and “wouldn’t want it to look any different”! The surgical site looks great and there are no new lesions. The small 6mm area of concern hasn’t changed since the last scan leading him to think that it may not be a tumor after all. This was great news! He felt that the brain tumor issues are behind us and she’ll just need to get a brain MRI every 3-months to keep an eye on things.
With the brain metastases under control, the focus comes back to systemic treatment of the disease in the rest of her body. Lisa’s oncologist is driving that bus so we stopped by her office to discuss the latest CT scans and the next course of treatment.
When analyzing CT scans, doctors look for abnormalities in the current scan and then differences between the current scan and the previous ones. In particular, they look for areas where known disease has enlarged and they look for new abnormalities.
The good news is that Lisa’s latest CT results showed that disease at known sites (chest, lungs, various bones) is stable and has not grown any bigger.
The bad news is that there is a “new enhancing mass in the left superficial parotid gland”. The parotid glands are the largest salivary glands. They sit in front of the ear and over the jaw joint. “New enhancing mass” means that there may be a new metastatic tumor in this area. We won’t know for sure if this mass is cancerous until they do a needle biopsy sometime in the next couple weeks.
We were not surprised by this news since Lisa has been feeling sore in this area since before her brain surgery. But over the last two or three weeks it has been getting progressively worse. So much so that she now has trouble hearing out of her left ear. The soreness has been progressing toward her throat and starting to interfere with her swallowing.
According to Lisa’s oncologist, the best treatment option for her at this time is to enroll her in a MGH Phase III clinical trial of a drug called T-DM1. Trastuzumab emtansine (T-DM1), is an exciting, new anti-cancer agent that combines Herceptin with a chemotherapy drug (DM1). It delivers Herceptin and chemotherapy directly to HER2-positive cells (the type of breast cancer that Lisa has) limiting the rest of the body’s exposure to chemotherapy. She signed up for the trial and her treatments will begin in May. Between now and then she will undergo several medical tests to establish a baseline for the trial.
Besides the soreness on the side of her face, Lisa is doing fairly well. Her balance and strength continues to improve. Fatigue, which is a long-term side effect of whole brain radiation, continues to be an issue. She still has her southern accent, which I think is pretty cool. Conversations with unfamiliar doctors, nurses, and technicians go something like this:
“Where are you from?”
“No, really, where are you from?”
“I knew it!”
Well, that’s it for now. See ya’ll later!