Tag Archives: SHP2 and lorlatinib

Like a whisper

“I came to live out loud.” Emile Zola.

And so I did. But over the past week or so I have been living quietly. Grieving, as yet another friend passed. A person too bright, too young, too loved. And yet, too soon gone.

Healing. I have a lot of healing to do. Physically and emotionally. A respite, if you will, before the next trial.

My latest scans were essentially stable. Not according to the radiologist, who saw progression. My oncologists always review the scans themselves, and Jess felt they were unchanged. I’ll go with her assessment.

As far as next course of action, I will likely enroll in the Lorlatinib/SHP2 inhibitor trial.

My big concern is that like binmetinib, a MEK inhibitor, SHP2 inhibition has the potential for retinal side effects. So that is an if for me.

However, by the time I would start, there should be several others enrolled and therefore additional data per potential adverse events.

In two weeks, I will check in with my team. In a month, scan again. And then, maybe, rock and roll.

In the meantime, this space traveler is enjoying the hell out of not feeling like shit.

And the goddess concurs

Alice called me today and we went over my scan report as well as my visit with Jessica Lin yesterday.

She is on board with a repeat scan in five weeks and then, almost certainly, a switch in treatment. Binimetinib plus lorlatinib is finishing up phase I so I would be entering at either phase IB or II. Most importantly, it will not preclude me from entrance into the SHP2 plus lorlatinib trial when that begins enrolling.

Her final assessment is that DS-1062a likely slowed down the pace of my cancer. However, given both the difficult side effects and the modest response, she agreed that it makes sense to give something else a go.

Not gonna lie, it’s always a bit scary moving from one treatment to another. And even though I am more than ready, progression is never a good thing.

Today I am totally wiped out but have also been wrapping my head around what is next. Back into the unknown. However, from this moment forward, I am focusing on recovering from yesterday’s infusion. Which is a postive.

Kumo is with his goddess, Susan. She spoiled him with long walks and a roasted turkey breast for dinner. I have been in my pajamas all day long–a rare but much appreciated luxury. My friend Diane came by briefly after her own scans the day before yesterday, and she dropped off a salmon filet which I finished this evening.

Thank the universe for good friends, stellar oncologists, and options.

xo

Game plan

My sense of where I am at and my scans are in agreement. And although I can continue to entertain the notion of free choice, Dr. Lin said today we were coming to that place where a switch in treatment is likely indicated.

First, the radiology report:

FINDINGS:

Lungs and Airways: There has been a prior LEFT lower lobectomy. Again noted are multiple peripheral nodules in the LEFT upper lobe the largest of which measures 1.5 x 1.3 cm on image 157 series, 4 unchanged from 9/15/2020, but increased from 8/3/2020 when it measured 1 cm. Other LEFT upper lobe nodules are stable in size and number. There is some persistent patchy enhancing 3 x 5.1 cm masslike opacification in the LEFT upper lobe image 245 series 4 that is also stable compared to the prior exam but slightly larger compared to 8/3/2020 when it measured 1.7 x 4.8 cm. While this may represent increased atelectasis, progression in consolidative tumor also possible.

There are multiple stable peripheral nodules in the RIGHT upper lobe and along the minor fissure. The nodule along the minor fissure measures 8 mm image 160 series 4. No right-sided new nodules are noted. No new nodules are noted. Airways are patent.

Pleura: There is a persistent loculated pleural effusion with increased loculation superiorly and posteriorly.

Of greatest concern is the (currently stable) spread to my right lung, the increased loculation of the pleural effusion, either greater consolidation of my largest (3 x 5.1 cm) mass or increased atelectasis, and the fact that one of the nodules in my upper left lobe has increased in size to 1.5 x1.3 cm from 1 cm when I was scanned on 8/3/20. Not rapid growth but also not slow.

The plan is to infuse DS-1062a one more time today. Scan in five weeks and revisit a decision then. The assumption is that I would start on a trial of binimetinib (a MEK inhibitor) and lorlatinib (ClinicalTrials.gov NCT04292119), but once the SHP2 plus lorlatinib trial becomes available, make a switch. Tell you what, I’m going to get a belt dedicated to trial participation, and start making notches on it.

So there you have it. No angst about throwing away a realistic option as my continuing progression concurs with my personal assessment. I asked about the side effect profiles of both binimetinib and SHP2 and am encouraged. First, they are oral medications (no more chemo!) and, as petty and paltry as this might sound, there is no hair loss. Goodbye buzz cut, hello curls, eyebrows, and eyelashes. Adios mouth sores. Hello my old friends diarrhea and constipation (manageable).

Of course, a new trial means more biopsies and initially more frequent visits. I’m down with that too.

Looking forward to a fresh start. I’ve got places to go and people to do! Kidding. I mean yes, once upon a time. But pandemic et al, you do you and I’ll do me 😉

But once I start feeling better (a forgone conclusion) and I’ve got my blond locks back, I’ll be back in the game.

xo