Week 230: The end

Written by Lars Haakon Soraas
20
Jan

Week 230 in our war on lung cancer was the last one. Dyanne died on Saturday. Here is what happened:

  • As mentioned in the previous post, Dyanne spent around two weeks in hospital in the end of December and beginning of January. Shortness of breath and low platelets were the main issues. On 30th December she started on low dose, weekly, irinotecan (a chemotherapy). Things got a bit better and she was able to come home, albeit on oxygen and still very weak.
  • Things seemed to get a bit better for a couple of days, but then they gradually seemed to get worse again. The main issue was shortness of breath. Initially she could walk a bit around in the flat with a walker. Then that became difficult and we got a wheelchair for her to get around. Eventually even getting in and out of the wheelchair left her heaving for breath.
  • As followers of this blog knows, we measure the two tumor markers CEA and NSE regularly. Over the years they have given us a good indication of whether the cancer is growing or shrinking. We were keen to see how these developed after Dyanne started the irinotecan. We measured the two markers the day she started irinotecan (30th December), the day she got the second infusion (6th January) and again on Tuesday this past week (14th January). We believe these two markers correspond to two different cancer cell populations: one population expressing CEA which consists of lung adenocarcinoma cells, and one population expressing NSE which consists of small cell lung cancer cells. The results we got were interesting and, we I believe, revealing. CEA dropped from 134 to 54, strongly suggesting that the irinotecan was very effective at killing the CEA clone of cancer cells. NSE, however, rose from 826 to 1303, strongly suggesting the chemo was not doing much against the NSE clone of cancer cells. Charts of CEA and NSE are at at the bottom of this post.
  • Based on the CEA and NSE results, and the fact that Dyanne’s condition had gotten a bit worse, we concluded that if further cancer treatment was to make sense, we had to find a treatment that we thought could hit the NSE clone. Given Dyanne’s shape, the treatment could not be too harsh, and, preferably it would not have to involve travelling to the hospital. After some research and reaching out to our network, we concluded the best bet was a chemo drug called etoposide, which can be taken orally (capsules). The plan was to do 50 mg etoposide per day for 2 weeks, and then take a break of one week and then repeat. Dyanne wanted to try this and we managed to convince her oncologist to support it to.
  • Thus, on Wednesday in this past week, I collected the pills from the pharmacy and all was set for starting the treatment. To avoid any nausea and vomiting from the chemo, however, Dyanne took an anti-nausea pill just before she was to take the chemo pill. Due to the trouble she had swallowing pills, however, this rather large anti-nausea pill got stuck somewhere in her throat and this caused a bad cough, breathlessness and also a bit of vomiting. She then decided she had had enough. Enough suffering. Enough pain. She did not want any more chemo and she never took the etoposide capsule.
  • On Thursday her breathlessness got worse again. By the evening we called an ambulance and she was brought to the hospital. There she was put on more oxygen than our home devices could provide. This helped a bit. Blood tests suggested an infection and she got some antibiotics. On Friday morning her condition was bad and a decision was made to stop the treatment and let her die. She recovered a bit on Friday during the day, but then declined again in the evening.
  • On Saturday morning it was clear her last hours had arrived. She drew her last breath a bit past midday that day.

We lost our war against lung cancer. We lost Dyanne.

CEA, the yellow marker shows when irinotecan was started
NSE, the yellow marker shows when irinotecan was started

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