Week 96 and 97 in the war on lung cancer has passed. Here are the highlights:
- Dyanne went to Frankfurt and started on the new version of the personalized peptide vaccine. The two old versions of the vaccine included 13 peptides. The new version of the vaccine includes some of the old peptides (the ones which induced an immune response) and around 20 new peptides as well. In addition, the long peptides in the new version of the vaccine are longer than the long peptides in the old vaccine cocktails. The new version of the vaccine is split into four cocktails, which means Dyanne received no less than 4 vaccine injections every time she is in Frankfurt. On top of this, she also got low doses of nivolumab and ipilimumab.
- We have found out that the tetrathiomolybdate (TTM) that we ordered from a pharmacy in Denmark was no good. TTM is not a standard and approved medicine, but a special drug that is made by what is called a “compounding pharmacy”. We have ordered from a pharmacy in Wisconsin before, but for various reasons, we were hoping it would be possible to get it produced here in Scandinavia. Turns out the pharmacy in Denmark was not up to the task and the products they sold us basically was very poor quality. As a result, Dyanne’s ceruplasmin level (a measure of copper in the body) shot up above the range we want it to be in. We have now switched back to the Wisconsin TTM and trust it will work better.
- Due to the unwanted break from proper quality TTM, which meant Dyanne now has to take higher doses of the Wisconsin TTM to get back in the wanted range, and potentially also the immunotherapy received in Frankfurt, Dyanne has had some stomach issues the last couple of weeks. She also still has some balance issues and she has been a bit tired.
This coming week Dyanne will do new MR and CT scans. We will learn the results the week after. I will go to a cancer symposium in Barcelona which is organized by the great Dr Rafael Rosell who, together with his colleague, Dr Niki Karachaliou, have given us tremendous help and advice in the last two years. I am also invited to give a short talk at the conference.
I have been doing some research the last couple of weeks trying to understand better what causes EGFR mutant lung cancer (the type Dyanne has). In this research, I have come across some very interesting research on the more generic question: what causes cancer in general? One line of thought (championed by Professor Bert Vogelstein of Johns Hopkins and others) is that cancer in most cases develops due to random mutations which occur when stem cells divide. Another line of thought is that cancer should be (championed by, amongst others, Dr Robert Gatenby of Moffitt in Florida) be viewed as a biological system where traditional, well-known, Darwinian evolutionary dynamics play an important role.
The views of Gatenby and Vogelstein can, perhaps, be viewed as competing. However, maybe uniting these two viewpoints provides the best path forward to understanding how and why cancer develops, and implications this may have for treatment. A researcher who seems to be exploring this path is the Dr Miguel Lopez-Lazaro who is based in Spain. I only discovered his work a week ago, but I find his writings very convincing. For anyone who wants to have an up-to-date understanding of cancer for this summer’s beach parties, I can really recommend this working paper by Dr Lopez-Lazaro: Understanding Cancer: 15 Questions and Answers. If you read and understand most of this, I believe your understanding of important aspects of cancer will be better than that of most oncologists. Enjoy!