Wednesday, June 29, 2011

In-N-Out Surgery

Met #11 was removed without incident yesterday. I'm fortunate that Dr. V doesn't hesitate to do these excisions in his office, which saves all the hoo-ha of surgery in the hospital OR. Including time to prep with local anesthetic, I was in and out of the procedure room in 30 minutes. If I’m going to be cursed by these recurring metastases, it’s at least a small blessing that most have required only minor surgery. I’ve had dental visits that caused me more grief.

We are, unfortunately, still talking about cancer. Before going to OHSU for my surgery, I had a 45-minute consultation across town with my oncologist at Providence Cancer Center. With new drugs available for metastatic melanoma (see previous post), I was eager to get Dr. C’s take on the best strategy for me, should I need systemic treatment. I’m hoping to delay that indefinitely, but I'm told that the cancer eventually progresses in most stage IV patients with recurring subcutaneous mets (as mine have all been). There’s no need to pursue therapy unless there’s sufficient “tumor target” against which drugs can mount an immune response. But you also don’t want to delay treatment until your general health is seriously compromised by a large volume of cancer in the body. The met removed from my upper left arm yesterday was only about 6 mm in diameter, which is pretty small by oncology standards. A delay strategy that relies on surgery alone prevails for now.

Dr. C said that he and other leading melanoma specialists from around the country met at the big oncology congress earlier this month to reach consensus on what first-line treatment for MM should be. By an 18-2 vote, the “melanomologists” agreed that interleukin-2 should remain the treatment of choice for most patients. The jury, in other words, is still out on Yervoy, the just-approved drug that has launched a thousand medical articles in the last few weeks. It has promise, based on recent clinical trials, but lacks the years of clinical experience that oncologists have with IL-2. Yervoy also costs about three times more, which is not an irrelevant consideration. The drug companies appear to be doing their part to bankrupt the healthcare system.

As for the lymphedema in my left ankle, neither docs seemed perturbed by it. They both advised I keep my leg elevated, as much as possible, and that I keep wearing the elastic stocking. The swelling should eventually ebb. And if it doesn’t, there are certainly worst things to worry about.


Anonymous said...

While the drug IL-2 may cost less than IPI, overall the treatment ends up costing more due to the need for inpatient care. My 2 weeks of inpatient IL-2 treatment and the required pre and post tests (stress test, CTs, Bloodwork, etc cost roughly $250,000! Yervoy on an outpatient basis, side effects and all still allowed me to work full time and cost less overall. When considering treatment costs, more than just the drug needs to be factored in. Just another consideration when making a systemic treatment decision.

Peter Ogle said...

Thanks for noting that. The overall expense of IL-2 treatment helps to account for Roche's pricing strategy for Yervoy. It certainly provides them cover for arguing their financial case with Medicare.