After performing tests and scans for several weeks, my first oncologist (Dr. M) provided a credible diagnosis of metastatic melanoma with active tumors in the lymph nodes located near my heart, in the upper lobe of my right lung, and in my adrenal gland.
Dr. M said that he prefers not to dwell on staging and probable outcomes. (I imagined that this would be a grim conversation.) We talked about available treatment options and how to work out which to select.
My primary physician (Dr. V) had stated that surgery was not an option – too many tumor sites, too close to my heart and major blood vessels. Dr. M confirmed agreed.
Dr. M provided the above treatment selection algorithm to inform the discussion. As shown by the highlighted decision path, primary viable treatments were:
Both options would rev up my immune system by increase tumor-attacking T-Cells in body tissues. In action, the fundamental difference is that IL-2 works by stimulating the production of T-cells (put foot on the accelerator), whereas IPI binds to the suppressor T-lymphocyte antigen-4 (CTLA-4), decreasing the dampening the action on T-Cell production (take foot off the brake).
Dr. M recommended IL-2 treatment under the care of an oncologist who specializes in this care. He explained that IL-2 doesn’t work in all cases, but when it does work, IL-2 is capable of providing a durable remission (many year remission) from metastatic melanoma. Ipi, when it works, is also is capable of providing a remission, but Ipi may provide a shorter remission. Side affects of IL-2 are reversible and less dangerous than Ipi. Treatment with IL-2 does not rule out nor negate future treatment with Ipi, should the IL-2 fail to subdue the tumors.
I appreciated this recommendation together with the clear reasoning and decided to proceed.
We met with Dr. C shortly thereafter. He concurred with the advice of Dr. M and recommended that we begin IL-2 treatment as soon as practicable. He warned that IL-2 treatment is rugged, meaning that it requires up to six weeks in the hospital, has several unpleasant side-effects, and provides no guarantee of success. He also stated that additional tests would be required to determine if I was qualified to take IL-2 treatment.
Additional physiological tests were performed to ensure that I was qualified for IL-2. These included:
- Pulmonary function (breath test)
- Cardio-pulmonary function (treadmill test)
- Brain MRI (scan for brain tumors)
Fortunately, I passed all these tests began receiving high dose Interleukin-2 infusion (IL-2) treatment in February 2014.
Treatment with IL-2 is just the first in a series of medical interventions for advanced metastatic melanoma. Please see blog posts for the latest story from my experience.