I vowed to take the heavier antinausea medicine. After that, queasy was the worst of it—and I have never been so grateful for queasy. How awful chemo must have been before the discovery of these more powerful medicines. The newer but more expensive drugs gave me, as they give many, a semblance of normalcy during a long stretch of toxic treatment.
There was something even more powerful that helped me get through this medical annus horribilis. The gene analysis showed my tumor matched the profile of those in the Toronto study that responded to chemotherapy. I wondered how it would have been had I gotten the opposite news. I would still want to know, I decided, but why, when it would only be a downer? I guess because I was already steeled for getting less favorable news, which I think is common when people first confront a cancer diagnosis. Perhaps a less positive gene reading would have influenced how I spent my time or increased my resolve to move sooner to more aggressive, experimental chemo with a bone marrow transplant. Maybe I would have opted for a lighter work schedule. But then again, maybe not—kicking back wasn't appealing under any circumstances, least of all the current ones. My family had to carry on with their lives, and I drew strength from knowing that I had to do the same.
I had my MRI scan after the first cycle of chemotherapy. It seemed as if a world of time had filled the eight weeks since my diagnosis. I was back at work, and life at home had settled into its old routines. I had successfully weathered one bout of bone marrow toxicity that troubled my bone marrow expert more than it did me. Relieved and hopeful, I felt that I could do this treatment and still carry on with my life as if I were entirely well.
But scan time brought me back to cancer's reality. My doctors warned me not to expect too much improvement after just one month of treatment, but this scan was still a kind of reckoning. There I lay, head rigid, arms fixed, eyes staring upward with nothing to see, encased in a sleek white sarcophagus.
I promptly came to life as the noise ceased and I was motored out of the narrow tunnel. There was my neurologist, Pat Sweeney, standing in the doorway right next to the computer console where the neuroradiologist was studying the scan. Sweeney flashed a big smile and held both thumbs up. I had won a reprieve. The drugs were working sooner than expected, and the second cycle looked like no big deal.
Speed bump. But things don't always turn your way in medical treatment. I hit a big speed bump early in my second cycle when I had a second and more serious run of bone marrow toxicity. Though I felt well, I popped an antibiotic to ward off infection, monitored my temperature, and gave in a bit more to the nagging fatigue of severe anemia. But I was buoyed by an even better MRI after cycle two, which showed that the tumor was seriously on the run.
My marrow, apparently, did not share my joy and refused to bounce back. Any more exposure to these drugs, and I ran the risk of doing to my marrow what I hoped to do to my cancer, turning marrow-filled bones into barren cavities. Here I was with a chemosensitive tumor that was melting away, and I could no longer take the miracle medicine that was doing the trick.
But by sheer luck something else was happening. Temodar (temozolomide), the new drug developed by Schering-Plough, had just gained Food and Drug Administration approval for use in brain tumors that had failed to respond to other treatments. It had a special knack for crossing the blood-brain barrier. And, crucially for me, Temodar delivered less bone marrow toxicity than PCV. I became one of its earliest users, and for the next year my scans steadily improved. Now this drug is recognized as a breakthrough in brain tumor treatment and is the first drug to be used routinely early in the treatment of glioblastoma multiforme, the most severe and common of the malignant brain tumors. For other, less common gliomas, like my oligo version, it's now standard care.