A plan in place

We had a wonderful weekend up in Sharon. We had dinner Friday evening with Simmie, Ronen, Eliana, and Maya. Joshua joined Barry and me for lunch on Shabbat day, and the boys spent much of the afternoon sorting through the 2018 Topps baseball cards which have become an annual Chanukah gift for Joshua. After Shabbat, Simmie, Dina, and I had a “ladies’ night out” at J.P. Licks. On Sunday we took the three older girls to see “Early Man” (I’ll need to write a review). Yesterday we spent the afternoon with Julia, who is an amazingly entertaining little girl.

While we were playing with Julia yesterday, Dr. Iyer apparently tried to call. He is off at a meeting for the next couple of days but wanted to touch base with us before he left, so he sent the following via e-mail:

I wanted to let you know that the biopsy confirmed my suspicion that there is cancer within the lymph node that was sampled and that it is bladder cancer. I suspect that some of the lymph nodes may have already been involved at the time that you were receiving radiation therapy but that there was too little disease at the time to be detected by imaging. The nodes that are involved are mostly outside the radiation field as well.

I think we should move forward with immunotherapy with pembrolizumab as we had initially discussed. While there is a small risk (<10%) for serious side effects such as pneumonitis or other autoimmune conditions, I think that the potential benefits outweigh the risks. There is no absolute right answer in this situation so I think that as long as you are comfortable with the decision, we should commit to starting the pembrolizumab.

We have you scheduled to come in for a follow-up visit this Friday but I would like to go ahead and schedule the first treatment with pembrolizumab for then as well. 

Pembrolizumab is given every three weeks as an infusion. You may have seen commercials for this compound, which is marketed as Keytruda^®. It was first approved for treatment of melanoma, and later approved for a number of other cancers including bladder cancer that had progressed after standard first-line treatment. Recently reported results of the phase III KEYNOTE-045 trial versus conventional therapy for bladder cancer showed an improvement in survival when pembrolizumab was used as “first-line therapy” (the first course of treatment following diagnosis), which led the Food and Drug Administration to approve this use.

So here we are, just hoping for the best.

Love,

Rebecca