Sherri at Pennypack Trust

The native grasses are restless [Oct 27, 2013]

Chemo infusion number 6 is in the books, and it was a relatively informative day at the same time. Two horizons are coming into focus:

  1. The chemo is taking a toll on Sherri’s blood counts; not unexpected, but reaching the edges of normal limits.
  2. Results are back on the genetic profiling of the pancreatic tumors, with several interesting mutations detected.

Blood Counts: A typical chemo regimen is designed to put misbehaving cells in the cell block, but they say collateral damage of up to 20% in certain good-cell neighborhoods is inevitable.  So let me get this straight; cancer’s law enforcement accidentally puts 20% of your upstanding citizens in the slammer, and that’s normal? That would be like the Cancer Congress just arbitrarily furloughing another 20% of the essential workforce every two weeks. Oh, yeah.

So to be more specific, Sherri’s white blood counts are at the lower limit; hemoglobin, hematocrit, and platelets are below normal ranges; and red blood count is low. No surprise (that’s why they check it every time) and it’s not critical quite yet, but we’re trending toward shaky ground. So we’ll need to make a few changes. First up: skip an extra week before the next treatment.

Genomic Alterations: I was just thinking the other day: what if the excessive proliferation and tumor formation was due to the amplification or overexpression of ERBB2? Clearly a mutation in the kinase domain of ERBB2, such as in ERBB2 L755S, could be an activating mutation capable of inducing oncogenic transformation in cell cultures. Well it turns out I was right! And not only that, but it turns out she has the ERBB2 R678Q missense mutation within the cytoplasmic domain of the HER2 protein, in the region of the nuclear localization signal and the region required for interaction with KPNB1 and EEA1… I’m thinking that would be in the region of amino acids 676 to 689-ish… I kid you not! (well, no that’s a lie. I got it from the report. See below.)

There is quite a bit more of this in a 17 page report from Foundation Medicine, who conducted their FoundationOne™ screening. In fact, they detected several genomic alterations that have FDA-approved therapies in use for other (non-pancreatic) tumor types, and identified a number of clinical trials underway that apply them to pancreatic. All you biotech gurus, medical researchers and practitioners, and extremely advanced hobbyists that we are proud to call our friends, let me know if you want to see this report and I’ll email you a copy!

We are happy to have this information. Our village will find something useful to do with it!

Next Steps: We’ve moved the next chemo trickle charge to a different date. We are waiting three weeks instead of two, so the next infusion will be on Nov 21. Our hope is that this will give Sherri’s system a little extra time to boost those platelets back up (unless someone can bring us a wheel barrow of real marrow, and say it 5 times, quickly…). Also this change will reset our normal two-week cycle to be out of sync with Thanksgiving and Christmas, when we will likely be trying to venture out a bit.

In the meantime, let’s all set our clocks back at different times this weekend just to keep things interesting.

13 thoughts on “Horizons

  1. Go Science! We are rooting for a win! Mutations don’t stand a chance. Hang in there and stay strong! You are in our thoughts every day. Sending much love and strength ~ SJAI

  2. I am not sure if this works – but whatever Dave describes sounds a lot like controlling turbulence – excellent description – thank you Dave for helping me understand. So, while that is going on – maybe your head can be somewhere else? Trying to think what would actually be helpful. To begin, I can do a better job of reading this thread and listening for signs of pleasure – in spite of the internal turbulence. It does my heart good to know you are (at least occasionally) getting out in this nice fall weather – that has got to be good therapy – the opposite of something else. I wonder if I can think of others? It sure is quiet in Doering Center today – very quiet. Maybe I will make some noise today.

  3. Wheel barrows are not big enough. I am looking for dump trucks carrying marrow.
    Sending you lots of love!


  4. Love the photo of Sherri in the grass. That’s a lot of fancy talkin’, Coopy, but what I DO understand is that continuing love and support would be good. So you got it! Let’s trade those two empty pie plates for a full one — maybe Sunday? xoxo

  5. Sherri, Dave, & family, hope your treatments next week are without complications – we are still in Arnold MD if you find yourself down here at Hopkins and need a place to stay – we love you & know that you will receive the best care & treatments that are available – please let us know if there is anything that you need! Love, Kalla & Don

  6. Good to get an up-date, as I have been thinking of you all! Great to see the lovely picture,too! Again I have appreciated Dave’s writing style–clear, sharp, and filled with gusto! I will be thinking of you on the 21st! As
    I tell my kids, Soc it tu um! Be as strong as you can be! Prayers and blessings to you and your family!
    Jane knowing that Michael sends prayers, too!

  7. Glad you are being attended to by smarter minds than our. We became hopelessly lost in the Genomic Alterations discussion. What we do know, however, is that our prayers are powerful. And you all are being remembered daily by many here in NC. God bless you and guide you through these treatments. Great picture of Sherri in the grasses!

  8. Thinking of you as you face the next round tomorrow. We look so very forward to seeing you back at Camp Crofty next weekend, where we will be thankful for many, many blessings. Sherri, of course, being one for which we are particularly thankful! Hang in there, Coops! xo

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