In the last episode, our heroine had been cornered by Peter Pancreas, a smallish villain who flits about undetected, then emerges from the fairy dust and strikes with random impunity. Shootin’ Sherri had deployed a Gem-Abrax nerve agent, but it was not effective on the elusive abusive. Faced with diminishing returns, she activated her trusty FOLFIRINOX belt as an interference tactic to confuse her foe while considering her next move. Momentarily disoriented by the fumes, she was still able to slip past the threat to continue the fight for peace and justice.
Meanwhile, Sherri’s trusted network of friends were back at the lab devising the next counterattack. Feigning sleep, SS fell into a trance and channeled the immunotherapy research machine. Scanning the vast universe of clinical trials, the network pinpointed several options that could advance her cause. Zeroing in on a promising technology she implemented a difficult mind-meld with the an-NIH-illator.
On Tuesday June 16, Sherri completed her 3rd FOLFIRINOX treatment since dropping the Gemcitabine-Abraxane cocktail that had failed to make any noticeable improvement. FOLFIRINOX is the same treatment that she started upon her initial diagnosis back in 2013. It worked then (although it became more toxic as time progressed), and it appears to be having some positive effect this time as well. Her CA19-9 marker, which had elevated up into the 900s, was back down in the 600s after two treatments. At the same time, we’ve been working on getting Sherri accepted into a new immunotherapy trial at the National Institutes of Health (NIH) National Cancer Center (NCC) in Bethesda MD.
Sherri provided me with some good drama for the blog this week. Anji and I were camping at Assateague Island in Maryland, and Sherri’s sister Sue was in Bryn Athyn to help out and accompany her to Fox Chase for a scheduled abdominal CT scan. During the few days prior to her appointment, she started to develop a fever, became confused, and had some trouble speaking clearly. On Thursday they went for the CT and met with Sherri’s primary oncologist. He indicated that the scan had shown improvement (!), shrinking the liver tumors substantially. He also admitted her to the hospital to check into the fever and confusion. We headed for home that afternoon.
Then things got interesting. By Friday morning, Sherri was incoherent in her speech and very shaky and unstable on her feet. The staff sent her for a head CT scan, and found a troubling shadow that they felt warranted evaluation from a neurology team. Their initial diagnosis was a stroke, but don’t worry this turns out okay! During an initial exam, the neuro team asked Sherri a series of questions and to identify left and right sides when they touched her arms and legs. She failed most of these tests, something like this: How old are you? (24) What year is it? (25) What is 3 x 3? (I don’t know). Show me your left pinky finger (holds up a peace sign with her right hand). It’s amusing in retrospect… But based on these indications, they confirmed the stroke theory and scheduled an MRI to get a better picture of what might be happening inside her head.
The MRI showed the same shadow, but clearly indicated that it was not the site of an acute stroke, and they could not find any other indications. In the meantime, she continued to move toward lucidity and by the afternoon she was correctly answering more complicated questions from her doctor: What genus am I? (homo) How many carbon atoms are in a glucose molecule? (6). I would have gotten these wrong, and been sent to rehab. It wouldn’t have helped me. The doc told her that she had scared the hell out of him, and he wasn’t alone. One new theory is that this was a reaction to the chemotherapy, so we’ll seek some additional opinions on that. She continues to show improvement day by day.
The new clinical trial is another immunotherapy that targets a PD-1 pathway in the immune system. There are quite a few of trials approaching this same pathway with different treatment variations. This one involves Medi4736 with stereotactic body radiation therapy (SBRT of pancreatic tumor). Medi4736 is an experimental drug developed by MedImmune, Inc. to target the protein PDL-1. The way I understand it, PD-1 is like a switch that can turn off your immune response for self-regulation, and PDL-1 flips the switch. The trial that we recently requested at Penn (where Sherri was not eligible) blocks PD-1, so the immune system can’t be switched off and therefore stays active. The NIH trial is to block the PDL-1 so it doesn’t turn off the PD-1 switch, which has a similar effect on the same pathway but using a slightly different mechanism. The radiation component is to damage the pancreas tumor to attract the immune system so it’s working where it’s needed.
This approach has been recommended by some of the best science minds we know – Sherri has reached out to contacts at leading university research centers (Penn, Hopkins, Duke) and bio-tech industry labs (Regeneron). They have communicated together about her case, and she has gotten a universal thumbs up that this line of treatment shows promise. It is not without risk. Still, she’s anxious to get started on or about July 15th, especially now that the severe neurological reaction is likely to be attributed to the chemo and does not put her at further risk in the trial.
It feels like we dodged a bullet this week. I guess it just highlights how fast things can change. Despite preparing for many scenarios we can think of, we still were caught off guard by this one. Nice to have another reprieve for the time being.
As always, thank you to our family, friends, and community for holding Sherri in your thoughts and prayers.