Memo: Phase 2 Treatment Plan – April 2021

We had to move. That was the message delivered to us on March 17, 2021 by April’s Mayo Clinic oncologist. April’s stage four breast cancer had leapt over the protective walls of her phase one treatment and had spread to her liver and lungs. Because the cancer only manifested itself through small amounts of fatigue, April and I had not anticipated the coming news. Still, we needed to move and move quickly. Here is why:

Why the Move?

The first phase of April’s cancer treatment attempted to starve April’s breast cancer to death. Because her cancer is hormone based (ER+ PR+ HER2-), her doctors sought to eliminate most of April’s hormone supply through the removal of her ovaries. Though this surgery significantly lowered the amounts of estrogen and progesterone pumping through April’s body, small amounts of the hormones still moved about her blood stream, providing her cancer with a meager supply of food. To keep the cancer molecules from eating, April took two pills, Letrozole and Ibrance. They were designed to plug up the cancer’s receptors or mouths.

ER+ PR+ HER- Cancer Cells

For the past 22 months, the phase one treatment plan proved effective. Lacking the ability to consume April’s hormones, the cancer cells began to shrink and eventually stabilize. April regained both energy and mobility.

Though April had begun to push the cancer out of her body, her cancers cells did not give up the fight. As soon as the Letrozole and Ibrance fenced the breast cancer off from April’s hormones, the cells began rummaging through April’s body in search of a new food source. Looking back through April’s blood counts and scans, her Doctors think her cancer could have found its new food source by November 2020. As the cancer cells grew in strength and size, they began to once again travel up and down April’s blood stream, forming the tumors in April’s liver and lungs that appeared on her March 2021 scans. The mutated cells have also begun to reinvigorate the old tumors, teaching them how to adapt to the new food source. In short, April’s phase one medications can no longer stop her breast cancer from growing. If April does not move onto a new treatment plan, her breast cancer will take over her body.        

What’s Next?

After consulting with April’s UVA and Mayo medical teams, we decided to drive past the standard of care option usually tied to phase two treatments and explore experimental treatment options.

Though turn-key ready, most of the houses in the phase two neighborhood house patients for an average occupancy of six months. If April and I decided to relocate her into the Faslodex treatment plan for example, she would most likely have to move to a new treatment plan before the end of 2021. Though we are thankful for the advances in the standard of care options, we dislike discussing turnaround times of less than a year.  

Thankfully, we were not alone in our assessment. April’s Mayo and UVA teams encouraged us to pursue other options. Over the last three weeks, April and I have been exploring clinical trials located at the Mayo Clinic in Rochester, the Dana-Farber Cancer institute in Boston, and the Inova Schar Cancer Center in Fairfax. After many conversations with medical teams far and near, we decided to relocate April’s breast cancer fight to the Inova Schar Cancer Center. Here, April will participate in the EMBER study. This trial hopes to effectively starve April’s cancer for two years through the administration of two new pills that will plug both the hormone receptors and the newly developed receptors, fencing the cancer off from both its old and new food sources. This trial offers the same potential benefits as the trials at the Mayo Clinic with the advantage of being only 60 miles from our home as opposed to 1060 miles. If for some reason, the new drug proves ineffective, we can always transition back to the standard of care options. With the blessing and full support of April’s Mayo and UVA teams, we began switching April’s care to Inova this past Monday, signing paperwork, and initiating a new set of scans and tests.

What Does this Mean?

In much the same way a family must adjust when moving to a new home, April and I must learn how to navigate a new hospital system and must develop relationships with a new set of doctors and nurses while keeping in contact with April’s teams at Mayo and UVA. We also must adjust to a new treatment regimen. By the end of the month, April will begin to take two new pills, the experimental drug, LY, and another drug that will be determined in accordance with a test being run on her liver cells as I type. When April starts taking the new pills, she will go through several weeks of intense observation. She will continue to undergo bone scans, MRI’s, and CT scans to determine whether the new treatment is effective. In addition to the normal tests, she will also have to undergo brain MRIs, EKGs, and frequent blood draws. Once in the study for three months, the frequency of appointments and tests will normalize to a slower pace. If all goes well, we hope to have all the boxes unpacked and to be fully settled into a new rhythm of life by this August or September.

How Are We Doing?

We are praying. Over the last few weeks, April and I have shed tears. We have mourned how quickly the first line of treatment ended. We have mourned that we must leave that which is comfortable and transition to that which is new. And, we mourn the less than enthusiastic treatment outcomes that are often associated with phase two breast cancer treatments. The whole situation is distressing.

Thankfully, the Bible exists for times such as this. In Psalm 4, David proclaims our hope when he says, “You have given me relief when I was in distress.” In verse 3 David goes on to note that, “the Lord hears when I call to him.” Knowing that God hears us, we take our concerns to him asking him to gift us a great new medical team that will provide the best possible care for April. We also ask you to join us in praying that the treatment proves effective for years to come.

Lastly, we ask that you pray for our souls during this transition. Pray that our ponderings upon April’s cancer will lead us away from anger and despair to worship and trust in the Lord. Pray that we will be able to say along with David, “You have put more joy in my heart than they have when their grain and wine abound.” We do not know why April’s breast cancer has progressed as it has. We do not know why she lacks health while others thrive. But this we do know; we do not have to fear tomorrow because the God Who reigns loves us and hears us. As the Psalmists says in verse 8, “In peace I will both lie down and sleep; for you alone, O Lord, make me dwell in safety.” At times resting in the Lord proves difficult for our hearts are weak. But our God is faithful and not put off by our frailty. He came, lived, died, and resurrected because he knew our frailty and loves us still. Pray that we will learn to live in his joy and sleep in His peace.

Thank You!

Thank you for keeping up with our story, for praying for us, and for meeting our earthly needs! When recount all that our family, our church family, and our friends have done over the last few years, our hearts overflow with gratitude. Thank you!

Contact Info:

EMAIL US AT: BIBLEFIGHTER@GMAIL.COM 

SNAIL-MAIL AT : P.O. BOX 637/ AMISSVILLE, VA 20106

CALL US AT: 540-937-6159.

SUPPORT US AT: APRIL WITKOWSKI MEDICAL FUND (GOFUNDME.COM)