Riding for Roses

Rachel is out of town and Friday, December 10, was procedure day. Our Lance Armstrong LiveStrong wrist bands arrived last week. Spencer brought a dozen to Dr. Sharp’s and the day surgery to give away. Somehow, while I was drinking my latte, a hospital employee wound up taking him through day surgery passing out wrist bands and collecting donations. We now have $15 for Spencer’s Ride for the Roses fund. You can donate to Spencer’s Ride for the Roses Fund and help fight cancer.

We opted to participate in a phase III clinical trial as part of Spencer’s treatment. The trial is CCG-1991 – Phase III Randomized Study of Escalating Dose Intravenous Methotrexate Without Leucovorin Rescue Versus Oral Methotrexate and Single Versus Double Delayed Intensification for Children with Standard Risk Acute Lymphoblastic Leukemia. I think perhaps the most frightening thing about the title of that study is that I completely understand it. My transformation is complete. I grok the four forks of the study. They study the 2 by 2 combination of “escalating does IV Methotrexate” vs. “oral methotrexate” and one vs. two delayed intensification phases. I have the schedules in front of me and I see the implications of the different side effects and possible values of the treatments. Yet nobody knows which is best.

Today, Spencer got randomized into the fork with oral methotrexate and 2 delayed intensifications. Interestingly, this is the fork that his oncologist would choose if he could choose one. His reasons were basically that the IV methotrexate with increasing dose has significantly greater side effect risks so that Spencer’s already good prognosis doesn’t justify that risk, and that the 2 delayed intensifications probably improve survival chances significantly without particularly bad side effects. This is probably not a surprise given that this fork of treatment was standard in the POG – the ancestor of the COG that our doctor was a member of.

We now have eight weeks of interim maintenance, which means no procedure for four more weeks, though we start IV Vincristine (and a slew of oral medication, including more steroids so get ready for the return of “tummy boy”) at the next oncologist appointment. I shall attempt to post at least after every oncologist visit. The next one is Monday, December 20.