The Plot Twist We Didn’t See Coming
Since coming home from his second hospitalization at the end of January, hydration has basically become a group project. Dave has been receiving supplemental fluids, and short of waterboarding him, we’ve all worked to keep him hydrated. Shout out to Gatorade Zero!
Thursday’s oncology appointment felt like the next major checkpoint.
We walked in prepared to meet with Dr. Hussain to discuss the ins and outs of the additional treatment we were told would be necessary: monthly infusions of Opdivo (nivolumab) immunotherapy for 12 months.
Pathology after surgery showed no residual cancer in any of the six lymph nodes or in the prostate that were removed and biopsied, which was excellent news. However, residual cancer was found on the bladder itself, which is what initially led to the recommendation for immunotherapy.
After Dave had his labs drawn, the three of us (Dave, Cheri, and Erica) headed down to the 20th floor to meet with Dr. Hussain. To pass the time, including an extra hour of waiting, Erica helped Dave with some paperwork and enhanced his documents with the tasteful addition of a wig and a butterfly tramp stamp. As one does. Shortly thereafter, Dr. Hussain walked in, and we got down to business.
Cue the plot twist of all plot twists.
Dr. Hussain explained that the amount of residual cancer found on Dave’s bladder does not meet the criteria set by the FDA to require twelve months of Opdivo. While she will present his case to the Tumor Board to confirm consensus among the broader oncology team, she feels that adhering to FDA guidelines is our best course of action. And for once, I am inclined to agree with the FDA.
So what does this actually mean?
The four cycles of dose-dense MVAC chemotherapy killed all of the cancer that had invaded the muscle layer of Dave’s bladder. The remaining cancer found at surgery was superficial, confined to the inner lining, meaning chemotherapy did what it needed to do where the disease was most dangerous.
Why do we still care about those leftover superficial cells if Dave’s bladder left the building on January 5th?
Because Dave’s cancer was T2, high-grade, aggressive, muscle-invasive carcinoma. These types of cells multiply quickly and behave badly. It’s possible that between finishing chemo and undergoing surgery, some microscopic cells lingered in the body. And those cells, if present, could attempt a comeback tour.
So what the heck happens now?
Now we monitor.
In Dr. Hussain’s words, we take things “one step at a time,” which happens to be Erica’s least favorite number of steps.
The next two years are the critical window. Dave’s cancer is most likely to recur within the first 24 months, which means frequent scans and close follow-up. At the end of March, he’ll have new scans of his chest, abdomen, and pelvis, and that cadence will continue regularly for the next two years.
When asked about recurrence risk, Dr. Hussain told us it’s essentially 50/50.
So the two-year countdown starts now.
Overall? This is genuinely great and unexpected news. Good news has been in short supply since last August, when this journey began. We’re taking the win.
The reality is that Dave’s life has changed dramatically in a very short amount of time, and this good news doesn’t erase the toll of the past several months. But I hope he’s breathing a little easier after Thursday’s appointment, especially after celebrating with a burrito from Burrito Beach.
We walked in ready to learn everything about a year of immunotherapy with Opdivo.
We walked out knowing there would be no OpDIVA in this house!
And that feels pretty damn good.
