We went to Virginia Mason today at about 3:00 so Darrel could get blood drawn before the appointment with Dr. Picozzi. Then, we sat and sat until about 4:15. The medical assistant took Darrel’s vitals, then Dr. Picozzi came into the exam room.

He was very personable. Asked questions about our family, what Darrel’s hobbies were and a few other things.

He then went into his background, a bit, and his interest and focus on pancreatic cancer. He told us that Virginia Mason and the studies going on were the best in the Western Hemisphere. He has the largest practice in pancreatic cancer in the nation. It still amazes me that we got in to see him within a couple of days.

He is a very optimistic person, and when he asked Darrel why we were there, Darrel said, to see if there was anything that could be done for him. Dr. Picozzi said, yes.

He focuses on quality and quantity of life. Sounds good to me!

The options laid out were:
1. supportive care – no treatment and take care of symptoms.
2. A new chemotherapy regimen – some of the same drugs Darrel has had but in a mixed up way of treatment.
3. Investigational studies. There are 2 available that Darrel qualifies for.

The first is an open study with 3 ‘Arms.’ It involves ‘vaccines.’ This open study means that the patient and doctor knows which ‘arm’ they are in. Everyone who enrolls is ‘randomly’ selected for which Arm they are entered into.
Arm A – the patient gets GVAX pancreas vaccine and CRS-207. GVAX is a vaccine made from other patient’s pancreatic cancer cells. CRS-207 is a weakened form of the Listeria bacteria. It all sounds strange and scary, but has been shown to work. This study gets treatments every 3 weeks
Arm B – those selected get just CRS–207 every 3 weeks.
Arm C – Involves the doctor’s choice of one chemotherapy drug out of 5.
My question regarding this study is that if Darrel is ‘randomly’ selected for the Arm C, it means he will get one of the same chemos he has had that have not proven effective for him.

No matter which study he gets into, he is free to stop at any time. So, another question I have is that if he gets into the Arm C, can he stop immediately and start another study and/or regimen.

The next study involves a new drug combined with gemcitabine as compared to a placebo and gemcitabine. This study is a ‘double blind’ study which means neither the doctor or patient knows what they are getting. So, he could get a placebo and gemcitabine for 7 weeks, or the new drug. I am hesitant to have him be without any kind of treatment for more that 8 weeks if he is chosen for a placebo.

We are leaning towards the GVAX vaccine study but have questions out to the doctors.

At least he is eligible and could benefit from the studies. We will know more next week. It could take several weeks before anything gets going, though.

We do know that a requirement for any study is a biopsy of his cancer which involves stopping his blood thinner for a day or so.

More to come once we make some decisions, but there is hope that new treatments can extend life for a while.