ANOMALOUS MRI RESULTS
About 28 days after starting Ibrutinib I had a follow up brain with contrast MRI. The next day I go in to see my oncologist to discuss the results and to get myself another LP. Because you know, I absolutely love spinal taps. Unfortunately the MRI results were a bit anomalous. What else is new? MRIs show you things in two ways when used with contrast media. The contrast media allows enhancement of the images taken. This is a method for determining if what you see is in fact lymphoma or not. This methodology is used in diagnosing other things, too, although the exact markers differ between diseases. The image sans enhancement are just that, simply images. In my case all traces of evidence that this was lymphoma was not present on the enhanced images. However, in addition to the two “smudges” found in the normal images there was now a third. In the back of my head. How delightfully confusing.
So, question of the day: did the Ibrutinib work? It’s assumed that it did something but to the extent of its effectiveness we are not sure. My spinal tap should provide some sort of helpful insight. Either my CSF comes back dirty and we can pretty much say the pill did nothing. Or my CSF comes back clean, which I highly doubt at this point, and we can assume it helped in some way to some degree.
ANOMALOUS LP RESULTS
Fast forward a few days and my CSF came back clean. It is also possible that my last LP was a false positive. So in effect, more anomalous results. WTF. So the Ibrutinib… worked? To some extent? Whatever the case due to the MRI results it is apparent that action must be taken. Swift action. Cell killing action. Some of that sweet methotrexate action. I’ll be put onto a simple regimen (relativistically speaking) of outpatient rituximab followed by 3.5 grams of methotrexate. This is the dose I had the first time around back in 2012. The second time I sustained 8 grams a pop. I will undergo four rounds of this in an attempt to clean my head out. No other chemo drugs will be used, like procarbazine or vincristine, but I will be put back onto Ibrutinib. I will take Ibrutinib only when I do not have methotrexate in my system.
In addition I will be getting a port put into in my skull in order to more easily saturate my brain with chemicals. This also allows for easy retrieval of spinal fluid. The existence of a tap in my head removes all need for any future spinal taps. Fuck YES! I’ll be put onto a rituximab maintenance regimen, likely twice a week to start. This is in addition to the outpatient intravenous rituximab I’ll get during my four rounds.
Brain surgery again. I am pretty stoked about this procedure. Some of that is just because it is badass to say. “Two for two on my brain surgeries Brugh what’s your record?” The other part is that I will be LP free likely for the rest of my life. This also opens up additional treatment options for me as drugs can now be injected directly into my brain where it can quickly mix and marinate with my CSF. This is an effective means to getting around the blood brain barrier issue we see with all brain cancers. Being that this surgery a short 1-1.5 hour procedure, which is done quite often, the chances of any issues are pretty low. There are obvious risks, like all surgeries, but since I am otherwise young a healthy I am not worried. The benefits outweigh potential risks by far.
I start outpatient this Friday.
Author: Dan Paluszek
I’m just a normal guy who likes beating up on stage 4 brain cancer repeatedly.