Update

I’ve been continuing chemo and finished radiation on my spine.
I am glad that the radiation is finished and I had a little surgical procedure, kaphoplasty, on my spine. It seems to have worked in alleviating some of the back pain, caused by my spine crumbling. I am able to function with less pain killers and I hope that the pain continues to decrease.
In the meantime, I am also scheduled for several CT scans and MRIs to monitor how well the chemo is working and I just had another liquid biopsy to see if I developed any new mutations that might help focus and personalize the treatment.
Please continue your good thoughts and prayers.
Those celebrating the High Holidays, have a Happy and Healthy New Year.

I have been on maintenance chemo the last month and I am tolerating it well. Everything remains stable and my next scans will be in August.
It is my birthday today and wanted to reflect on that.
Reflections on my birthday.
I have always celebrated my birthday month because one day doesn't seem like enough time to celebrate, but I would like to take a moment to thank everyone for their birthday wishes and to reflect on my relationship with all of you.

I have always felt lucky that God has always handed everything to me on a silver platter.
Until age seven, I lived in Tiberias, Israel, with my parents, a few minutes from the gorgeous Sea of Galilee and near my father's small and loving family. Even though I was very young I have learned so much from living in the Holy land, surrounded by true idealism.
We then came to New York, where I had a  wonderful home life growing up with my mother's extended family. I was came home everyday from school greeted by my grandmother and her delicious "Babbi Cookies".
There was nothing I lacked. As I grew up, I continued enjoying all that life had to offer. A fun loving extended network of multi-generational aunts, uncles and cousins in addition to my parents and siblings. Every day was a lesson in respect and kindness towards all, and if there was a problem it could always be fixed with a joke and a laugh.

As life continued, I got married to the love of my life, had seven amazing kids and at last count, nineteen wonderful grandkids. I am so lucky that they put up with me and my life long philosophy of "Partito, ergo sum" "I party, therefore I am".

My dear friends continue to make sure, I stick to that credo. Celebrating every occasion and non occasion and living life to it's fullest.

I am not saying I didn't have any bumps along the road of life. However, because of the bumps, (not in spite of them) I was able to clearly see and smell the roses along the road.
It is my family and friends that helped me realize all the blessings that I am bestowed with. Therefore, when asked "How are you?" It should be no surprise that I  have to honestly answer "Perfect".
I want to thank each and everyone of you all for the very important role you continue playing in my life.
I'd also like to thank you all for your continued prayers and good thoughts. It gives me great emotional high knowing that you are praying for my full and speedy recovery.

Connect the Dots

A quick update.
I'm continuing the chemo and was able to tolerate a substitute drug instead of the drug I was allergic to.
The new scans however showed that one of  the tumors on my spine is getting larger and pressing against spinal cord. It is also causing some pain. Therefore, I will have that area nuked next week. This week I went to get prepared for the radiation.
For those not familiar, before the radiate any body part, they mark the area with little tattoos dots. Since this is my third radiation, my body is beginning to look like a page in my grandkids 'connect the dots book'.
However, I am looking forward to getting the tumors to shrink and the pain to subside. They did warn me that the pain will get worse before it gets better, but as long as I know that it will get better eventually, I am glad to have this done.
I am still hoping for the blood biopsies to show a DNA marker that will make me eligible for either a targeted therapy or clinical trial, until then I will continue with whatever treatment is available.
Thanks again for all your prayers and good thoughts.

You may be interested in this article

My oncologist and I were interviewed about liquid biopsies that are used to find DNA markers that can help find a more specific treatment.
I've mentioned this before, but I think this explains it clearly. I've am currently having these blood tests every three weeks, but so far all the markers I've had mutated and disappeared. Hopefully they will identify a new mutation that they can treat.

https://www.mskcc.org/blog/some-people-cancer-simple-blood-test-can-be-lifesaver

Small change in Infusion

I went for my second treatment yesterday. Unfortunately, I developed a serious allergic reaction to the Taxol  (Paclitaxel) and had to stop taking it.
I will continue with the other three drugs and hopefully they will do the trick and help keep the cancer from progressing.
Keep up with your prayers and good thoughts.

A New Path

I am happy to report that the radiation killed the active cancer cells in my skull and hip.
In addition my lungs and brain are stable which means the clinical trial was working well on my lungs and brain.
However, I developed more tumors on my spine.
Even though they don't hurt me, I cannot continue on this clinical trial. With this much progression of disease, they kick you off the trial. Unfortunately, there is no clinical trial that I am currently eligible for. 
I have had several liquid biopsies to see if there are biomarkers that can be useful in finding a targeted therapy or clinical trial, but the latest only showed a slight EGFR mutation and the previous mutations disappeared. It appears that the cancer cells are smart enough and learn to resist the treatment drugs used.

Thankfully, I am not out of options.
Next week I will start a new chemo regiment of four powerful drugs.
Paclitaxel and Carboplatin which are system wide general chemo drugs. These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.
Avastin, which blocks a specific protein (VEGF) in the cells, since some cancer cells produce too much of this VEGF.  Blocking VEGF may prevent the growth of new blood vessels that feed tumors.
The fourth drug is Tecentriq, which is an immunotherapy drug. Which can help to reactivate the immune system so that it can recognize cancer in the body and destroy it.
 I am not an ideal candidate for immunotherapy. Immunotherapy is most successful when the patient has high levels of a certain protein (PDL1) in their blood. I don't, but since it can't hurt to try it, I will get will be immunotherapy as part of my new cocktail.

I will go in once every three weeks for the infusion. Hopefully this new treatment will work for a long while. I will keep u posted.
Please continue to keep me in your prayers and thoughts.

Brief update

I saw Dr. Jonathan Yang, a wonderful radiation oncologist.
I ended up with radiation to my skull and to my hip.
My skull, because of the pain and its proximity to the brain stem and jugular. It was also near my right cochlear, which will cause permanent hearing loss on that side, but other than using the phone with my left ear, the other side effects, pain and fatigue should abate within six weeks.
The hip was also nuked, because the tumor on my hip bone was growing and caused a hairline fracture on my hip, which they feared will grow and cause a larger fracture.
Other than that I am doing great.
Hopefully, the next scans will show that the radiation caused bone tumors shrink and that the chemo keeps working to keep me stable.
It's been exactly three years that I was diagnosed.
As crazy at it seems, I truly miss New Year's Eve in Times Square. It was an annual ritual I hope to resume. Perhaps, next year.
Keep up with the prayers and good thoughts, they are working.

To all those celebrating have a merry Christmas and happy New Year.

A Bump on the Journey

The clinical trial I have been on has done an excellent job of keeping my lungs and brains free of growing tumors.
It's been a while since I've had any complications, except for the annoying side effects.
However, yesterday we found out that there are several tumors on my bones. Specifically on my skull, my spine and my hip.
While tumors on the bone can be a nuisance, if it does not cause pain or grow too large, they are usually left alone and just treated with the regular chemo or clinical trial.
Unfortunately, the one one my skull is causing pain and also protruding on the jugular vein.
So while I will stay on the trial because I have had a great response to it, I will additionally have radiation to my skull.
I will meet the radiation oncologist soon and hopefully zap this tumor quickly.
I will keep you all posted.

Thanks again for all your prayers and good thoughts.

Update

I apologize for not posting for three months, but two people very close to me reminded me of how long it's been, so here I updating my blog.

It's funny how our mind works.
When we are healthy, we take our good health for granted.
When I first got sick, I learned to appreciate every breath I take and every anatomical function that works. Walking, talking and breathing were all skills I was suddenly acutely aware of. I praised God for every moment of each day. I realized it was a gift that was not owed to me, but one that was graciously and generously handed to me.
As my scans came back repeatedly clear, I fell into a trap of taking these gifts for granted.  Sure, I continued praying for continued good health and thanking God for granting me each day, but it started becoming routine and my prayers were said by rote.
How foolish we can be that we often need a reminder that everyday is a gift from God. Everyday and every breath is to be cherished as if it is the first day of our life. It's ironic that good health is what makes us foolish, and through the grace of God we are sometimes blessed with a needed reality check.

Back to my health.
My recent scans continue to show the lungs and brain clear of any progression of the cancer.
My fatigue is less and I am able to enjoy spending time with my family and friends.
Thank you all for your continued prayers and good thoughts.

Transitioning

It's been totally amazing. My scans which I've faithfully have every six weeks, continue to show that the clinical trial medications are doing their job. My scans continue to be clear and the side effects are manageable.
I apologize for not updating more frequently but I now find myself transitioning from a 'lung cancer patient' to a 'person with lung cancer'.
It might seem trivial but it is wonderful to go about my daily activities and enjoy life, without the immense gray cloud of disease.
I am still under treatment and I am a regular fixture at MSKCC, but  I can plan activities for a month from now, without thinking will I actually be able to....

Thanks for the continued prayers and good thoughts. May they continue to keep working and may you all be blessed for you kindness to me.

I will try to update with good news more frequently.

A Chanukah miracle

Chanukah is a holiday that celebrates miracles that occurred a long time ago.

There is the military victory of the Jewish Maccabees against the huge Greek army and a seemingly insignificant miracle of one small cruse of oil that lasted eight days. 

We commemorate the miracle of the oil by lighting the menorah. True it was a miracle, but it was just an extension of nature, similar to your cell phone battery almost dying, but lasting until you find your charger.

Often we think of miracles necessarily being against nature, a small untrained army victorious over a huge military presence, but most miracles occur everyday. 

They are an extension of what happens naturally, and are often taken for granted by us. We must work on recognizing the miracles around us and viewing then as a gift from God.

This week I have had my own Chanukah miracle.

On Wednesday, the first day of Chanukah, I had an appointment to get my latest test results.

As the previous scans in November by lungs and brains were totally free of any tumors, as were all my internal organs.

An additional test, called a blood biopsy was done. My lung cancer was not only present in the tumors but also in my blood, causing gene mutation that helped pinpoint treatments. In May of 2017 my blood contained three tumor friendly gene mutations; EGFR, MET-C, and TP53. After being on the newest clinical trial for six months, I have had a 100% response to the gene mutation. My newest test results show no cancer loving DNA mutation in my blood.

I might not have explained it correctly or clearly, but this is truly a Chanukah miracle, an extension of a natural occurrence. With the help of my oncologist, research team and all of your prayers and good wishes I have truly experienced my own Chanukah miracle. 

I hope to continue with this clinical trial and hope to continue seeing miracles everyday.

Continued Great News

My latest scans, done ten days ago showed that there was absolutely no metastasis in the brain.
All the previous tumors in the lungs have also shrunk into oblivion.
This means that the clinical trial medication is working well.
The bones of the skull and spine show unchanged osseous metastasis, but the doctors feel it is just  the bone metastasis healing. In either case, they are not increasing nor causing any pain, so we are on the right track.
Thank you all for your continued prayers and good thoughts.

Great New Year

I just returned from the doctor to get the results of my most CT scan and MRI.
Thank God since starting my clinical trial on June 27th all the tumors on my brain and lungs have disappeared.
The only cancer remaining is a little on my bones and skull and those thank God do not give me any pain.
The side effects are manageable and I am thrilled with results.
Thank you all for your prayers and good wishes.
This being the eve of the Jewish new year, I wish each and every one of you a year of blessings, joy and good health.

It's working

I started the new clinical trial meds on June 27th.
AZD9291 and AZD6094. I am on this specific trial because the new biopsy showed a new mutation of a gene called MET-C and the AZD6094 is a MET-C inhibitor.
I had a CT scan and MRI to se if the new meds are working and all the tumors have either decreased in size or remained the same. 
They will continue to do scans every six weeks to make sure these drugs continue working.

On another note, the old clinical trial meds caused me to have constant tachycardia and I was put on beta-blockers. Now that I am off the old trial, I was able to get off my heart medication.
The only side effect of this regimen is fatigue but I am already used to this new normal. However I do miss taking advantage of all New York City has to offer.

Thanks again for all your prayers and good wishes.

Thank God

I am so excited!
When the clinical trial medication I was on stopped working, a biopsy was done and the preliminary results showed that I was not a candidate for any clinical trials or targeted therapy. I was therefore scheduled for traditional chemo, which I was to start today.
I went in to start my chemo regiment today and found out that my final biopsy results showed a new mutation of a gene called MET.
This means I may qualify for a new clinical trial of a targeted therapy combo of two new drugs, AZD9291 and AZD6094.
So no chemo today, but I should start the clinical trial within two weeks.
This is great because targeted therapy drugs that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer and are thought to be more efficient than traditional chemo.
I owe you thanks for all your prayers, there is no question that your efforts changed the course of my treatment.

Prayers needed

I am starting the new chemo cocktail tomorrow.
Carboplatin, Pemetrexed and Bevacizumab.
Please pray that it works.

A brief lesson and update

Some people have asked that I explain the basic types of treatment for stage four lung cancer.
I was diagnosed with stage four non-small cell adencarcinoma that has spread throughout my body.
There are three basic types of chemotherapeutic treatment for cancers that have spread widely throughout the body, before any treatments start.
1- targeted therapy
2- immunotherapy
3- standard chemo.

I started off with standard treatment and that worked for a short while. There are dozens of combos of standard chemo and that will always be available to me.

Targeted therapy is used when the tumor is tested for common gene mutations (such as in the EGFR, ALK, or ROS1 genes). If one of these genes is mutated in your cancer cells, treatment will likely be a targeted therapy drug:

* For tumors that have the ALK gene change, crizotinib (Xalkori) is often the first treatment.
* For people whose cancers have certain changes in the EGFR gene, the anti-EGFR drugs erlotinib (Tarceva), gefitinib (Iressa), or afatinib (Gilotrif) may be used as the first treatment.
* For people whose cancers have changes in the ROS1 gene, an ALK inhibitor such as crizotinib might be used.

My tumor was positive for the EGFR gene and I was on a clinical trial of super high doses Tarceva starting April 2016 for 13 months until it stopped working. While it worked Tarceva shrunk and eliminated most of my tumors.
By stopping to work, I mean that they found a bunch of new tumors, primarily along my spine.

They redid the tests again to try find any new mutation that will respond to a different targeted therapy drug and the initial results showed no new gene change. So unless further tests show a gene mutation, targeted therapy is off the table for now.


My tumor cells might were  also be tested for the PD-L1 protein. Tumors with higher levels of PD-L1 are more likely to respond to certain immunotherapy drugs, so treatment with pembrolizumab (Keytruda) might have be an option. People with the EGFR mutation that I have usually do not respond to immunotherapy. Ironically, immunotherapy works best on heavy smokers. I will be a candidate for immunotherapy if all other treatment options fail.

At this point I will return to standard chemo, as long as it keeps working or my tests indicate a better treatment plan.

The chemo along with all of your prayers and good wishes will let me continue enjoying life to it's fullest.

Thanks to all of you for everything.

update

I have not posted for a while because things were going well.
I feel great and except for the annoying side effects of the Tarceva (chemo) I was able to function.
When I started the clinical trial of Tarceva, (thirteen months ago) they explained to me that it often works for about one year at which point the cancer may get 'smart' and mutate and a new drug will be needed to fight the cancer.
On Tuesday I had my regular brain MRI and torso CT scan.
Yesterday I got the results and it seems that the Tarceva is no longer working.  Thank God there is no new growth on the brain. However, they found small tumors along my spine and other bone areas.
I will go for a spine MRI tomorrow for further examination and will be scheduled for a new biopsy. They will look to see if there are new genetic markers that will respond to a targeted therapy.
They will then change my regiment accordingly.
This may seem like bad news, but the fact is that there are great advancements in lung cancer and there are many medical paths to have a life full of quality.
I feel blessed to have so many family and friends praying for my good health.
I will keep you posted on new test results and treatment.

Continued good health

I had a CT scan and brain MRI yesterday.
The results are very good. Nothing has grown since the last set of scans.
Tarveca is really keeping the metastatic cancer from spreading any further.
I feel great and I am able to enjoy doing things that I planned on doing during my retirement, like spending time with family and traveling.
Thanks again everyone for your prayers and good wishes.

Thanks.

Wow! I can't believe that it's almost a year since my diagnosis and I feel great.
I've learned a lot this past year, but the most important thing I learned is that I can rely on my family and friends to be there for me.
I would not be doing so well were it not for all your help, advice, prayers and good thoughts.
Please keep it up.
Wishing you all a wonderful Chanukah, Christmas, Kwanza, belated Diwali, and Festivus.
My apologies to anyone I left out.