Wednesday, January 15, 2020

Dr. Solti and the Three Scenarios

On January 3, Anne-Marie had her first consult with the new oncologist Dr. Magdolna Solti who is based out of the Vancouver branch of Compass Oncology.  Dr. Solti is Hungarian-born, speaks with a heavy accent and stands about 4'-11".  She has a reputation for being thorough, yet kind and for being soft-spoken, yet concise.

Our new doctor told us that she had spent significant time reviewing the past 14 years of Anne-Marie's medical records and had been in conversation with Dr. John Smith as part of a transition plan.  She had questions.  Dozens of questions.

We went through the story of every thing that happened in 2006, 2012, 2016 and 2018.  We described family history, surgeries, treatment plans and most of what you see published here.

Because our time with Dr. Smith ended with the decision to switch treatment plans (away from PARP inhibitors), Dr. Solti is the on tasked with creating the new plan.  Here are the possible scenarios, starting with the steps to diagnose:
  • A perfusion brain MRI will be performed.  This is still being scheduled, but this special MRI is primarily used on people that have previously had a stroke.  This will allow Dr. Solti and her associates to examine Anne-Marie's brain on a more detailed level to see if there's any advancement of cancer.

  • An in-depth genetic panel will be compiled using a sample of Anne-Marie's blood.  This will allow Dr. Solti to understand the specifics of the BRCA 2 gene that we believe originally caused the cancer.
The results of the two tests will allow for one of these treatment plans:
  1. IF the brain perfusion scan reveals that the cancer has NOT sufficiently stabilized, Anne-Marie will enter a clinical trial for a hopeful medication that is in the approval process.  This medication will have the small-molecular structure required to pass through the blood-brain barrier and effectively treat cancer cells in the brain.  If the cancer IS stable, then:

  2. (This option will NOT happen if Option 1 is chosen.)  This second scenario uses the genetic panel and a yet-to-be-scheduled biopsy of Anne-Marie's right lung to analyze if the cancer will respond to hormonal treatment.  If the cancer does NOT respond to hormonal treatment, Anne-Marie will enter a clinical trial, different than the one referenced above.  This medication will be focused on treating cancer that is both hormone-receptive (the old cancer) and non-hormone receptive (the new cancer).  If the cancer IS receptive of hormones, then:

  3. (Again, this option will NOT happen if Option 1 or 2 is chosen)  The third scenario is for when the lung biopsy show the new cancer is hormone-receptive.  This would be the same type of cancer that Anne-Marie has been fighting for most of the past 14 years.  If this is the result, Anne-Marie will enter into a conventional, FDA-approved treatment.
We are hoping the perfusion MRI will take place early next week so we can be ready for our consult with Dr. Solti scheduled for January 27.  This will determine whether we are going into clinical trial or headed to the hospital for a lung biopsy.

I know this is very complicated in a Choose-Your-Own-Adventure kind of way, but we're praying for an accurate and correct outcome and believing that it will all become less complicated in February.

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