A New Hope

 The “War on Cancer” was first launched by Richard Nixon in 1971, less than two decades after the discovery of the DNA double helix by Watson and Crick. Like many of America’s wars, we were initially unprepared for the formidable challenges imposed by an enemy we didn’t fully understand. When you consider the state of science and technology in that era, it was almost like we were using bayonets to attack the Death Star. If anything, the fear and dread of a cancer diagnosis has only become more terrifying in the decades that followed. Ever since the first revelation of: “That’s no pneumonia…it’s an adenocarcinoma,” we have struggled to find the courage to face this disease.

There now seems to be a consensus among oncologists from three of the best cancer centers in the galaxy that what we are dealing with is an unusual type of lung cancer. The estrogen receptor staining was just a trap to lure us down the wrong treatment pathway. The Death Star is fully operational with planet killing potential. If it behaves like other lung cancers, the PD-L1 receptor target won’t offer us many advantages when it comes to immunotherapy. But just as the Death Star was constructed with a vulnerability in the form of a thermal exhaust port about two meters wide leading to the station’s main reactor, this cancer features a RET fusion mutation that we can target with a drug that seems to be even more effective than a proton torpedo. Joyce is scheduled for a follow up PET CT tomorrow, and she will likely have swallowed her first dose of selpercatinib before exiting the radiology suite. The drug acts so quickly that if she takes it before the study there’s a risk it will have shrunk the tumor to a point where we can no longer accurately assess the impact of the first two cycles of chemotherapy. Based on the clinical trial data with this agent, five-year survival seems not just hopeful, but maybe even probable. Every oncologist we’ve spoken to has been so bullish on this treatment that there is some reluctance to consider an unproven alternative in the context of a clinical trial.

The past 36 days have been a crash course in tumor biology. Just about everything I thought I knew has been turned upside down. Lung cancer was supposed to be a bad thing unless you’re one of the small number of people with a RET mutation. Immunotherapy was supposed to be our only hope until Tyrosine Kinase Inhibitors arrived on the scene. It almost seems like the more I read the farther I get from understanding the truth. In times like these, I am reminded of Proverbs 3:5-6. “Trust in the Lord with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight.” I can’t even describe the peace that has come from trusting Him when nothing else makes sense. As Evelyn Underhill reminds us, “if God were small enough to be understood, he wouldn’t be big enough to be worshipped.”