It sounds very undramatic, I think: I have achieved a partial response. But it's amazing. It means my tumours have shrunk by half since starting this therapy in mid November 2016 and my CA125 is down from just over 580 at the start to 56 in mid January. The cancer is in retreat.
That was the news yesterday and I must say I did feel like cartwheeling round the cancer centre. As I sat grinning over a cup of tea in the in-house Costa, though, there was a woman at the next table in tears so her meeting had obviously not gone so well. So I restrained myself.
I've not had many good meetings with oncologists. It doesn't really go with the territory. There was one when I had finished all my first line treatment back in January 2015 when my doctor had delivered the "no evidence of disease" verdict. That was a good one. Then back in November when my current consultant told me she had got hold of the PARP inhibitor Rucaparib for me. But more often it's been about hearing bad news and I think there is nothing worse than bad news for which you are unprepared so I have developed a technique of thinking of the worst and best case scenarios for each consult. The best for yesterday's meeting was NED, CA125 down to normal level - a complete response. The worst case was that the CA125 was rising and the scan showed growth in the tumours. The reality was likely to be somewhere in between.
In truth, I was expecting things to be at the better end of the continuum. I had been feeling quite a lot better with the fatigue at last receding since mid January. It felt like the RAC had come out to move the bus that had been crushing me and at last I could sit up. I'd had a few days with whole mornings or afternoons of not feeling actively unwell. I'd managed a couple of short walks in Knole Park and the occasional swim and had stayed awake all day on a number of occasions. I'd felt like putting on a bit of make up. You learn to measure progress in small increments in this game.
So yesterday morning I'd put on my war paint and headed to hospital. I was ready with my answer to "how are you?". I was going to say "well enough to put on some make up." But she was ahead of me as usual. "How are you feeling? Well enough to put on some make up, I see." What's not to love about a consultant who notices her patients' make up?
She was thrilled with the progress she had to report. The scan was done Jan 29th and my doctor had managed expectations quite carefully ahead of time. When we last met on January 10, she'd highlighted the falling CA125 from around 580 at the start of treatment to 470 at two weeks and - the latest result at that point - 230 in mid December. She was sure this trend indicated we were achieving a response and she wanted a look and see but a scan may or may not show up a change in the tumours, she warned. It can often take 4-5 months to get a visual on the tumour reduction.
In the event, we saw dramatic changes. The tumours in both lungs are halved in size; the para aortic tumour in my abdomen is down from 3.3cm in November to 2cm now and it much more diffuse. There are similar changes in the small tumours in my groin and the scattering of spots across the dome of my liver has disappeared. At least, that's the gist of it. And the CA125 - measured on Jan 10 - was down to 56. Normal range is below 35.
This is officially a partial response. It feels like an amazing response. It's not a cure and typically, women with a BRCA mutation and . high grade serous carcinoma who respond well to Rucaparib will have a year or so before they develop resistance to the drug. So this is the start of a breathing space when I can, I hope, feel relatively well and lead a relatively normal life. Now, where's my contacts book...time to think about going back to work.
