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The Numbers Game – John’s Cancer Battle

The next step on my unexpected journey was to the Christie, luckily for me one of the countries leading cancer hospitals and just a short drive away. I met with a consultant and a nurse practitioner specialising in drug trials to discuss what to do next. The news was immediately better, they didn’t think the cancer was fast growing, it looked as if it had been there for years. Their prognosis moved to 15 months based on chemo alone, but that’s an average based on all people with similar cancers at a similar stage. As many of these were older the I am and/or had other significant health issues my relative youth and fitness should be on the top end of the curve with 15 months being the likely minimum. There is no maximum in these cases, if the chemo works well I might get years. Nice to hear but I’m not counting on it.

There are two drugs trails available to me, end here is where the numbers start. First a little background on drugs trials, please skip this if you know this stuff.

Trials used to be done against placebo, e.g. some participants take the trial drug and some get nothing. For serious diseases like cancer they now test against the standard of care treatment, the best proven therapy available. Most trials are double blind, 50% of patients get the new drug whilst the others get the standard care. Nobody knows who is getting the new drug, not even the trial administrators as that data is kept secret until the trial has ended and the results have been analysed. This is essential to ensure there is no bias. My two options were:

  1. FLIGHT. A trial of a new US drug that attacks cancers with a particular genetic fingerprint. If I went on that trial I would get the drug one way or another, they swap you from one arm to the other if you are not progressing as they would like, this was not a double blind. The anticipated improvement over standard care was 40%. However, only 15% of people have the ‘right type’ of cancer and are allowed on the trial.
  2. TOPAZ. This is one of the new flavour-of-the-month immunotherapy drugs that hold significant promise, although these are early days. In this case the improvement would be rather less at 15% with only a 50% chance of actually getting drug.

There is of course a catch, I’d need a biopsy for either trial and that would delay starting treatment for a few weeks, although the comsultant wasn’t concerned about this in my case. So now all I had to do was sign up for the trials and wait for my biopsy to be done. Oh, and do some maths. Pending the biopsy what could I hope for from these trials?

  1. FLIGHT. A 40% improvement if my cancer has the right mutation: 40% x 15% = 6%
  2. TOPAZ. A 15% improvement if I get the drug: 15% x 50% = 7.5%

I don’t need to choose one until the biopsy comes back, but the answer is obvious – FLIGHT if I’m eligible otherwise TOPAZ. So the next waiting game starts, watch this space…

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