ASCO Follow-Ups

Very quick post. I wanted to share a couple of follow-up or analysis pieces from ASCO.

About this time (maybe 3 weeks after ASCO is over), we start to see some commentaries and analysis from the conference. One of the many oncology websites will ask one or more cancer experts to comment on what they thought as most important or impactful from ASCO.

I have two to share with you. The first was sent to me by William, a long-time reader whose wife is a Follicular Lymphoma patient. It's from the website Healio, and features a very brief interview with Dr. Matthew Matasar from Rutgers Cancer Institute. In the video, he mentions several important presentations from ASCO, including the one that I mentioned before on Epcoritamab. He confirms that bi-specifics are getting a lot of Lymphoma experts excited.

The other link is for a podcast from ASCO that highlights developments in blood cancer research. The podcast features a conversation between Dr. John Sweetenham from UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and Dr. Marc Braunstein from NYU's Perlmutter Cancer Center. 

Dr. Braunstein also mentions the Epcoritamab presentation as being particularly significant. He walks through the results of the study, pointing out the great numbers for effectiveness and mentioning the side effects. As he says, "I think the addition of epcoritamab certainly shows high overall response rates and we'll need randomized data to confirm the efficacy, but it's definitely encouraging in high-risk follicular lymphoma patients." In other words, a larger clinical trial will be necessary that provides a direct comparison to current treatments to really show how good it is. 

But, once again, both realize how important bi-specifics are becoming for Lymphoma.

I'm sure there will be more analysis of the ASCO conference to come, and my guess is that the Epcoritamab presentation will continue to be a part. I'm hoping that some others will get a mention as well, though as I've been saying, Follicular Lymphoma was not a prominent subject this year.

But there's still plenty to talk about. More to come soon.

ASCO: CAR-T in the Real World

More from this year's ASCO conference.

As has been the case for the last few years, there were a lot of presentations this year on CAR-T. That's not a surprise, and if you've been reading for a while, you know that CAR-T (along with bi-specifics) is one of the treatment types that gets Lymphoma specialists most excited these days. As you probably know, CAR-T describes several specific treatments. All of them work the same way -- a patient has T cells removed from their blood (T cells are a type of immune cell), the T cells are changed in a lab to recognize cancer cells, and then they are put back into the patient to do their job. It can be a very effective treatment, though it comes with some potentially dangerous side effects, and since each treatment is individualized for each patient, it can be very expensive as well.

Two presentations that caught my eye were "real world" studies of CAR-T. A "real world" study means something very specific. When a clinical trial is designed, researchers make up a list of patients who will be included -- a specific disease, specific previous treatments, etc. But they also include a list of "exclusions" -- things like the time since a last treatment, and most importantly, specific comorbidities, or health already existing health problems. This can be controversial, since it excludes a bunch of people who might otherwise benefit from the trial. But the logic makes sense -- if the treatment in the trial might cause heart problems, then one group excluded from the trial might be patients who already have heart problems. That way, if patients in the trial begin the develop issues with heart rhythm, for example, the researchers will be confident that the problems came from the treatment being tested. 

But the other controversy that comes from this practice is that it could give an unrealistic picture of how safe and effective the treatment is. In other words, if a trial involves 500 patients, and none of them have a history of heart problems, then we really don't know how the the treatment will affect the roughly 80 million people in the United States who have some form of heart disease. 

That's where "real world" studies come in. After a treatment has been approved by the FDA, the are no  ore requirements for doing studies. But some researchers will perform "real world" studies, without the kinds of exclusions that happen in a trial. It's a way of collecting information about how a treatment is going outside of a trial -- how effective it actually is, and how safe it actually is.

As I said, there were two "real world" studies of CAR-T this year that involved Follicular Lymphoma patients. The first is "7509: Real-world early outcomes of axicabtagene ciloleucel for relapsed or refractory (R/R) follicular lymphoma (FL)." This one looks at one specific type of CAR-T, known as Axi-cel, or Yescarta. 

The study involved 230 patients who received Axi-cel, including those 92 who would not have been eligible for the ZUMA-5 trial that looked at Relapsed or Refractory FL patients. In the trial, about 94% of the patients had a response to Axi-cel. The study looked at 151 patients who were available for follow-up. The results were very good. The Overall Response Rate was 93% (compared to 94% in the clinical trial), with an 84% Complete Response. The estimated Progression Free Survival at 6 months was 88%, and the Overall Survival at that time was 96%. Safety was good, too, with only 2% of patients having severe Cytokine Release Syndrome (probably the most serious possible side effect), and 13% having severe nerve issues. The PFS and OS were about the same as those in the ZUMA-5 trial, though it was more common for patients who would have been excluded from the trial for health reasons to have more severe side effects.

Overall, then, the "real world" study confirmed that Axi-cel was as effective as it seemed to be in the clinical trial, with some safety issues for patients with more health problems.

The second "real world" presentation at ASCO was called "18896: Real-world duration of hospitalization for CAR-T treatment: U.S. patient experience in multiple hematologic malignancies." It looks at all 6 types of CAR-T that have been approved for blood cancers,and looks specifically at how long patients needed to be hospitalized during the CAR-T treatment process.

The study looked at a total of 212 blood cancer patients, including 47 who were diagnosed with Follicular Lymphoma, who received CAR-T sometime between 2017 and 2022. The researchers found that the median duration of the time spent in the hospital was 12 days. One question they asked was whether or not hospital stay lengths have decreased over time (since doctors are getting much better at identifying side effects early, before they cause severe problems). The answer is that there is a slight decrease -- for patients who had CAR-T between 2017 and 2019, it was 12.3 days, and for patients who received it between 2020 and 2022, it was 11.9 days. 

They also wanted to know if patients who had Cytokine Release Syndrome (remember -- potentially dangerous side effect) ended up with a longer hospital stay. The answer to that question was, again, a slight difference -- 12 days for patients with CRS, and 11 days for those without.

Since all of this information came from a database (rather than studying individual patients), the researchers point out that there needs to be more research into other factors, like the hospital systems themselves, and the details of the patients' individual health issues, to really get a sense of how accurate their research is.

But like the first study, this research shows how important it is to continue to study treatments, even after they have been approved, to see how they actually affect patients in the "real world." 

As for CAR-T, there's no evidence that it isn't as effective as it had already been found to be. And it certainly seems that doctors are getting enough experience with CAR-T patients to identify and treat side effects as soon as they can. CAR-T is certainly here to stay. It will be interesting to see just how many of us end up having it as a part of our treatment in the future.

There are still a few more interesting ASCO presentations to share, but I'm also seeing a whole bunch of non-ASCO stories that you'd probably enjoy. I'll have plenty more to share and comment on soon.

ASCO: Uncertainty and Coping

 More research from ASCO:

"Uncertainty and coping in patients with newly diagnosed indolent non-Hodgkin’s lymphoma (iNHL)."

The title of this presentation gives you the basics of what it's about, and it's pretty likely to make you say something like "Do you really thinkmI needed an ASCO presentation to tell me that?" Basically, what it says is that patients with indolent lymphomas (like Follicular Lymphoma) are anxious and uncertain because they have a slow-growing but usually incurable cancer, and need some help with developing coping strategies.

Yes, we do know that this is true.

One of the nice things about being able to register for ASCO as a patient advocate is that I get access to some additional materials besides the abstract/summary. So while it all seems pretty obvious -- yes, we are anxious -- the additional materials help round things out a little bit.

So here's the rundown:

The research focused on newly-diagnosed patients with indolent NHL. They collected PROs (Patient-Reported Outcomes), with patients giving their own thoughts about how they were feeling. They used several different surveys to do this, including Functional Assessment of Cancer Therapy to measure Quality of Life; the Hospital Anxiety and Depression Scale to measure psychological symptoms; the Prognostic Awareness Scale to measure how well they understood their prognosis; and the Brief COPE to measure their ability to cope with the diagnosis.

[Import note before we move on -- the links above will take you to either descriptions of the surveys, or the surveys themselves. If you are thinking about taking one of the surveys yourself, think carefully before you do. They are meant to be reviewed and discussed with a mental health professional. It might not be a good idea for some of us to start looking at issues on our own that we can't explore without some help. As you know if you've been reading for a while, I'm a huge believer in taking care of our mental health -- that's why this presentation was so attractive to me. But I think it's better to deal with these issues with some help.]

Then they looked at the ways the patients tried to cope with their diagnosis. They categorized the strategies as one of two approaches. The first is called "approach-oriented," including doing things like active coping, using emotional support, positive reframing, and accepting the diagnosis. The second approach is "avoidant" -- disengaging, denying, and blaming themselves for the diagnosis. Essentially, they think it's good to deal with the diagnosis, and bad to avoid dealing with it. They're probably right about that, though I think we all deal with it in the way that makes the most sense. I know people who coped very well by disengaging, for example. 

The study looked at 48 patients; about one third of them had FL (the rest had CLL, another indolent blood cancer). At the time the the patients entered the study (within three months of being diagnosed), they were given the surveys. The results of the surveys:

31.2% were found to have symptoms of anxiety and depression.

45.8% said the uncertainty about their prognosis was "the most stressful part of being a patient."

31.2% said they had "difficulty letting go of thoughts about their prognosis."

47.9% reporting that they thought a cure was at least "somewhat" likely (even though they were told it was an incurabe cancer).

None of that is very surprising to me. One thing that does surprise me, though, is that the researchers seem concerned that almost half of the patients think a cure is "somewhat likely." And I guess that is concerning, especially with patients that are less then 3 months out from a diagnosis. But that's a tricky thing. I think of myself as being just about as informed as a Follicular Lymphoma patient can possibly be, and I do think that a cure is somewhat likely to happen in my lifetime. I also have 15 years of experience with living with this disease, and the knowledge that I probably have a fairly slow-growing version of it, and as a result, I expect my "lifetime" to be pretty close to "normal." That gives researchers some time to work on this.

I'm less certain that, at 3 months, I would have felt the same way. But I also think that Hope is being undervalued here. It's an awfully hard thing to attach a number to, and numbers matter in something like an ASCO presentation. But Hope -- in this case, the uninformed or under-informed belief that everything will work out OK -- is something that I would consider an active, positive coping strategy. I'm all in favor of whatever helps a newly-diagnosed cancer patient get out of bed and face the day. (And I'm happy to talk more about that in the comments if anyone wants to.) 

As for what happened after the patients started using coping strategies:

56.3% used acceptance.

47.9% used denial.

47.9% used emotional support.

The patients who used multiple approach-oriented strategies (the active ones) reported fewer symptoms of anxiety and depression, and reported a higher Quality of Life. This makes perfect sense to me. An active approach gives a patient a feeling of control. That's why I've been writing the blog for 15 years. It's always made me feel like I'm doing something, especially at a time when I could do nothing but watch and wait. I don't think an avoidance strategy would work for me. Though, as I said, I've known and heard about patients who have used it very effectively. I think for someone with an incurable cancer, the ability to not think about it every day could absolutely lead to a better Quality of Life. Indeed, the study found that patients who use avoidance strategies had higher symptoms of anxiety, but not of depression, and did not have a lower Quality of Life. They are living their lives despite the cancer. (And maybe to spite the cancer.)

The researchers conclusion isn't to recommend any particular strategy for coping. Instead, they suggest that interventions are necessary. And that seems right to me, too. And strategy can work, even denial or avoidance. As long as the avoidance doesn't do any harm, then it's OK. And for me, the harm would be avoiding treatment. I've seen that up close, with people that I love denying that there was a problem until it was too late to do anything about it. But getting a diagnosis, and then putting it out of your head until a problem pops up? That's fine with me.

It makes me think about a patient that my oncologist told me about very soon after I was diagnosed. He said this patient had been diagnosed with FL about 30 years before. He retired and moved to the Bahamas, and once a year, would come back to the New York City area to see his oncologist, and then see a couple of Broadway musicals, and then head back to where it was warm and sunny for another year. 

I have to be honest -- that sounds a whole lot nicer than being hunched over a keyboard all winter, reading medical journals and writing bad news to you about PI3K Inhibitors. 

But we all find the best ways we can to cope, and to maintain the best Quality of Life that we can.

So if it's working, keep doing what you're doing.

And if it isn't -- talk to someone who can help you figure out what might work for you. Your oncologist is a good place to start. They might know about resources that are available to you.

And remember that I'm always here and happy to listen.

Take care.

 

ASCO: Unnecessary PET Scans

Continuing with a look at Follicular Lymphoma research at ASCO this year.

As I said before, this year's ASCO didn't have any real blockbuster FL research. But some of the most interesting work at the conference are the presentations that do things like confirm what we might already suspect, or look at what seem like small issues, but which might make a pretty good difference in patients' lives.

The presentation I'm looking at does both of those things, and it deals with an issue that's important to me. It's called "Impact of imaging frequency on progression free survival in Alliance clinical trials enrolling patients with untreated follicular lymphoma." It asks the question, If FL patients in clinical trials receive fewer PET scans, will that affect Progression Free Survival?

The answer is No. Fewer scans do not have negative outcomes for patients, and in fact might have some benefits.

The research was done by a team that is concerned with the ways testing is done on FL patients. Their previous research looked at Bone Marrow Biopsies, and called for eliminating them as part of FL patients' testing schedule. That means less money spent on testing and a small improvement in Quality of Life. 

This research comes to a similar conclusion. More PET scans means higher treatment costs, as well as increased exposure to radiation, and eliminating them would help with Quality of Life. 

For the research, the team looked back at FL patients who were diagnosed between 2008 and 2016 and who had not yet been treated, and who were entering clinical trials. When a trial is developed, patients are put on a schedule for PET scans. (Those of you who have been in trials will know this.) They usually get a scan before treatment starts, to get a baseline -- a measure of how active the cancer is and where it is showing up. They might also get a scan at the midpoint -- maybe after 3 of the 6 rounds of treatment, for example, so get a sense of whether the treatment is working and if it's worth continuing. Then they will get a scan after the final round of treatment, and maybe another a few months later to see if the results were durable. PET scans are an easy and objective way of measuring how well a treatment is working.

Some trials use PET scans more frequently -- maybe after each round of treatment. The more frequent scans (the thinking goes) might help the doctor see whether or not the treatment is working, and if it isn't, allows the doctor to change direction and try something new.

The ASCO research looked at different PET schedules among the patients in the study, with one group getting the scans twice as frequently as the other. But there was no real difference between the two groups in terms of Progression Free Survival. In other words, the more frequent scans don't help doctors catch the cancer earlier. And the frequent scans just add more negative things -- more radiation, more money spent, more time traveling to the imaging center. And lower quality of life.

As I said, this one is kind of personal for me. A few years ago, I had an oncologist who insisted I get a PET scan. I asked if there was some reason for it that I wasn't aware of (my blood work was normal and I hadn't reported any new nodes popping up). He said no, but it would be good to have a "new baseline," since I hadn't had a scan in about 5 years. I didn't make the appointment, and I switched oncologists. I'm still young, and I expect to live for many more years. I don't need the unnecessary radiation. My current oncologist has actually been involved in some research that backs up the idea that FL patients get more scans than are necessary (though I didn't know that when I first started seeing him).

So this is not research that will get much attention -- there are no articles being written about it on oncology websites. But it's one of those ASCO presentations that I really like coming across, one that speaks to out everyday lives as patients, and tries to make them a little bit better.

More ASCO reviews coming soon.

ASCO: Epcoritamab and R-Squared

Finally, I'm giving you some ASCO news. A little later than usual, but I'll try to review some abstracts over the next few weeks.

As I said in my last post, there are fewer Follicular Lymphoma presentations than in the past. Not sure why, since there's plenty of FL research going on. It could be that researchers are presenting results at other conferences instead of ASCO. Or maybe, with the FDA being a little more strict about the evidence they want before they approve a treatment, researchers are holding off presenting early results. Those are just guesses from me. 

Whatever the case, there are fewer FL presentations, but still some good stuff to share.

Over the last few years, there haven't really been any big "blockbuster" presentations on FL at ASCO. The last one was probably in 2018, when the results for R-Squared were presented. R-Squared (Revlimid + Rituxan) was a big deal because it showed that it there could be a non-chemotherapy option that was just as effective as chemo, even if its side effects were just as serious (though a little bit different). There was a lot of discussion about that presentation, and we're seeing how important R-squared has been 5 years later.

This year, I've only seen one presentation that has created a lot of excitement online, on Twitter and on oncology websites. It's #7506, "Epcoritamab + R² regimen and responses in high-risk follicular lymphoma, regardless of POD24 status." Yes, R-Squared is involved. 

The research reports on results of a phase 2 clinical trial, and it involves adding Epcoritamab to R-Squared for high risk FL patients. Let's look at all of those things.

Epcoritamab is a bi-specific, a newer type of treatment that gets a lot of Lymphoma experts excited these days. It operates sort of like Rituxan and other monoclonal antibodies, which attach themselves to lymphoma cells when they find a protein on the surface called CD20. A bi-specific is different because it seeks out a second protein (CD3) on the surface of a T cell, another kind of immune cell, and attaches itself to that as well. By bringing the cancer cell and the immune cell next to each other, the bi-specific helps the immune cell destroy the cancer cell. 

By adding Epcoritamab to R-Squared, we have three different mechanisms for finding and destroying cancer cells. Of course, that also has the potential for creating three times the side effects. A few weeks ago, the FDA gave accelerated approval to Epcoritamab for some Diffuse Large B Cell Lymphomas, so it has already been through some trials.

The twist in this ASCO presentation is that the research is focusing on POD24 patients. As you might remember, POD24 stands for "Progression of Disease within 24 months." FL patients who have received successful immuno-chemotherapy (like R-CHOP or B-R), and then have their disease come back within 24 months, have a lower Overall Survival than other FL patients. About 20% of FL patients are identified as POD24, and researchers have tried to make them a priority in the last few years.

A successful trial for this combination would be a big deal for a few reasons. It would help a group of FL patients that need the help, and it would do it without traditional chemo (which many of them have probably already had anyway).

So what are the results? Very promising.

With a median follow-up of just under 1 year, the 104 patients in the trial showed a 98% Overall Response Rate, with a Complete Metabolic Response Rate of 87%. (A metabolic response rate means the response was measured by PET scan.) That's excellent. The researchers look forward to reporting results again, after some time, to see if the results are durable, and last for longer than a year.

What about safety -- did the combo create lots of side effects? The researchers call them "manageable." About half of the patients had Cytokine Release Syndrome (all of which were treated successfully)  or nerve issues. Others included fatigue and injection site reactions (the Epcoritamab is an injection, not an IV).

At this point, it seems like the combination could be an excellent option for POD24 or other high-risk FL patients. It's a phase 2 trial, so it's a little on the small side. But there's certainly good reason to expand the trial and include more patients. 

As I said, this is probably the only FL presentation from ASCO that is getting a lot of wide discussion, and it seems like there is good reason for it. Definitely something to keep an eye on, and with the success of other bi-specifics, not really surprising. 

I'll have more ASCO news soon. No blockbusters, but some interesting research to share.

Oncologist Appointment Today

I had an oncologist appointment today. I'll give you the good news first -- everything looks good. 

As usual, I saw my oncologist after 6 months. It's always the same general check-up: I get a blood draw, he does a physical exam, and we talk about any symptoms I might have (I have none). I go to a large research hospital for my check-ups, which is good in some ways (I see a lymphoma specialist instead of a general oncologist). It's less good in other ways. The phlebotomist who did the blood draw was very good (I didn't feel a thing), but not terribly friendly. Same with the nurse who took my vitals. They just seem to be in a big hurry. I miss the kind of personal connection I used to get when I went to a private practice. (Though, to be fair, they see me every six months, so it's not like I've developed a relationship with anyone.)

Still, all of the stuff that happened before I saw the doctor went very quickly and smoothly, even if it was kind of robotic.

I was led into the exam room, and before I saw my oncologist, Dr. H, I met with a blood cancer Fellow. My hospital has a group of about 8 recent medical school graduates who want additional training in blood cancers, and sometimes it works out that I see one of them as part of their training. The one I saw was very nice. He basically asked me the same questions that the oncologist asks, though the two of them talk about me before the oncologist comes in. I'm happy to be a part of this process. Education matters.

After the fellow did his physical exam, he asked me if I had any questions. As I have done in the past, I said I had a semi-personal question -- "What made you choose oncology?"

The fellow told me that he loves research. There are some specialties, he said, that already have lots of treatments (like high blood  pressure). But for others, like some cancers, there still need to be more treatments found for patients, and he wants to be a part of solving that problem. He said he comes from a country where there are not a lot of treatments available, and he would like to be able to help cancer patients in his country by finding new ways to treat them. I thought it was a very good answer. 

He also pointed put that I could easily do my appointments one year apart, instead of six months. I told him I like the security of every six months. I also feel like it helps me maintain a relationship with the oncologist.

He left and a few minutes later, he came back with Dr. H. As always, it was like seeing an old friend. I like him. He's friendly and understanding. Right away, he asked me how my trip to Italy was, and we talked a little bit about it, and about traveling in general. We often talk about things like the best places to get hot dogs, or our favorite whiskey. This time, we talked about gelato flavors (Italian ice cream). Mine is stracciatella, in case you are wondering. 

He got my blood test results during the exam -- all normal. Felt my nodes -- no problems. 

It got to be time to schedule the next appointment, and he said, "OK, everything looks good. We'll see you next June."

The fellow jumped in -- "The next appointment should be in December. He likes to do appointments every six months."

Good for him! He listens! He's going to make a good oncologist.

So I go back in January (7 months). I fully expect that I'll have another easy, boring appointment then.

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I'm still looking at all of the research at ASCO, getting ready to share some things with you. Not as many Follicular Lymphoma presentations as in the past, but a few good ones that I look forward to sharing with you.

More soon. Stay well.

I'm Back (from Italy)!

I've been reminding you that I'd be hard to get a hold of for a couple of weeks, but now I'm back. I was on vacation.

My wife and I spent 12 days in Italy.

We've been talking about doing this for 30 years, and a few years ago, we decided we would go there to celebrate our 30th anniversary, which was earlier this year. (Note that I was confident that I'd still be healthy enough to make the trip.) We went on a tour with Road Scholar (and if you're over 50, enjoy learning, and are hoping to travel abroad from the U.S., I highly recommend looking into what they offer). We went to Rome, Florence, and Venice. 

I can't really describe it all yet, but it included some wonderful experiences -- an after-hours, private tour of the Sistine Chapel; a tour of the olive oil production works (and a farm-to-table dinner) in Fiesole; a slow afternoon walk through the maze that is Venice; the many incredible works of art that fill Rome and Florence. Maybe just a few of the many pictures that we took will give you a sense of what we saw and did.

You know a trip was great when you're on the plane home and you're already planning the next one. We're still deciding where it will be. But there will be a next one.

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So what does this have to do with cancer? This is a cancer blog, after all.

There are two things.

I decided the first connection to cancer long before we ever made it to the airport. It's a lesson I hope we all already know. Cancer makes us prioritize. We need to do the things that we want to do. It took my wife and me 30 years to do it, but we did it. It's easy to want to pack as much into a life as possible, and easy to be disappointed if things don't happen immediately. But that doesn't mean they never will happen. Find the things you love and work toward them.

A few months ago, I saw a meme online. And while I don't think internet memes are meant to be a guide for life, this one hit me hard. It's a quote attributed to Buddha, but it was actually from a very modern book that was about Buddha. Yet the sentiment still stands:

"The trouble is, you think you have time."

Cancer patients probably know the truth of that more than most people. I've burned it into my brain. I knew it before this trip. But still, I want it to guide a lot of things I do.

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The second way this relates to cancer has to do with someone I met on the trip. Of course, she is a cancer patient.

The tour we went on included 16 other people. They were all amazing. Over 12 days, we had the chance to get to know each of them, hear their stories, hear their experiences. They were all the living embodiment of "The trouble is, you think you have time." 

As much as we tried to get to know everyone, we spent more time with one family than the others, a married couple and her mom. Wonderful people. And as we talked and shared our stories, it came out that the wife was a cancer patient, diagnosed with a form of lung cancer about two years ago. (I'm trying to respect her privacy, so I apologize if the lack of detail makes things a little harder to follow).

She and I have similar backgrounds, as far as work and education go. She's a writer and a Cancer Nerd, too. We traded blog addresses (she started one very soon after she got her possible diagnosis), and I read hers that night.

It always amazes me that our cancer stories are unique to us, but the details show how similar we are. She had gotten a Peloton bike just before she was diagnosed. As she was waiting for test results, she thought, "I can't have lung cancer. People who ride a Peloton can't have lung cancer." It reminded me so much of my own experience, running in 5k races, being in the best shape of my life, and thinking, "How can I possibly have cancer?" There were a bunch of those things in her blog, experiences that she wrote about that were so much a part of her own story, but at the same time so much a part of mine, and of all of our stories.

So here's this woman who has a story like mine, who lives clear across the country from me, and we had to travel to Europe to meet each other. (And in a weird coincidence, a couple of people that I love very much live within a half mile of her.)

I guess cancer has a way of connecting us. There are experiences we share that others just can't really understand, no matter how much they'd like to, and try to. And we somehow have a way of finding one another. 

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The ASCO conference started today, and I haven't looked at any of the information yet. I'll get there, and I'll write about what I see and read. Probably next week. Still enjoying that post-travel glow a little bit.

I wish you all good health, and the time to enjoy it.