Decisions, decisions

Professor Gore ended the name game. He should be called Professor Jolly - but apparently prefers "Martin".

He didn't really give us any new information about Quentin. He confirmed that, although immunotherapy doesn't have a great success rate, fit people with small volume lung disease (ie Quent) do relatively well. He did say that the chances of the speckles NOT being cancer deposits are pretty small, because of the status of the kidney tumour and the way they look.

We need to see if Quent's speckles grow. We will repeat the CT scan mid December and again every 3 months until they grow, when we will start treatment. "Tonight, the news is no panic". He said they can't really predict things like life expectancy for Quent until they have more of a pattern of how the speckles are performing (6 to 9 months worth of data, unless they have grown very quickly before that).

Martin trained Dr Savage and says he is very good. For most of the consultation it looked as if the choice between where we would go for treatment would have to come down to trivialities like the colour of the curtains. (Marsden would win hands down. This NHS hospital even has carpet in the reception!) But then, just near the end he revealed a key difference:

• Dr Savage / Charing Cross gives a combination treatment (triple therapy) of interferon, interleuken and 5FU.
• Martin / Royal Marsden only gives interferon. They only use treatments according to results not hunch. The triple therapy has gone back into trial as it seems to be better than interferon for only 5% of cases.

Which to choose? It seems the key downside of the triple therapy is its toxicity (it has worse side effects). Also that it is harder to administer, so difficult to justify cost-wise unless they can prove it really does work. The upside is that it does seem to be better than interferon in some cases and he even seemed to mention a cure for a few cases. (Although Dr Savage wasn't claiming that).

The results of the trial will not be known for a year, so we need to choose, in case Quent needs to start therapy before then. (We can't have both, and so there is a chance that if we go with Martin and the interferon, the trial will subsequently say that the triple therapy would have been better).

We have decided to find out more about the side effects. If we are risking flu like symptoms for even a tiny chance of a cure, Quent will probably prefer to go with the triple. If the side effects are more serious - like amputation or something - then maybe we'd think again.

One important thing Matey Martin raised. The next stage of treatment (the serafanib) is not available on the NHS yet, so we need to stay private.

Have a great weekend. Our Indian takeaway has arrived and I need to open the wine ... did I mention that Martin rubbished all things "Holland and Barrett"?