Bryan Chagolla: Maintaining Balance in Life, despite Metastatic Gastric Cancer
I was sitting in a tiny room of my local emergency room waiting for my test results when the doctor came in, grabbed my hand, and said, “We’re 95 percent sure it’s cancer.” I had an immediate feeling of despair, denial, and shock. It felt like darkness, like I was sinking into a void. One week later, I received my official diagnosis of stage IV gastric cancer. After a series of initial treatments, I was put on a newly approved drug called fam-trastuzumab deruxtecan-nxki (Enhertu). Since then, my cancer markers have gone down drastically, and the scans show continued shrinkage of the tumor. I am maintaining life balance and calm, focusing on the present, and spending time with family. It all started in January of 2019. I was experiencing some abdominal symptoms such as loss of appetite, indigestion, heartburn, and difficulty eating. Between January and April, I lost nearly 40 pounds. I also had abdominal pain and started feeling faint throughout the day. Because of some issues with my health insurance, I did not have coverage during this time but decided to see a physician as my symptoms were getting worse. My doctor recommended some dietary changes and ordered a few standard laboratory tests. None of the test results were abnormal, but my symptoms got progressively worse. At the time my wife and I were expecting our second child and I thought that I would wait until she was born to take care of myself. One day that June, however, the pain became so severe that I had no choice but to go to the emergency room.
They performed an ultrasound and a CT exam after which I was told they were 95 percent sure it was cancer. I was 38 years old with a young daughter and another child on the way. I was in complete shock. They needed to do a biopsy to be certain. I was sent home with pain medications as I was waiting for my biopsy results. A week later I was in so much pain that my sister had to drive me to the hospital. At a friend’s suggestion, I went to Cedars Sinai where I received my official diagnosis of stage IV gastric (stomach) cancer. My sister works as a medical administrator and has been a guardian angel for me. She helped me navigate the health care system and get back on health insurance. She also helped me find an oncologist at the City of Hope Comprehensive Cancer Center, which is where I received all my treatments.
Genetic testing of the cancer revealed that it was HER2 positive. My initial treatment was a chemotherapy regimen known as FOLFOX combined with a HER2-targeted agent called Herceptin. It was a biweekly treatment that I received for about six months. The treatment was quite effective. It reduced my tumors. I had a large tumor on my esophageal juncture that had spread to the liver and over the course of treatment that tumor shrank by 75 percent. However, I was also starting to experience some serious side effects. I had severe neuropathy in my hands and feet, and difficulty eating and putting on weight. Because my tumor was responding so well, my oncologist decided to remove one of the chemotherapeutic agents in FOLFOX and put me on a modified chemotherapy regimen along with Herceptin. I received this treatment from January 2020 until about November. In addition to my chemo, I was also trying some alternative medicine approaches, including nutritional guidance and acupuncture. Overall, I was doing well. I had gained some weight and my tumor seemed stable.
In June of 2020, while I was still on the modified chemotherapy, my lab tests showed that the level of one of the cancer markers, carcinoembryonic antigen (CEA), was increasing. Since my tumors were still shrinking according to the scans from earlier that year, we decided to wait and watch. By October, the levels of CEA had skyrocketed, and my scans also confirmed that the tumors were growing again. My oncologist suggested a clinical trial that was testing a combination of two molecularly targeted therapies. I started on the trial in early January. Unfortunately, I experienced some serious adverse effects and had to discontinue the treatments. Luckily, in mid-January 2021, the FDA approved the HER2-targeted therapeutic called fam-trastuzumab deruxtecan-nxki for patients with gastric cancer. In early February I started receiving the new treatment and have been on this drug ever since. I do get some fatigue and nausea after treatment, but these side effects are less severe and more manageable compared with FOLFOX.
Since I’ve been on fam-trastuzumab deruxtecan-nxki, my CEA levels have declined drastically. A scan in May 2021 confirmed that my tumors are shrinking again.
I am grateful that the treatment is working. I am also thankful to have a very supportive family and home life. I feel that I am at a place that is stable and consistent, and my goal is to keep things this way and continue to work toward improving. What my experience has taught me is that I must maintain my balance and calm. Right now, I am focusing on my mental, physical, and spiritual health and spending time with my family and loved ones.