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The animation above shows my most recent PET scan. See the bright yellow sparkles in the pair of otherwise dark areas above the center of the image? Those are the tumors in my lungs. Some appeared since the last set of scans; others are metabolizing more, and thus showing up brighter. For comparison, the left image below is from last November, and the right is from this most recent scan.

These are not good results. Obviously, the chemotherapy has not prevented tumor growth. Medical literature would say I have reached the regimen's "time to progression", that is, the point after starting treatments at which the disease advances or reappears. Despite the provocative title of this post, that does not necessarily mean that the chemotherapy has stopped working; it just means it is time to try something else.

Unfortunately, my options have become much more limited over the past year. By last March, I had long passed the maximum lifetime dosage of one drug (ifosfamide). Last July, side effects prompted my oncologists to remove another (docetaxel) from my treatments. These latest results show that the remaining drug (gemcitabine) alone has not been effective.

My oncologist searched through the medical literature for other treatments. There is not much, since I have already tried almost everything, and the pool of patients with recurrent, metastatic osteosarcoma is so small as to limit the number of clinical trials for new drugs. Nevertheless, he found one clinical case study in which a combination of gemcitabine and a drug called irinotecan most often used to treat colon cancer was beneficial in a case very similar to mine.

The combination of gemcitabine and irinotecan has shown acceptable toxicity and synergistic activity against many refractory solid tumors. Our case report demonstrates an excellent clinical and radiographic response in a heavily pretreated patient with recurrent osteogenic sarcoma...Due to the absence of a radiographic response to gemcitabine and irinotecan used as single agents, we think that synergism between the 2 drugs makes their combination effective.

So far I have undergone one cycle of treatments with this new pair of drugs. Time will tell if it will work for me.

But truthfully, while I remain optimistic, I don't expect to find the silver bullet. At best, this new regimen will most likely just stabilize tumor growth, and the prospects of experimental treatments or more drastic alternatives like surgery or radiation are not much better. That makes, "try something else and see if it works," an unsatisfying answer to the question posed in the title of this post, but it is the only answer I have for now.