Today we met with Dr. Mansfield, the lead oncologist on Nelson’s case. Nelson will be under his leadership for the duration, and it was this doctor who pushed hard to start chemo and immunotherapy ahead of what others recommended. We saw the reasoning behind this when Dr. Oliver told us he thought Nelson was close to death last week and wouldn’t have made it without the treatment being started.

Dr. Mansfield spent over an hour with us today, much of it trying to simplify the science behind his plan for Nelson. Even with that we had difficulty understanding. For the most part, here’s what he told us.

Nelson has a commonly known type of lung cancer called adenocarcinoma, which is a non-small cell cancer. It’s the kind that’s not necessarily connected with smoking.

We learned how important the process of a biopsy is and why many of the doctors wanted to wait for all of those results before beginning chemo/immuno on him. After nine bits of tissue were taken from Nelson’s lymph node two weeks ago, the lab began performing different tests on them, hoping to find the specific signature mutation on the cancer itself. If they can discover that, they can understand how to attack the cancer.

Once they know the mutation, they can activate Nelson’s immune system with a pill that targets only the cancer cells. In other words, they can train his body to attack his own cancer. This is what Dr. Mansfield is striving for. Targeted immunotherapy is a new science that was unavailable to cancer patients just a few years ago. The treatment is easier on the patient’s body than chemo and produces better results.

Dr. Mansfield simplified the search for a mutation like this. If we lined up 20 different locks but had only one key, we would try the key in each of the locks until we found out which one would open. With targeted immunotherapy there may be far more than just 20 locks, but that’s the goal of a thorough biopsy. If the key we had didn’t open any of the locks, we wouldn’t be able to use our key.

Today’s lab equipment can literally read the DNA strand taken from Nelson’s lymph node. Then laser beams that are too small for the naked eye to see produce gigabytes of information that are read and analyzed by computers. This information is what Dr. Mansfield is working off of.

The first wave of biopsy results have come back negative, meaning no mutation has been found that matches our key, but it’ll be two more weeks before all the information is in. We are still hopeful. The doctor believes there’s still about a 40% chance they’ll find a mutation we can use to unlock what we need in the remaining study. In order for Nelson to qualify for the targeted immunotherapy, his DNA will need to show a match.

The immunotherapy he’s now getting, along with the chemo, is a general boosting of the immune system, but what they really want is the targeted immunology, which is the lock and key that works better than general chemo.

So what does all this new information do for Nelson today? Not much. His first infusion of chemo and immuno therapies happened eight days ago. Their effects are ongoing, and Nelson feels better today than he did before the first IV drips began. His symptoms haven’t changed, but their intensity has. We like to think it’s the infusions that are causing the changes.

He’ll have his next infusion on June 28, and three weeks later, another one. Between those two, he’ll undergo scans to see what kind of progress he’s making. And the doctor will assess his symptoms to make sure things are getting better, not worse.

Meanwhile, his blood is being tested, and today we learned his platelets are low. He’ll have another blood draw on Monday to check this again. His arm and ankles are still swollen and he’s starting to accumulate fluid in his belly. All of this is being produced by the cancer. As the chemo kills those cells, less fluid will be produced. That will be good news when it happens.

From Nelson: Please be praying that my tests come back in that minority 40% and the docs will find the right key and lock combination. These two paths are day-and-night different from each other. And though we wait on the doctors for their expertise and knowledge, we know who is the real Physician and who does the actual healing.

“Some trust in chariots and some in horses, but we trust in the name of the Lord our God.” (Psalm 20:7)