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This afternoon I met with Dr. Nyen Chong, a Kaiser Permanente thoracic surgeon, approximately performing a biopsy of my tumor. (Kaiser's Interventional Radiologists have said that a guided FNA not an numerous for this new tumor location.) We reviewed the location of the tumor, its proximity to 4 specific veins, some lymphatic ducts, and nerve bundles. Dr. Chong explained that the tumor location would be very puzzling although not impossible to entry. He believed he may well successfully carry out a robotic-assisted biopsy, but that the risks of serious complications (serious bleeding or nerve damage causing paralysis) have been approximately 10%. Regarding scheduling, he would not be able to hold out the biopsy until mid-June. I understood him to opine that that he would recommend proceeding with the biopsy only if the percentages of it providing info that would trade the course of therapy exceeded the percentages of the risks.
As I perceive it, the percentages that this new tumor is anything other than mets BC are very low, i.e., the low single digits. I have sent the subsequent three questions to my three oncologists (Dr. Ferrera at Kaiser, Dr. Apolo at NIH, and Dr. Hahn at Hopkins):
1. Do you agree with Dr. Chong's comparability?
2. In view of the biopsy risks, would you recommend proceeding with the immediate resumption of nivolumab without having a biopsy?
3. Or, would you insist on having the biopsy prior to my resuming therapy?
I'm leaning away from having the biopsy on account of the both the risks and the passage of time, but wish to hear hear how oncologists answer my questions. Of course, either Dr. Ferrera or Dr. Hahn will have to agree to renew treatment without a biopsy, and for me to enter Dr. Apolo's cabo/nivo/ipi trial, I'll have to first resume nivolumab, then have tumor progression. I'll doubtless persist with their consensus.