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Hello everyone,

I got a CT scan yesterday and the results are mixed. The bad news is that my current treatment has stopped working and that the cancer has grown. The good news is that I apparently have a slow growing cancer and that my oncologist thinks I should last several years even without any treatment. And that's longer that I expected with treatment.

Generally lung cancer gets you fast and - if Google is right - half of all people who were diagnosed the same time I was are now gone. So I'm already in the top 50%. And - I no longer have to deal with the side effects of the drugs I'm currently taking. So I should be healthier in a few weeks than I am now. A few months ago pneumonia almost got me but I'm mostly recovered - except for my voice. Hoping I get that back eventually.

Form what I can tell, my best guess is that the current treatment killed all the cancer cells that were vulnerable to these drugs and that what is left is the cancer that isn't affected by these drugs. Generally this is what happens with cancer treatments and I had hoped it would have been effective longer - but it wasn't. One of those casino moments where I didn't get what I wanted. The current treatment was never a cure. It was something to buy more time waiting for advances in immunotherapy. I'm still going to continue taking some of the other supplements I've found because I think it will slow the cancer down and have no down side if it doesn't work.

Now that my current home brew cocktail isn't working you all no longer have to hear me brag about what a medical genius I've become. Although it was somewhat of an achievement and my oncologist thought it could have worked too. And I'm still alive without having to go through chemo infusions and have had a pretty good life during this 8 month period. But I will miss the bragging.

So - what's next?

I'm going to get my biopsy looking for something called PD-L1. If I have it - that's good news because that means I have an 80% chance of doing the cancer significant damage and possibly a cure using immunotherapy (Opdivo). If I don't have it the effectiveness goes down to like 20% and probably not worth doing. I had hoped my current treatment would have lasted longer to give immunotherapy a chance to develop more. This has always been my second plan. I should know in 2 weeks if I have PD-L1.

The easiest way to understand immunotherapy and PD-L1 is that people get mutations all the time that can lead to cancer, but the immune system knocks them out. PD-L1 causes the cancer to be invisible to the immune system and is the "I'm a friend" signal. Opdivo knocks out PD-L1 and unmasks the cancer so the immune system sees it and kills it.

The news wasn't what I expected but if I have 3+ years because my cancer is slow growing I'm actually ahead of expectations. When I first was diagnosed I was expecting less than 6 months of quality time and it looks like I'm getting a lot more than that. So probably more good news than bad.

And as I said at the time - I've lived a great life. I'm already over 3/4ths of a normal lifespan, and what's left is the worse 1/4 part. If you look at quality life, I probably got and even higher percentage. So I have nothing to complain about. And - quite frankly - these too many stupid people these days and it's getting worse. So part of me is ready to wrap it up. Kind of like being at a party at 3:00am. Still having fun - but it's time to go home. But who knows. If I hang on for 10 years I'll probably be able to upload my brain to a Tesla and I can continue to live as a car - where I can get upgrades and replacement parts.

So - don't feel sorry for me. I'm doing fine. I'm not the one who will have to live in a world without me in it. So it's me who feels sorry for all of you. My final adventure is far from over and wierdly enough, there's something strangle exhilarating about it, as odd as that sounds.

I have my living trust done, I have a plan for my business, and I have a friend who is going to take over the Church of Reality. So I'm not as panicked as I was when I was first diagnosed. And everyone has been very supportive and life is still good.

So - I'm going to be around for some time it seems and I'm still the same guy I've always been.

Marc Perkel

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