So.

It may be hard to see in the photo, but there have been changes in the tumor since the last scan. (Click on the photo above to see an expanded version.) The left is an older scan from June 18th, the right is from this past Thursday, August 20th. 

Dr. Lobbous discussed Richard's case with the 'Tumor Team' at UAB today, and he called this morning to let us know their consensus. 

Consensus is progression.

The Avastin will be stopped and in two weeks another MRI will be done to see how aggressively the tumor is growing, then we need to make some decisions.

We were given a list of things, but one of the possible options is another clinical trial, and this will likely be our choice if he's still considered eligible after the next MRI.  The trial uses an engineered virus to target the cancer. I'd read about it before and thought it sounded promising.  Here are a couple of links if anyone's interested.

https://www.healthline.com/health-news/doctors-using-herpes-virus-to-fight-brain-cancer#1

https://www.clinicaltrials.gov/ct2/show/NCT02062827

The gist is it works two ways. One, it's a virus that is engineered to target cancer cells, so it kills directly, but then two, it sends signals to the body's own immune system to help it 'learn' how to target the cancer as well. In the past trials, the best outcome has been for some percentage of the patients to actually develop an 'immunity' to the cancer itself. There are six- and seven-year survivors from the past trials and the more it is studied the better the virus can be engineered to increase the percentage of 'immune' patients.

So even though progression is never a good thing, this trial has both of us cautiously optimistic, maybe even hopeful.