July 6, 2026

Lenvima and Balversa sound like towns in Italy. They may be. In the medical world they’re in a category called “antineoplastics,” which are used to treat cancer, also called chemotherapy. Balversa is the one I know. Oncologists call it erdafitinib. Lenvima also has a funny name, levantinib. Both are in pill form, taken orally.

We’re constantly learning. Right now Balversa is the past, Lenvima is the future, as far as it goes. The present is logistics, transitioning from the downtown Cancer Institute to a branch only ten minutes from our house and getting to know a new doctor. He’ll be replacing the guy who tackled my problem nearly six years ago and never stopped working for me.

Dr. Britt Bolemon is a prince who stands head-and-shoulders above the medical technocrats. Over those years he smiled, he listened, he taught. But as the Prisma health care system pushed the docs to herd patients through the building faster, around 15 minutes per consult, he decided that was not his medical vocation. He found the practice and the philosophy he believed in 30 miles down the interstate in Anderson. Saying goodbye was tough.

We think of cancer in broad-brush terms: breast, colorectal, stomach, lung, pancreatic, cervical, esophageal, others, which are categories of hundreds, even thousands of specific strains of disease. Smoking, environmental factors like exposure to harsh chemicals and industrial pollutants, radiation, prolonged sunlight, obesity, diet, are factors. But the real battle is fought at the cell/molecular level, where for mysterious reasons things sometimes go haywire. 

One outcome may be something the oncologists, who are scientists, call the FGFR3 mutation. This is where my cancer, thymic carcinoma, begins. After all those oncology appointments, the doc’s tutorials and briefings, the gene-level tissue analysis he ordered in 2021, we heard the message but only vaguely grasped it. The analysis helped him decide I should go with Balversa which, like some other chemotherapy drugs, attacks where gene mutations form, and where we really live our lives.

Through these six years we watched the scans. Thymic carcinoma originates in the thymus, in the center of the chest, and like other cancers may travel elsewhere. The “urothelial” cancer in my kidney in 2018 reappeared along my rib cage in 2020. In November of that year when we landed in this town, Dr. Bolemon took charge. A week before Christmas surgery did the job, backed up by radiation.

A recovery year sped past, followed by a year of immunotherapy with Keytruda, the famous drug advertised on the evening news shows. It didn’t help much. Things lurched backward a bit. We talked about Balversa. In February 2024 I gulped down the first pill. I pushed the start date a day or two later to avoid side effects on my birthday.

A year passed in a blur of strange symptoms, numbness in my fingers, sensitivity to light, tiredness, similar things.  But soon the scans looked better and the doc cut the dosage from eight milligrams to six. Finally a thumbs-up, he called off the medicine, I took my drug holiday. Meanwhile the drug company kept sending pills, a 30-day supply every other week. I built up a stockpile. I waited a few weeks before canceling the deliveries, just in case.

But cancer doesn’t quit, those eerie shadows on the scans didn’t go away. “Let’s look at a PET,” the doc said. I got the PET scan at the downtown hospital. He studied the images. “Start back with three milligrams,” he said. I pulled the remaining Balversa bottles down from the kitchen cabinet, about six months’ supply. One tiny pill each morning.

Compared to the original eight-milligram dose, three doesn’t seem like much. Maybe it should have worked, maybe more would have worked. Three milligrams minimizes side effects, I never felt a thing. I went to the gym, jogged, took naps. For a year the scans looked good, those dark shadows fluttering around just a bit, growing a centimeter or two.

But then, two consecutive scans showed change. After the first the doc said simply, “It’s a stable scan.” But he could see, we all could see, this is a trend.

The late-June scan showed more growth. “Nothing remarkable,” he wrote in his notes, “but this combination warrants a change in therapy.” Cancer adjusts. Increasing the Balversa dosage probably wouldn’t have helped.

A first thought was a biopsy and another molecular study. Instead the doc proposed moving to Lenvima for four weeks to check tolerance, then a lab workup. He’s recommending 20 milligrams/day, a stiff jump from the three with Balversa.

Twenty milligrams of chemotherapy means business. Chemo targets fast-multiplying cells, cancerous or healthy, which could mean only hair loss, but possibly attacks on internal parts.  Depending on how the lesions behave after being hammered by Lenvima for ten weeks, the new doctor may order the biopsy and tissue study.

We kept up the rituals, exercising, getting coffee at our local place and, after ditching the road-trip idea, buying plane tickets to Idaho Falls for Kathleen’s and Steve’s September wedding party. We’ll get a car and drive to the site in Ashton.

Memories percolate back. Fifteen years ago we passed through Ashton, barely noticing it, on a road trip from Breckenridge, Colorado to Ennis, Montana. Maybe 20 miles farther north the highway divides into ID 87, which continues north through big-ranch country to Montana, and U.S. 20, which takes you to the west gate of Yellowstone National Park. We’ve gone both ways.  

So we have that. That follows our two-week expedition to Alaska in mid-August, a train, bus, and boat ride from Fairbanks to Vancouver. We’ll take photos, pick up souvenirs. More grist for “On the Road.”

Starting eight years ago, our plan was to see the country. We’re down to four states we’ve never set foot in, the Alaska trip will leave three, Arkansas, Oregon, and for Sandy, North Dakota. That would be nice. We’ll whisper a short prayer. The Lenvima is in the mail.