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The Last Option

For three 'lazy and happy' years, cancer retreated to let Dave Musso savor life's every moment. Suddenly the darkness was back, and only an uncharted path remained.


Hope washed over Dave and Mary Musso one day in 1992, a warm sensation that felt peculiar to the Northridge couple accustomed to the gloom of battling cancer minute by minute for almost a year.

It came in September, just after Dave opted against having his tongue surgically removed. He had been forced to consider such an operation after the tumor on his tongue--which stripped him of his ability to taste, smell or swallow--resisted chemotherapy and radiation treatment.

Instead, Dave chose another round of painful, nauseating chemotherapy. When the time came to die, he figured, with his tongue intact he would at least be able to say "goodbye."

Then Dave was reborn.

The cancer vanished as abruptly as it had appeared 10 months earlier during a long vacation.

Pals cheered, including the nurses at UCLA's Jonsson Comprehensive Cancer Center who'd been won over by Dave's stoic demeanor.

"We dodged a big one," Mary said, beaming.

Dave, dizzy with joy, said, "Man, this is it!"

From now on, he would savor every moment. Things great and small--from his grandson's first step to the newest drama in the sports pages--all became momentous to him. To mark their fresh start, the Mussos filled their large house with the ebullient presence of a small dog, Nicky. Dave learned to swallow again, one slow teaspoon at a time.

The world shimmered with possibility for--as Mary put it--three "fat, lazy and happy" years.

Then in summer 1995, the coughing returned. Like an assassin in the night, it clutched at Dave's throat.

"Oh, God, here we go again," Mary said.

The Mussos were tossed back into their sea of despair, only now it was darker.

Waiting for them there was Fairooz Kabbinavar, Dave's new physician. Smiling, the stout, black-haird doctor greeted the couple in a lilting voice flavored by the Urdu he spoke in his native India.

He tackled Dave's illness armed with the usual arsenal of physicians, plus a secret the Mussos would learn only later.

'Maybe It Will Give Me a Fighting Chance'

Shortly thereafter, new tumors were found in a sector of Dave's left lung, causing him to cough up blood specks. Kabbinavar ordered the entire segment surgically removed. The following summer, the cancer had moved on to Dave's larynx. Out it came, leaving him voiceless. In 1997, two parts of his right lung went.

"It has all been so hard," Mary sobbed.

This summer, Dave found out his left lung was again riddled with tumors--one the size of a fat baby's fist.

Surgery was not an option, Kabbinavar said. The tumors covered too much of Dave's lung. Nor could they be eliminated with chemotherapy, radiation or any other available cancer treatment.

Dave--reduced to speaking with an artificial larynx and gasping for air through a hole in his throat--was marching inexorably onto the list of 160,000 Americans who will die of lung cancer this year. His life expectancy? "Between seven and nine months," Kabbinavar said.

But that made Dave a perfect candidate to enter a realm closed to most of Kabbinavar's other patients.

Kabbinavar had for years been making great strides in his second role at UCLA's cancer clinic: researcher.

Dave's condition--beyond all other remedies, with nothing to lose--appeared ideal for testing the effectiveness of angiogenesis inhibitors, a new class of drug being investigated by Kabbinavar and cancer specialists across the nation.

The drug starves tumors by depriving them of oxygen and other nutrients they need to grow. Where chemotherapy works like a nuclear bomb, blasting tumors with chemicals that also destroy other healthy cells nearby, the inhibitors operate like smart weaponry. They target specific blood vessels the way Dave, as an Air Force bombardier in World War II, picked off factories and warehouses that supplied the German war machine.

The new compounds sparked a frenzy in May when reports circulated that successful tests on tumor-ridden mice had been conducted by Dr. Judah Folkman, who pioneered angiogenesis inhibitor research in the early 1970s. The news sent cancer patients around the country flocking to their doctors, pleading that they be given the new compounds.

Because Dave was in remission at the time, the Mussos had paid scant attention to the clamor. Later, though, the couple listened with interest as Kabbinavar informed them that one of several varieties of angiogenesis inhibitor was ready to be tried on a small group of humans. For about six years, it had produced impressive results in mice with lung cancer, sometimes eliminating the tumors.

Now, Genentech Inc.--the South San Francisco company that developed the compound--was launching an experiment on 99 patients in five states. Kabbinavar invited Dave to join 29 others in testing by UCLA.

The compound, derived from a mouse antibody, could in fact kill humans. But Dave accepted.

"Maybe it will give me a fighting chance," Dave suggested, his voice droning through an electronic voice box dangling from a cord around his neck. "If not, well, maybe it will help others out down the road."

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