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"I didn't know who Lance Armstrong was. It's funny, too, because I really follow sports. Football, baseball, basketball. I just didn't know anything about cycling. I've had athletes before--testicular cancer is a disease that strikes young men. Then I started receiving these calls and e-mails from oncologists around the country, around the world. I realized this was someone special."
There are choices with all treatments. After examining Armstrong, the doctors devised a course of treatment for him. The primary goal was survival. The secondary goal was to allow Armstrong to resume cycling. Einhorn and Nichols laid out choices that would make the resumption of an athletic career possible.
"There were two major decisions," Einhorn says. "The first involved the brain tumors. Chemotherapy doesn't work as well on brain tumors for some reason. We don't know why. The standard treatment is radiation, but one of the effects of long-term radiation is a slight loss of balance. Not enough to affect the average person, but certainly enough to keep someone from riding a bicycle down the Alps. We chose surgery for Lance. It's slightly riskier, but he had only two tumors and they were in a position where a surgeon could get to them.
"The second decision was on the chemotherapy itself. The drug we usually use is bleomycin, which produces less nausea, vomiting and other side effects than ifosfamide, another possibility. One downside of bleomycin is that it slightly diminishes the patient's lung capacity. Again, for the average person, this would not be a problem. But for a cyclist? Lance chose the ifosfamide, taking the short-term discomfort for the long-term gain."
The brain surgery was performed on Oct. 24. The chemotherapy was administered in three separate five-day stretches. Armstrong would come to Indianapolis for a treatment, go home for 21/2 weeks, then return for more treatment. His hair fell out. He lost between 10 and 15 pounds of muscle--he had nothing else to lose, since he had begun the treatments with less than 2% body fat.
Armstrong's hope had been that his athlete's physical conditioning, even his focused, positive athlete's mind, would be an ally. Cancer doesn't work that way. The weak survive as often as the strong. "I've had wonderful, positive people, people who ate all the right things, did all the right things, not make it," Einhorn says. "I've had some of the most miserable, ornery people, complaining all the time, survive to resume their miserable, ornery lives."
Einhorn's first indication of success was a clean chest X-ray. A dead lung tumor can remain in the picture for a year, indistinguishable from a cancerous tumor. The tumors must disappear before the doctor knows they're dead. This happened for Armstrong in April 1997.
The second benchmark was a blood test, tracking a factor called the HCG count. A normal HCG count is 1.5 or less. Armstrong's was over 100,000. It had to return to 1.5 and stay there. The count dropped to normal in February 1997; when it was still normal in October '97 (a year after his first chemo), he was pronounced cured. He had beaten cancer. "He's no more susceptible now to other cancers than anyone else," Einhorn says. "In a world filled with sad stories, Lance's is a wonderful story."
The second half of his story is almost as startling as the first. Armstrong never really left cycling--he took 30-mile rides in Austin during the recovery time between chemo sessions--but as he returned to full-time riding, he gradually found that he was even better than he had been before he became sick. The weight loss from the chemo had left him with a lighter and leaner body. The experience had left him with a different mind. He was more mature, more serious, more directed.
He got married. His wife, Kristin, became pregnant in vitro with sperm he had frozen before he started chemo. He looked at all the possibilities. He looked at the Tour de France.