Thursday, July 9, 2009

Left adrenal gland is tumor free

I could be a radiologist. In fact their written report was just about as informative as mine when I posted that there are still lesions on the liver. They didn’t compare the results from the previous scan so there is not yet a clear indication of progress. One thing is for sure, the left adrenal gland is now tumor free. From a quick comparison, Dr Sharfman did seem to think that there was progress or shrinkage of tumors on liver. He is going to call the radiology department at Washington Hospital Center and have them actually compare the results.

Having no real results ready all we could really do was speculate and talk about the options for either outcome. He did confirm that if his quick comparison holds true that we would continue with IL-2 for another two rounds of treatment. I always said that I would stick with a plan or treatment while it is working. I think in this case I would go for it and head back to the hospital. On the other hand if the results come back showing that we are not making progress we would want to change gears and Dr Sharfman had quite a few options.

The first option was a Phase II Trial at the National Cancer Institute run by Dr Rosenburg. It is a type of cell therapy where they would surgically remove one of the tumors from my liver and extract the white blood cells. The cells are then regrown and administered back into my system with IL-2. The thought here being that the white blood cells that made their way into the tumors are especially wired to identify and attack the malignancy where others are not. The chances that they can fight off the disease are then increased when these white blood cells are cloned and the new reinforcements are sent back in. They are seeing somewhere near 50% of their patients receiving significant responses. Of course there are restrictions, candidates must have the correct blood typing and genetic markers. Apparently 60% of people have these markers. I had blood work taken today before I left just in case. This option would have me held up at the NCI in Bethesda for about three to four weeks. Doesn’t sound like a whole lot of fun.

The BRAF inhibitor is an option where I would take a pill at home. This option has minimal side effects and they have seen a nice success rate or about 60%.

ANTI PD1 treatment is given via IV in an outpatient setting. Every two weeks I would go back to the hospital for a new dose. The concept here is that the immune system has certain brakes (PD1) so that it won’t harm healthy cells. Sometimes those brakes also prevent the immune system from fighting off melanoma. The thought here is that once the brakes are removed, the already super-charged immune system (after IL-2) can then fight off the disease.

"This is the second trial to evaluate MDX-1106 in cancer patients.  In the first-in-human clinical trial recently conducted at Johns Hopkins and 3 other centers, patients received progressively higher doses of MDX-1106 as a single intravenous infusion every 1-3 months.  Tumor regressions were observed in some patients with melanoma, kidney, colon and lung cancer, and there were minimal side effects.  This new trial will use more frequent dosing of MDX-1106, every 2 weeks in 2-month cycles.  Patients with advanced metastatic melanoma (stage III or IV) whose disease has recurred after standard treatment may be eligible for enrollment, regardless of the site of their original melanoma (skin, eye, mucosal, unknown).   In addition to melanoma, patients with advanced cancers of the kidney, lung and prostate will be included.  Because MDX-1106 has immune stimulatory properties, patients with autoimmune diseases are not eligible." -- http://www.hopkinsmelanoma.org/content/index.cfm?cID=29


Temodar is a chemotherapy option in a pill format which can be taken at home. Side effects are supposedly more mild than chemo drugs of the past. For example, patients on Temodar do not usually lose their hair. I also asked about its known toxicity and how harmful it was to the liver. He told me that it was a safe drug and that the liver would be fine. I'll need to do a little more research on that. Temodar still only has a 15% success rate and typically holds off melanoma for one or two years. Thought here being 5 days of pills could provide two years of survival. If the tumors come back, try the pills again.

Temodar with PARP Inhibitor - Same as above except 2 out of 3 patients get an additional trial drug that attempts to inhibit the DNA repair of melanoma as the chemo does it’s job. Apparently while the Temodar drug breaks down the DNA in the malignant cells, this PARP enzyme begins repairing it allowing the tumor to stick around. This experimental drug will attempt to prevent this PARP enzyme from doing it’s job.

The first three options are all Phase II trials in which are not random. I would actually get the medication in a full dose. Temodar, like IL-2 is an FDA approved chemo drug that is considered a standard treatment. The fifth option which includes the inhibitor is a random trial where I would still get the full amount of Temodar, but I may or may not get the experimental drug. All of these options are worth having a close look. Monday’s trip to Pittsburgh to see Dr Kirkwood might also provide more options.

With any luck I’ll have the new results from the radiologist by tomorrow. I’ll then post the official findings. It would also be nice to have the results prior to seeing the new doctor. I’d like to have as much information as I can seeing as driving up to PA for a follow up visit would be quite a PITA.

Another exciting route that I am taking is with at the Natural Health and Acupuncture Clinic in Frederick, Maryland. I want to talk with them about my diet choices. See what they have to say about blood alkalinity and associated diets. Also I want to start down the path to find a doctor that knows supports or knows anything about LDN and some of the low cost medicines that are thought to fight off diseases such as MS and cancer with no side effects. I have an appointment next Wednesday.

1 comment:

dougsmoonbaby said...

Sounds like optomistic news!

Glad you are still checking into all your options; education is the key to making wise decisions.

Keep the positive light shining on you.

Ellen