4th Erbitux, 2nd Chemo Treatment

Karen's been having sharp pain in the right side of her abdomen the last 24hours. This is similar she says to the pain experienced when she was first diagnosed. We are not sure but are hoping this is shrinkage or some other good effect of being back on chemo.

Tomorrow she'll go for the 2nd chemo treatment but 4th Erbitux treatment for those keeping track. This'll knock her out for a good few days but overall is still less of a burden than the original regime (another "easy for me to say").

We'll ask Doctor Dan what the pain means and perhaps he might have some suggestions although with only external exam it's very hard to be sure what's going on.

CEA Result

One of the nurses called today, completely out of the blue, with some amazing news: Karen's CEA is down from 237 to 65!!! This is great news and something we were not expecting. This type of impromptu call is also an example of the great care we are receiving at Overlook and how much the team there takes a personal interest in the patients.

3rd Erbitux Treatment

Karen's doing well. She had her third Erbitux dose today. Dosage days are iffy but the largest side effect is a skin rash which is proving bothersome but tolerable. CPT-11 will be given next week (the 28th) which will knock Karen out for a few days. Other than that the regime is going ok (easy for me to say) and Karen's doing a great job coping with everything.

In happier news; Sydney turned 4 this week and we had a lot of family fun with her. Photos are available on Picasa for family and friends, email us if you'd like the link.

1st Erbitux + Chemo Session

I will update quickly tonight although truly not in the mood. Karen went back on chemo last Thursday (Feb 7th). Her new protocol is CPT-11 (chemo) every three weeks and Erbitux every week. This will continue for 12 weeks at which point a PET and CT scan will be repeated.

Erbitux is scheduled again on Thursday the 14th, (Valentine's Day).

Karen's baseline CEA from last Thursday is 230. Before surgery it was way down in double digits so this is quite a jump. However we must remind ourselves that she's been off chemo for some many months. Hopefully the next measurement will be lower.

Starting Over

The last week has literally been an incredible roller coaster of emotions. Karen had a CT scan last Monday (Jan 28th). Dr. Dan was away at the American Society for Clinical Oncology's 2008 Gastrointestinal Cancers Symposium all week so rather than wait for his consultation we decided to get a CD from the scan and look at it at home.

We have some experience looking at these things so this wasn't as crazy as it sounds. Unfortunately we were not prepared for what we saw. Karen's entire right lobe shows up engulfed in tumor. After thinking about it for a while we concluded this must be inflammation from her RFA burn in November.

The radiologist's report came through on Thursday and our nurse Nancy walked us through some of the salient points over the phone. Unfortunately this did not sound good at all. One of her tumors which was 5.6cm is now 10.5cms in diameter. The report made mention of increased growth, progressed disease and so on. So naturally we both lost it and have been struggling pretty much all week. I did not update the blog as I just couldn't bring myself to do it and besides, we didn't truly have things from the horse's mouth.

Today we met with Dr. Dan. He was firm and confident as ever and he walked us through the scan results. We learned a couple of things:

1. The radiologist's report was given by taking the scan as a point in time and not in the context of Karen's RFA. Hence a lot of what is seen on there IS due to inflammation.
2. Many of the larger tumors have a "classic" ring of calcification indicating necrotic tissue.
3. RFA does tend to cause more inflammation and hence increased tumor size than other treatments.
4. Karen does still have cancer and it's still growing in there so it's time to start chemo again.
   

He also laid out the new plan; Erbitux and CPT-11. Because she is still healing from the incision, she cannot start back on Avastin but rather than give things a chance to grow, Erbitux will be introduced.

Erbitux is a very new drug [LINK] which works similar to Avastin in that it blocks the tumor from binding to a certain protein it needs. The result is that the tumor shrinks and dies. It's insanely expensive and I need to check with our insurance in case we need pre-approval.

Karen will start chemo (CPT-11) on Thursday (7th). On this plan she'll receive chemo once every 3 weeks and Erbitux (which is technically not a chemo drug) every week. This'll continue for 12 weeks after which she'll have a PET and another CT scan. There are side effects which I'll cover in another post and probably a few other surprises in store but we'll deal.

Net-net we've had some very hard, very dark days this week but we are still kicking and remain confident that Karen is getting the best treatment possible.