john
-
Posts
1,513 -
Joined
-
Last visited
Content Type
Downloads
Store
Profiles
Forums
Gallery
Blogs
Events
Posts posted by john
-
-
Sorry about the news. There is a new drug called HKI-272, it is supposed to work if Tarceva stops.
Not sure of what trials are available but it might be worth doing some research to see if you think it is an option
Take care
-
For 2b they should do surgery unless like Ryan said they can not get clear margins.
A 2nd opinion is always a good idea, especially since there was bleeding. I can not say anything about the expertise of your surgeon, but having complications would have me a little concerned.
When we took slides of my mom's operation to Slone for a 2nd opinion. The 2nd opinion Dr said something like, "I have never seen a cleaner incision, completely amazing. who was the surgeon?". Make sure your surgeon is the best in the area.
-
For the TNM staging the N is all based on "regionally local lymph nodes" - lymph nodes in the chest area. They are lymph nodes that are at the lower part of the lung N1, middle part N2 and upper part N3.
N1 makes the cancer a Stage II cancer.
N3 makes a cancer Stage IIIb so most of the times is inoperable.
There was a case for "debulking" a tumor, but the logic now is - If a tumor is not local and can be completely removed then a "systemic" treatment such as chemo must be used.
It also partly depends on which side of the lung the surgeon is operating on. The surgeon can not get to all lymph nodes (there is no access). Surgeons don't open the whole chest up.
I guess a medianoscopy can be done on both sides of the chest to check for "contralateral" lymph nodes. If a node is positive on both sides of the chest it is inoperable.
When a surgeon goes in they can do a full lymph node disection or a sampling of nodes. Studies have shown a full lymph node disection results in longer survival.
Yes it is complicated.
-
Hopefully there can be more research in this area, but unlikely because of the cost.
One thing I wonder about is that there are certain cancers that are estrogen dependent. Studies have shown good and bad results related to tumor growth (and soy intake) so maybe it is good for some people and bad for others based on factors such as premenapausal, etc
http://findarticles.com/p/articles/mi_m ... _n18609988
I guess if your body is craving it and it makes you feel good then maybe it is good.
-
You might want to ask about clinical trials. They may or not be right for you (your choice), but the more information the better
There is NIH's National Cancer Institute, Georgetown and UMD for second opinions if you feel you need them. Obviously Johns Hopkins is one of the best
Take care
-
There is also a dosing schedule called metronomic or "low dose" chemo being studied. I am not sure what the latest results are.
-
It could be that the drug is actually working and causing the fever/rash.
Certain drugs and foods may cause an increase in the amount of drug in the body, so make sure there is not any food or drug interaction.
Talk to the doctor, maybe as people said 100mg maybe is better.
Don't know. Good luck. Ask the Dr.
-
There is a thing called a paraneoplastic fever or neoplastic fever. Nothing alarming as far as I have read. It means a fever can be caused by the tumor.
From what I have read no one is exactly sure of the cause. One theory is that dead tumor cells could cause the fever or cytokines (an immune response) is causing the fever
Tarceva can also cause interstitial lung disease (ILD). This can be serious, but since your mom went to the hospital and the lungs are clear they probably ruled this out
Good luck
-
Hypersentitivity reactions can be handled using rapid desensitization for many cancer treatments (besides chemo)
Background: The purpose of the study was to investigate the safety and efficacy of a rapid desensitization protocol used in the inpatient and outpatient settings for patients with hypersensitivity reactions (HR) to carboplatin or paclitaxel. Methods: The 3-solution, 12-step protocol combined gradual increases in the rate of infusion and concentration of the chemotherapy, infusing the target dose over 5.8 hours for inpatient and 3.8 hours for outpatient administration. Patients were premedicated with antihistamines without additional corticosteroids. Results: Between February 2000 and December 2004, 45 patients with history of ovarian (n=39), fallopian (n=3), endometrial (n=2), and peritoneal (n=1) cancer who had moderate to severe HR to either carboplatin or paclitaxel were evaluated. The 26 patients who reacted to carboplatin received a median of 8 courses before developing their initial HR while 16 of 19 patients with HR to paclitaxel reacted on their first exposure to the agent. 17 of 22 patients with HR to carboplatin had positive skin tests. All 45 patients successfully completed 195 planned courses of desensitization (88 courses of carboplatin and 107 of paclitaxel). After undergoing successful inpatient desensitization, 6 patients thus far have received 22 desensitizations in the outpatient setting without adverse reactions. Of 26 patients receiving carboplatin desensitization for recurrent cancer, 10 had a radiographic response (partial or complete response) and/or >50% drop of initial CA125 value, 11 had stable disease radiographically and/or CA125 response (<50% drop), 1 is still unevaluable for response, and 4 had progressive disease after 2 cycles of carboplatin. Conclusions: The rapid desensitization protocol has proven to be safe and effective in the inpatient and outpatient settings for patients with HR to either carboplatin or paclitaxel. This protocol has allowed appropriate patients to continue chemotherapy in the setting of moderate to severe HR, and the study warrants the incorporation of the protocol into standard clinical practice.
-
Donna,
Yes that is typical. The tumor gets so big it cuts the blood supply off to itself so it dies inside. I think it is called cavitation.
Take care
-
Yes doing "neo adjuvant chemo/radiation" (chemo and/or radiation) before surgery has shown to be I think more effective in some cases.
A central mass that is big is sometimes squamous cell cancer which has a slightly better prognosis (from what I have read) than other types
Of course trying to quit smoking is important if surgery is going to happen because of the lung function will be affected
Good news and good luck
-
I think it is because the doubling time for cancer is over 1 month that a scans are not given every month. Maybe at least two months.
Since CTs only have a certain resolution it won't help doing scans too often.
Also for younger patients the radiation exposure may be an issue.
-
A big problem is that there is not a lot of research on this. Clinical trials cost a lot of money and since drug companies can not make money from vitamins there is little research.
NIH and the goverment need to offer more grants to find out the what vitamins are good / what vitamins are bad / when they should be taken, etc.
Unfortunately the answers are not clear so and Drs don't have time so they just say no as Ernie said.
-
I think it is normal to see a surgeon first, but I also think it probably is good to form a "board of doctors" or tumor board with different specialties that can consult with each other.
I think at some major cancer centers it is done this way. That way everyone is on the "same page" and can discuss the case face-to-face
-
You might want to research HKI-272. It is in clinical trials.
Also sometimes people develop two primaries. I am not sure how rare this is but it can happen. *maybe* there are two different types of cancer.
Another thing that could be happening is that one area has become resistent and the other has not.
Also maybe the tarceva needs more time to work. Not sure how fast responses are. Maybe it is working in one area and has not started in the other.
Just guesses. I would ask the Doctor any questions you have.
-
-
Most Drs I believe do not warn against a daily vitamin. But also don't think high doses are good. I think this is the most common view. Some Drs say no vitamins during chemo, so it is confusing.
A lot of research does seems to support that it does not hurt. There have been no large trials that are "statistically significant"
One researcher, Prasad, says vitamins are good. Randy just posted an article that says vitamins and chemo lead to better outcomes.
http://www.jacn.org/cgi/content/full/24/1/16
http://www.doctormurray.com/articles/Chemotherapy.htm
There are drug companies that are trying to make synthetic vitamins to use with chemo, so maybe there is something to using vitamins.
Search for Vitamin D and lung cancer
-
There was an interesting article in the Washingtonian magazine (it is a local DC mag) about melatonin, circadian rhythm and cancer risk
It is also interesting that there is a researcher that is invesitaging the timing of chemo or radition. That cancer may actually be more suseptible to treatment at certain times of the day
-
I've read that CoQ10 might help with cardio toxicity that can occur with certain chemo such as adriamycin (sp?)
-
Some of the information says that the PH has to be lower than 5?
Dr West, how high (basic) does the stomach get after taking a PPI or TUMS?
How fast is Tarceva absorbed into the bloodstream.
Yirol, It seems like if he needs antacids then there might be a better time to take them. It seems best to not take them around the same time as the Tarceva.
Dr West could you provide more input. thanks
From one of the tarceva clinical trials:
Study Specific: Patients on enzyme-inducing anticonvulsants will be changed to non-enzyme inducing anticonvulsants or will not be allowed on this study. Patients receiving proton pump inhibitor or H2 blockers will not be allowed on study. Patients taking antacids will be allowed on study although they should not take the antacid for two hours before or two hours after taking erlotinib.
-
It appears that anti-acids may reduce the effectiveness of Tarceva
Erlotinib is characterised by a decrease in solubility at pH above 5. The effect of antacids, proton pump inhibitors and H2 antagonists on the absorption of erlotinib have not been investigated but absorption may be impaired, leading to lower plasma levels. Caution should be exercised when these medicinal products are combined with erlotinib.
http://emc.medicines.org.uk/emc/assets/ ... ntID=16781
Agenta Effect Mechanism
--------------------------------------------------------------------------------
CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, barbiturates, St. John’s Wort) Decreases gefitinib/erlotinib plasma concentration and reduces efficacy Enhances gefitinib/erlotinib CYP3A4 metabolism
CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, clarithromycin, protease inhibitors, grapefruit juice) Increases gefitinib/erlotinib plasma concentration and increases toxicity Decreases gefitinib/erlotinib CYP3A4 metabolism
Proton pump inhibitors (e.g., omeprazole) Reduces gefitinib absorption (not documented for erlotinib) Sustained elevation of gastric pH
Histamine H2-receptor antagonists (e.g., ranitidine, cimetidine, famotidine) Reduces gefitinib absorption (not documented for erlotinib) Sustained elevation of gastric pH
-
There are drugs that are being developed called
irreversible EGFR inhibitors.
They are *supposed* to work once Tarceva stops working
One that is in trials is call HKI-272
-
If it is BAC there is a better chance that it will work.
There is a genetic test that should show if the cancer is susceptible to Tarceva.
http://www.genomenewsnetwork.org/articl ... r_drug.php
Mass General Hospital might have more info on the test
-
I *think* you should avoid St Johns Wort
nuclear factor - kappa beta
in CLINICAL TRIALS
Posted
There was an interesting article in Scientific American about cancer and inflammation and the immune system.
According to the article the immune system does fight cancer but paradoxically may also provide a micro environment for the cancer to thrive and grow.
It says there are two immune systems and that the "inate one" that is the first line of defense and causes inflamation may actually encourge the cancer to grow.
It also said that cancer vaccines have not been working out yet. my opinion - maybe avoid them for now.
Also it talks about a protein called NF-KB.
When this was inhibited the cancer in an experiment stopped growing.
I am sure there is a long way to go but if anyone is looking for clinical trials this may be one to follow.
One such drug is INGN 241 (I am pretty sure there are others)