2007-April

Learning about Zevalin

The Protocol is Started
The last time I wrote I mentioned that I was getting ready to start the Zevalin treatment regimen (a CD20-directed radiotherapeutic antibody). That protocol started on April 11, when I reported to KU Medical Center’s Cancer Center for administration of Rituxan. You may remember that is given through an IV and when it was finished they immediately pushed the Zevalin indium into the IV (only one stick YEA!). I was monitored for two hours then sent for a baseline PET scan.

Then, two days later, on April 13, I returned to the hospital for a second PET scan to double-check the flow of the medication throughout my body. I also had a baseline blood test run in preparation for ongoing monitoring that will start shortly. The results of that scan indicated I didn’t have any problems so I was scheduled for the actual Zevalin treatment on April 18. The administration process was the same except when it was finished I was released to go home without any additional PET scans.

The only problems I have experienced from the treatment are commonly described as flu-like symptoms (headaches, nausea, and fatigue). Since I am an old pro at this I know that I have to keep moving in order to control Mr. Fatigue. I have also learned that I need to rest more to allow my body to repair itself during this time. As you might expect this is a difficult balancing act that I have to deal with one day at a time. I have also been taking some medication to help with headaches and nausea. Overall I am grateful to tell you that I am doing very well!

What’s next? On May 2, I start weekly blood tests to monitor my blood counts. That will last approximately 60 days. I also have to carefully monitor my body and if I feel excessive fatigue or have any problems at all I have instructions to call my doctor. My next doctor’s appointment is scheduled for May 16, when I will find out where we go from here. I expect to have a PET and/or CT scan(s) in the next several months to determine if the tumors in my abdomen that started this whole ordeal back in December of 06 are gone. My medical team and I remain optimistic and hopeful that I will get good results from my latest treatments and news from those tests.

Finally, my motivation for sharing my cancer story is to help people learn about cancer and its treatment regimens. I truly hope that by sharing my first hand experiences I am able to help other people in some way. With that in mind perhaps you will enjoy reading an excerpt from a presentation I watched recently that explains why my doctor harvested my stem cells, and why he is using Zevalin to treat me at this point in time. The presentation was being done by a panel of doctors and is called “How To Choose the Best Treatment Option When Indolent NHL Returns.”


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Comments by: Morton Coleman, MD, FACP Weill Medical College of Cornell University

MORTON COLEMAN, MD: Well, I do use autologous stem cell transplant, usually, when I get the sense that the pace of disease is beginning to increase, that the disease is becoming more aggressive. I have had very good experience with using autologous transplantation in patients where I sense the disease is transforming into a more aggressive form of disease, which very often indolent or follicular lymphoma may do. In those instances, I feel that autologous transplant could be also — really almost virtually life-giving.

But in addition, the radioimmunotherapy has been used now in cases of refractory disease where the patient is not responding to chemotherapy. I think that perhaps maybe we ought to define for the audience what we mean by monoclonal antibody therapy and what we mean by radioimmunotherapy. When we talk about Rituxan, we’re talking about a monoclonal antibody, that is, a biologic agent that’s directed specifically to the lymphocyte so that it spares other tissues.

In the case of radioimmunotherapy, we also have a monoclonal antibody directed against the lymphocyte or the lymphoma cell, as the case may be. But in this case, we’re carrying a warhead—that is, a radioisotope—and we have a double means of killing the tumor. That is, we can kill it by the monoclonal antibody itself, or we can kill the tumor by the use of radiation. And the nice thing about it is, is that the radiation will hit cells that have not necessarily been hit by the monoclonal antibody itself, what we refer to as a crossfire effect.

From: www dot Healthology dot com

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