2013-February

What’s Next on the Agenda

With the completion of 25 radiation therapy treatments and 4 Rituxan treatments, I had finished the first phase of the treatment plan. It was time to move forward and get the tests run that would tell how well my body had responded to the treatment regimen I had been on for over two months. I would see the two oncologists who had treated me for the reports.

If all of the tests came back good it would be time to move me into the second phase of the treatment plan.

Tests and Results

  1. February 8, 1013 – PET-CT scans
  2. February 14, 2013 – Post radiation follow-up with Dr. Reyes (administered Rituxan)
  3. February 22, 2013 – Post radiation follow-up with Dr. Wang (administered radiation therapy)
  4. February 28, 2013 – Start Revlimid Cycle #1

The new PET-CT scans were done to:

  • Evaluate the post radiation state of the tumor
  • Establish a baseline for comparison to future scans

After waiting for my next follow-up appointment with Dr. Reyes I finally got to hear great news: Dr. Reyes said my body had responded very well to the radiation therapy. During my follow-up appointment with Dr. Wang, I also heard that he was pleased that the radiation had successfully reduced the size of the tumor. I was very thankful for the progress!

With all of the good news I still had to hold onto the hope that the chemotherapy treatments I was about to embark upon would get the cancer into full remission.

Learning About REVLIMID (lenalidomide)

Since this was the first time I had taken a chemotherapy pill at bedtime I wanted to learn about it. The questions I asked my oncologist and the research I did on the internet helped me understand how all of this worked. Remember, this is from my perspective only and any and all questions you have should be directed to your doctor.

What Strength Do I Take For Each Treatment Cycle

First, let me share with you what I have learned about the way REVLIMID dosing works. This chemotherapy is manufactured in capsules with 2.5, 5, 10, 15, 20, or 25 mg strengths. So I would learn that my oncologist would combine multiple capsules to create the total strength I needed. Another fact I learned is that the chemotherapy strength is based on a 28 day treatment cycle. And you can only purchase a 28 day supply at any given time.

Second, I learned about two scenarios that are used for patients who are on this regimen (Again, remember this is from my perspective only):

  1. When a patient is on a “treatment” strength, they take the chemotherapy capsules for 21 consecutive days and then don’t take any more for 7 consecutive days. The break is to allow their body to recuperate before they start their next chemotherapy cycle begins.
  2. When a patient is on a “maintenance” strength, they take the chemotherapy capsules for 28 consecutive days without a break. Their next 28 day chemotherapy cycle just starts over. And, I also learned that when a patient is on a maintenance regimen, their physician makes the appropriate adjustments to the strength of their prescription.

When I started the REVLIMID regimen it took me a while to understand how using multiple capsules worked to create the strength I needed (I didn’t have to worry about it because my wife had everything under control, but I wanted to learn about it).

The Rest Of The Treatment Cycle

The Revlimid regimen I was on required the administration of Rituxan at different times. Cycle # 1 was an exception to the rule because it required three doses of Rituxan administered at approximately one-week intervals. All of the subsequent cycles only required a single dose of Rituxan which were administered at approximately 28 day intervals. Let me share with you the additional details about the Revlimid regimen.

Day 1:

  1. Take Dexamethasone with breakfast
  2. Drive to the cancer center
  3. Get blood tests drawn
  4. Appointment with Dr. Reyes
  5. Get Rituxan infusion
  6. Drive home from the cancer center
  7. Take the Revlimid dose at bedtime

Day 2:

  1. Take Dexamethasone with breakfast
  2. Take the Revlimid dose at bedtime

Days 3 through 21: Take Revlimid dose at bedtime (Remember the exception I mentioned for cycle #1 when I had 2 additional Rituxan treatments).

Days 22 through 28: No treatments at all – this time is for rest and recuperation.

Start the next cycle: Since the Revlimid cycle runs for 28 consecutive days, and I began my chemotherapy cycle on Thursday, Thursday became my day 1 for routine blood tests, seeing Dr. Reyes for follow-up visits, and got the Rituxan treatment.

Time To Start Revlimid Cycle #1

Wait, I have one more question. Because I have Epilepsy I asked Dr. Reyes to consider starting my first cycle of REVLIMID at a low strength because I was afraid that the new chemotherapy drug might cause me to have seizures. Based on that conversation, Dr. Reyes determined that my starting strength would be approximately 15 mg. Then, based on the results, he said he would increase the strength until he reached the optimal strength that would be used for my treatment regimen.

With all of my questions answered, on February 28, 2013, I started on cycle #1.