[MOL] Mark Dusek [00967] Medicine On Line

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[MOL] Mark Dusek

Title: Mark Dusek

Hi Mark and welcome to the MOL forum.  We are comprised of people w/ many types of cancer and people that also are caregivers to friends/loved ones w/ cancer.  We are not Physicians but do have some collective insight and real life experience that we can offer.  You didn't mention what part of the country you are in but I will include some sights that can possibly help you & your brother in law in your decisions where to go and what type of therapy to look into.  I realize this is a trying time for your family but cancer does not have to be a death sentence.  They are making real progress in treating cancer.  Good luck in finding the right course and we hope you will stay around a while and keep us updated.

P.S.  Call the Cancer Society for the best Hospitals for his situation, also my Mother has bile duct cancer that has spread to her liver and I will tell you that Xeloda was effective for her in reducing tumor size for approximately six months, hardly any side effects and she was able to take it in pill form.  Just a thought and there is an article below.

Your friend,

The study of hepatic arterial infusion of chemotherapy after resection of hepatic metastases in patients with colorectal cancer, reported by Kemeny et al. (Dec. 30 issue), (1) represents a positive development in the management of colorectal cancer. However, clinicians planning to use this therapy may be confused by the dosages reported in the article. By convention, the dosage for hepatic intraarterial chemotherapy is based on the amount of drug delivered to the patient. Since infusion devices have variable flow rates and deliver only part of their contents in 14 days, the total dose of floxuridine placed in the device is much more than the dose the patient receives.

> Kemeny et al. state that the infusion pump was filled with "0.25 mg of floxuridine per kilogram of body weight per day for 14 days in combination with 20 mg of dexamethasone; 50,000 U of heparin, and enough normal saline to result in a volume of 50 ml." This does not mean that the dose delivered to patients was 0.25 mg per kilogram per day for 14 days. Because the average flow rate for these devices is approximately 2.0 ml per day, the dose of floxuridine that each patient received was about 0.14 mg per kilogram per day.

> Given the risk of hepatobiliary toxicity and the narrow therapeutic index for this treatment, (2) the dose of hepatic intraarterial floxuridine is a critical factor in the safe administration of regional chemotherapy. The dose of floxuridine should be based on the flow rate of the pump used to deliver the drug.

> Alan P. Venook, M.D.
> Betsy Althaus, Pharm.D.
> Robert S. Warren, M.D.
> University of California, San Francisco
> San Francisco, CA 94143

> Patients With Metastatic Colorectal Cancer May Benefit From Xeloda
> NUTLEY, NJ -- April 19, 2000 -- Patients with metastatic (advanced)
colorectal cancer may benefit from the oral anti-cancer agent Xeloda(R)
(capecitabine), according to a new study published in the Journal of
Clinical Oncology. Data from the study show that treatment with Xeloda
reduced tumor size beyond 50 percent in more than one of five (24/108)
patients in the study.
> The Phase II, 48-week, randomized study was conducted at 21 cancer centers
in eight countries including three centers in the United States. In
September 1999, Hoffmann-La Roche Inc., maker of the drug, submitted a
supplemental New Drug Application (sNDA) to the Food and Drug Administration
(FDA) for approval of Xeloda's use in metastatic colorectal cancer. Xeloda
is the first oral enzymatically-activated drug that works through
therapeutic conversion to the cancer-fighting substance 5-FU. The sNDA is
currently under review by the FDA and has not yet been approved. Xeloda is
also being studied in different combination regimens in colorectal cancer.
> "The results of this study suggest that Xeloda may offer a new treatment
option as an oral single agent in advanced colorectal cancer," said Alain
Thibault, M.D., medical director of Oncology at Roche. Colorectal cancer is
the fourth most common form of cancer, and the second leading cause of
cancer deaths in the United States. About 50 to 60 percent of patients
diagnosed with colorectal cancer eventually die of the disease.
> The study followed 108 colorectal cancer patients whose cancer had spread
beyond the colon or rectum. Patients were randomized to one of three
treatment arms to receive capecitabine monotherapy (arms A and B) or as
combination therapy in conjunction with leucovorin (arm C).
> -- Patients in arm A received continuous monotherapy with
capecitabine-1,331 mg/m2/d
> -- Patients in arm B received cyclical intermittent monotherapy with
capecitabine - 2,510 mg/m2/d (days 1-14) with a six-day rest period
> -- Patients in arm C received cyclical intermittent therapy with
capecitabine - 1,657 mg/m2/d in combination with oral leucovorin - 60 mg
(days 1-14) with a six-day rest period
> The primary outcome measures for the study were tumor response and time to
disease progression. Twenty-one percent of patients in arm A had tumors that
had complete response or partial response compared to 24 percent in arm B
and 23 percent in arm C. A complete response occurs when the tumor virtually
disappears and a partial response is tumor shrinkage of more than 50
> The median times to disease progression were 127 days in arm A, 230 days
in arm B and 165 days in arm C of the study.
> Overall, diarrhea, nausea, and hand-foot syndrome were the predominant
adverse events reported in all three treatment groups. These side effects
were reversible and manageable with treatment interruption, dose reduction
and symptomatic treatment.
> Patients who received capecitabine plus leucovorin had more acute toxicity
(diarrhea, vomiting, abdominal pain, and hand-foot syndrome) than those
receiving capecitabine alone.
> Hoffmann-La Roche Inc. (Roche), based in Nutley, N.J., is the U.S.
prescription drug unit of the Roche Group, a leading research-based health
care enterprise that ranks among the world's leaders in pharmaceuticals,
diagnostics, vitamins, and fragrances and flavors. Roche discovers,
develops, manufactures and markets numerous important prescription drugs
that enhance people's health, well-being and quality of life. Among the
company's areas of therapeutic interest are: virology, including HIV/AIDS
and hepatitis C; infectious diseases, including influenza; cardiology;
neurology; oncology; transplantation; dermatology; and metabolic diseases
including obesity and diabetes.


Hepatic Cryotherapy Offers Option for Liver Cancer Patients

Cryosurgery is a technique that destroys cancer by freezing the cells. It
has been used at some top medical centers for tumors of the prostate, liver,
lung, breast and brain as well as for cataracts, gynecological problems and
other diseases.

Cryotherapy of the liver at Harper Hospital offers a treatment alternative
to otherwise difficult hepatic resections and an option for patients who
would not otherwise be surgical candidates. Harper as part of the DMC, is
the only medical center in Michigan and one of less than 10 nationwide,
actively performing hepatic cryosurgery. Highly experienced in the procedure
is Peter J. Littrup, M.D., radiologist at Harper Hospital and associate
professor of radiology, urology and radiation oncology at the Wayne State
University School of Medicine.

As part of a comprehensive cancer center, Harper Hospital offers technical
expertise in ultrasound guidance and the surgical experience required in
cryotherapy of the liver. "Cryotherapy requires a close working relationship
among the cancer surgeons and radiologists," noted Dr. Littrup. Surgeons,
Drs. Donald Weaver and David Bouwman have performed cases with Dr. Littrup
and coordinate follow-up care. Most cases selected for hepatic cryotherapy
involve metastatic disease from colon cancer. Other indication may include
patients with neuro-endocrine tumor metastases and selected primary liver
> Ten Commandments to Fight Cancer
> by Richard Bloch
>  #1. Recognize you have a life threatening disease.
> Facing the truth is a necessary ingredient to starting on the road to
> successfully fighting it. The fact that it is not as bad as you
> imagined it would be, that you feel too good, or whatever, do not deny
> it. That would get in your way. Never look back. Apply all your
> energies to conquering it.
> #2. Make a commitment to do everything in your power to fight.
> The most difficult single decision you will have to make is to make
> the commitment to fight. Once this is done, everything is simple. If
> it could possibly help, you do it. If it could possibly hurt, you
> don't. It makes no difference how pleasant, how convenient or how
> comfortable.
> #3. Get a qualified independent second opinion.
> Cancer is an extremely complex disease. Often there is only one chance
> to successfully simply you doubt or have less faith in your physician.
> It is your life and you are entitled to be certain.
> #4. Realize that knowledge is your greatest asset.
> The more you know about your disease, the better you are able to be a
> team with your physicians and help yourself fight the cancer. In old
> days people were not told they had cancer. Today it is said that
> doctors don't beat cancer. Patients beat cancer with the help of their
> doctors.
> #5. Have complete confidence in your doctors.
> Once you find a qualified doctor in whom you have faith who believes
> he can successfully treat you, trust this doctor and follow his advice
> to the letter. Do not doubt and do not continue searching. Use all
> your energy in fighting cancer and do exactly as this doctor
> recommends.
> #6. Understand and believe in the treatments you receive.
> Forget everything you have heard about cancer treatments. You are an
> individual and a unique person. Your cancer is not like any one
> else's. Understand what each part of your treatment is supposed to do
> and how it works. Help that treatment by visualizing it doing its
> job.
> #7. Seek and accept support.
> This is a time in your life to be selfish. Let others who want to help
> you do it. When you have recovered, you can repay them. Join or create
> a support group. It has been clinically demonstrated that cancer
> patients who join in a support group do better than those who don't.
> #8. Plan for the times you will be depressed.
> Everything about cancer is very depressing including the diagnosis,
> the treatments and the disease itself. Expect down days and plan
> things that cheer you up to do at the times you will be depressed.
> #9. Maintain a strong desire to live.
> Life can be beautiful. Have a reason for living. Whether it is
> children to play with, work yet to be accomplished, trips to be taken
> or just to read tomorrow's newspaper and see what happens, a strong
> desire to live will help in the successful outcome of cancer
> treatments.
> #10. Enjoy each day. Live one day at a time.
> Do not look back at yesterday or worry about tomorrow. Today is all
> that counts. Enjoy it and be grateful you have it. If you are taking
> unpleasant treatments, remember, you are doing this voluntarily
> because you want a chance to continue living. Savor the flavor of
> today and each night be grateful you had the wonderful experience of
> that day.