Archive | Chemotherapy RSS feed for this section

Preparing for the Parps

10 Aug

I’ve used the term “roller coaster” several times to describe my bumpy  pancreatic cancer fight. A couple of days ago, two of my daughters danced into my room while I was resting , delighted with news they couldn’t wait to share: “Positive progress on the Parps. Abbott Laboratories[1] are starting Phase 2 trials – and it seems that you’ll be getting their drug”. Good news indeed.

Bad news is absolute – but this news left me stunned. For so long Pam has talked about the Parps as being the “game changer” while I’ve tried to temper her enthusiasm with what she saw as cynicism. I found the good news hard to digest. The concept of stopping chemotherapy for something better – that has “no side effects” – is too much to process. The belief that a cure will come keeps me going – yet just as it seems that we’re one step closer, I still can find no reason to celebrate. Inexplicable.

To think that Abbott is a corporation that grossed nearly US$ 40 billion last year – about a sixth of Israel’s total gross domestic product. That Abbott spent more than US$ 4 billion on research in 2011 – almost as much as Israel’s entire Ministry of Health budget. But it has brought them to Phase 2 trials of their drug Veliparib[2].

Veliparib, or ABT-888, is an orally active poly (ADP-ribose) polymerase potent inhibitor of both PARP-1 and PARP-2 that potentiates DNA-damaging agents in preclinical tumors. In the MX-1 breast model (BRCA1 deletion and BRCA2 mutation), it causes regression of established tumors, whereas with comparable doses of cytotoxic agents alone, only modest tumor inhibition was exhibited. Veliparib has been around since 2008 when trials first started for metastatic or unresectable solid tumors or non-Hodgkin lymphoma. Abbott’s trial version is specifically directed at pancreatic cancer suffers with the BRCA2 mutation.

I’m certainly no scientist, nor do I profess to have a working knowledge of these drugs. But I can recommend any and everyone that has pancreatic cancer to test whether they are a BRCA2 carrier. If so, contact Memorial Sloane Kettering, who are running the trials, (or Tel Hashomer Hospital, if you’re in Israel or your national oncology facility).

I was sitting outside my oncologist’s waiting room on Wednesday, waiting to hear more details of her breaking news the day before. Inevitably I flipped through my phone’s inbox to find an e-mail blinking. To be a messanger of bad news is not easy. A pancreatic cancer sufferer I tried to help had passed away. I couldn’t hold back the tears.

I’ve looked back to see if I mentioned him in a previous blog. On 20th May, 2012, I made a reference to him. He was my source of the trial I referred to in that blog. And here I was waiting for news of another trial.

I looked myself in the mirror this morning and seemed to perceive that my hair has slightly grown back. Is it just longer or is it the result of stopping Abraxane? I can’t wait to find out. 

 


 

[1]   Abbott’s website is worth a visit. Click on  www.abbott.com

[2]  I haven’t found any information through Abbott Laboratories but can direct you to  www.inhibitor2.com for more information.

 

The Pen Gets Lighter

31 Jul

My pen has rested heavily recently. I’ve avoided the temptation to put it to paper even though I could’ve told you “No news is good news”. But today changes are afoot.

Today, I changed my hospital, changed my oncologist and changed my protocol. Is something dramatic going on? I think not. Faithful followers will know that my move from Tel Hashomer to Ichilov was not exactly clear cut. I followed my oncologist to whom I have so much to be grateful. Today I changed back to Tel Hashomer. And the change of protocol is a tactic I’ve been recommended to follow for a long time.

Oncology is not an exact science. Far from it. It’s an on-going experiment and I’d love to be around long enough to see how the story unfolds. It’s developing at quite a pace. But unlike the Olympics – there’s no way to measure progress. The individual or team that crosses the line first in finding the elusive cure for cancer will deserve more than gold.

I’m no betting man but my new oncologist seems sure that the elusive Parps are the direction to follow. I’m waiting patiently. No-one will be more relieved to see me on the Parps than Pam. No wonder. The concept that a capsule can replace chemo without any side-effects is cheering indeed. But I have to keep things in perspective.

In the meantime I changed to Mytomycine C – a monthly chemo supplemented by Xeloda. Capsules swallowed daily at my own convenience in the comfort of my home. A Mytomycine infusion in 45 minutes instead of four hours plus of my previous treatments. It’s almost like a marathon runner moving down to middle distance. A walk in the park for me. I’m finding it hard to come to terms that my weekly visit to hospital could now become a monthly affair.

Strange going back to Tel Hashomer. Not exactly re-connecting with an old friend. Nor is it a game. Although it takes an Olympian effort to keep up the challenge.

What a Difference a Day Makes

18 Jun

This time last week I would’ve been having the third and last of my current series of Abraxane. Only I moved the treatment a day forward to give me more time to recover before our trip to South Africa– for a wedding.

What a difference a day makes. Fortunately, the flight to South Africa went well and landed me in a different world. From the heat of Israel to the cold of Johannesburg. But what a warm reception! We were met with pure love and joy by truly special friends – the parents of the bride. And we’ve been treated like royalty ever since.

How happy I am that Pam and I were again blessed with the ability to travel. I knew what a challenge the trip would be. For a day or two after landing something seemed not quite right. I can’t explain. But going to a wedding of dear friends provided me with the incentive to take up that challenge; attending happy occasions is what life should be about. And the change of surrounds has been far better than any rest – or regular break from chemo.

What could be better than the luxury of Illovo? Wide, broad avenues of quiet and seeming tranquillity. Houses that require a re-definition of palaces. The frenetics of a full day chemo replaced by the hospitality of friends. And best of all – a pampering for Pam. I’d like to think of the trip as a special thank you for Pam. So far we’ve been simply spoilt – largely because of the massive goodwill generated by my late in-laws. They were a very special couple whose kindness and generosity seemed to know no bounds.

Fighting pancreatic cancer is a full time job. I’ve always known the importance of giving myself goals – including, in my case, continuing to make travel plans; anything to keep lethargy from creeping in.

Such is the nature of this illness. You just don’t know where you stand – yet have to live with it and keep going.

Triumph or Trivia

28 May

You may remember that when I was in Canada I trivialized over writing a best selling book “Guide to Inter-continental Cancer Centres” – based on personal experience (see my posting “The Impossible Dream” dated 15th February 2012).

Today, I had my first treatment at Ichilov Hospital. I now feel suitably “experienced” – based on that unacceptable statistical sample of one – to share my findings. Today was, of course, the first working day after a long holiday weekend, so the results maybe even less representative. Hopefully the table of comparisons will help. I realize that it is more relevant for those in the Tel Aviv area but I’d be interested to know the experience of cancer patients wherever you are:

 

 

Subject

Tel Hashomer

Ichilov

1

Arrival Time

Never less than 45 minutes

Half an hour

2

Parking

Free parking right next to oncology dept

Free parking, 4 escalators, 5 mins walk & lift to department

3

Registration

Maximum 7 minutes

Over 1 hour wait

4

Blood Tests

Results within 45 minutes

Results took an hour an half

5

Vital Signs

Not taken

Blood pressure, temperature & weight

6

Pharmacy

Drugs arrive within an hour

Drugs arrive after an hour and half

7

Chemo Management

 1. Sterilisation kit                       2. Mechanical drip counter

 1. Manual hand scrub            2. Electronic speed control

8

Nursing Care

Excellent

Excellent

9

Catering

Free tea, coffee & soup

Free tea and lunch

10

Physical Conditions

 1. In need of restoration (British   under-tement)                           2. No view                                3. Possibility of private bed

  1. Brand new tower block         2. Sea view                             3. Comfy-chair in cubicle 

11

Treatment Time in Total

About 6 hours

About 9 hours

12

Getting Home

About 40 minutes

About 40 minutes

 

At the end of the day you look up to see whether the Sword of Damocles is still hovering in the same place or inching slowly downwards.

If it’s the latter, the travail turns from triumph to trivia. Time will tell.

In the meantime I’m more than aware of both options.

 

A Real Dilemma

20 May

This time last week I wrote about my so-called dilemma of following my oncologist from Tel Hashomer to Ichilov (from a spralling hosiptal in a Tel Aviv suburb to a tower-block hospital in the city centre). Well, my week went past without much to report. A “break” week which, unfortunately, was interrupted by the need to have our first meeting with Dr Wolf in his new rooms. The meeting itself was pleasant enough, but we did encounter the all too-foreseeable administrative hiccoughs. I perceive that today’s lack of working norms is responsible; something that would “never” have happened in the good-old days/old country. But that’s not the story of the week.

I mentioned to Dr Wolf that I’d heard of a new treatment being administered by a Dr Sela at Assaf Harofeh Medical Centre in Tzrifin, near Rishon Lezion. The treatment is a new a Phase 2 clinical trial of an anti-angiogenic product called TL-118.

TL-118 was previously tested in a mouse model of pancreatic cancer. In pre-clinical trials, TL-118 monotherapy has been shown to inhibit tumour growth significantly, compared to the standard-of-care chemotherapy.

TL-118 inhibits new blood vessel formations in tumours and thus inhibits their blood supply and growth. TL-118 is an oral solution administered once daily and comprises a combination of agents that target different, non-overlapping aspects of the angiogenic process.

Here’s a link to a recent press release:

http://tiltanpharma.com/apress%20releases/310804.php

Sounds simple. But how does one know whether one trial is better than any other? I’ve been waiting for the Parp Inhibitors – and up pops Tiltan. Is this another option? Dr Wolf tells me that there is no conclusive evidence yet that allows him to form an opinion – other than the trial is moving the new product forward.

Joining any trial is a real dilemma – I’m not there yet.

Keith’s Perspective

1 May

Other than Pam’s two perspectives, the only other contribution so far, not written in my own hand, was from my brother-in-law Pip “Can Cancer be Fun”. Now, it’s my brother-in-law Keith’s turn to give his professional perspective. I have no words to thank these two incredible human beings:

 

Shortly after Martin’s diagnosis of pancreatic cancer, Sheila and I flew to Israel, painfully aware of the dire situation and the grim prognosis. The initial ultrasound assessment had showed a possibly benign cyst in the pancreas, but the MRI scan was far more sinister – highly suggestive of an invasive pancreatic cancer.  A diagnostic laparoscopy confirmed the worst–adenocarcinoma of the pancreas with multiple metastatic deposits in the peritoneum.  Aggressive treatment with radiotherapy and gemcitabine chemotherapy was started the day following his laparotomy. Within days Martin was gravely ill, primarily as a result of side effects of his treatment regime.  We arrived to this awful scene, finding Martin severely weakened and exhausted.

I needed to spend time with Martin and Pam at the hospital during his treatments. Sheila took to spending hours researching conventional and alternative treatments for pancreatic cancer.  Just prior to flying out, we had become interested in the growing movement showing various health benefits to a low carbohydrate/ gluten free diet. Surprisingly, some of the research Sheila was investigating showed this approach might influence tumor progression and growth.  Unfortunately no well- researched studies have ever been done in this area, so we had to be guided by the basic science and our instincts. There certainly was evidence that individuals with metabolic syndrome, elevated blood glucose and diabetes were more likely to develop pancreatic cancer.  Martin’s blood testing had revealed glucose intolerance.  The basic science also made sense – pancreatic cancer cells lose the ability to switch to metabolize ketones instead of glucose – an ability normal, healthy cells retain. The theory was simple and compelling – decreasing the amount of glucose available to tumor cells would choke their growth and lead to cancer cell death. This is the metabolic approach to tumor genesis, known as the Warburg hypothesis (proposed by Nobel Laureate Otto Warburg).

Could a simple dietary intervention be effective in treating such an aggressive cancer? What other safe interventions looked promising?  The research showed Curcumin (an extract of tumeric) effective as a synergistic agent with standard chemotherapy, resveratrol as a powerful antioxidant with activity against tumor cells, and metformin (a glucose lowering drug used for diabetes) to be the prime candidates. How though to convince Martin to embark on this restrictive diet and multiple supplement regime, with a dearth of scientific evidence to back it up? Well-intentioned oncologists and nutritionists were treating him with intravenous glucose infusions and encouraging him to eat ice cream and sugar in order to “gain weight”!

Somehow Martin found the strength to live up to the challenge, and became the most compliant and faithful “patient” I have ever seen! Since hearing the theory and explanation, he made his decision to embrace the diet and supplements and has stuck 100% to a ketogenic lifestyle subsequently.  His blog attests to the remarkable progress he has made. At the time of writing, his disease remains in a stable remission, he has done numerous overseas trips (including a fantastic visit to us in Canada!), plays golf regularly and for the most part has good energy and no pain.  There have been various changes in his chemotherapy regime, which can be read in his blog.

There is no way of telling what factors have led to such a remarkable outcome. Perhaps it is a combination of medical therapy, diet and genome.  It is highly unlikely that a good double-blinded study will be done soon on the ketogenic diet effect on cancer. Rather than wait for that day, Martin has made a lifestyle switch, which seems to have had a very positive effect on his condition. He has by chance or fate become part of the “paleo” movement, which sees the modern Western diet as the source of many chronic diseases and he has shown that eating a more “ancestral” diet can be a healthy and possibly therapeutic choice.

We pray that our “experiment” will go on for many, many years!

Is Change As Good As A Rest?

27 Apr

Monday was probably my last monthly meeting at Tel Hashomer with my oncologist, Dr Ido Wolf. The month before he informed us he was leaving for the largest hospital in Tel Aviv, Ichilov. A bombshell for us, possibly not less of a surprise for Tel Hashomer. Either way – a problem.

So when most other Israelis were touring the length and breadth of the country for their Passover holiday outing, our sight-seeing was the oncology department in Tel Aviv. The tenth floor of the new Ted Arison tower block. New building, beautiful interior design and staggering views of the Mediterranean– especially from the “recreation” room.  A well-appointed lounge with library, computer terminals and comfortable couches. They need it. The wait could be worrying. And so to the problems. Is the devil you know better than the devil you don’t? We “grew up” at Tel Hashomer, know the ropes and the nurturing nursing staff. Eighteen months later we’re still hanging in together. Their new Head of Department hasn’t even been named. My natural choice, a wonderful young doctor in the department, announced that she too is departing soon – for a Sabbatical in The States. 

But do we need change at this time of my roller-coaster life? Administrative adjustments, parking permits to purloin, new nursing staff and the tortuous traffic in and out of the never-sleeping city? All to stay with our oncologist. When our local hospital, with a reasonable reputation, is walking distance away. While Dr Bill Isacoff in UCLA and my brother-in-law, Keith are still helping us call the shots. Will we find someone else as accommodating and willing as Wolf? His interest for us to join him was certainly inviting.

Our insight of Ichilov is improved by a chance meeting with the Head Nurse, Bruria. So professional and patient. But she does warn us about waiting. “We work under pressure. Place is at a premium”. Not always a bed available. In fact, unlike Tel Hashomer, they don’t have beds in private cubicles, but comfy couches. Is this difference defining?

Our difficult decisions used to be whether to go to Denmark or Dubrovnik. We’re certainly in a different ball-game now.