Really a Plan

We've been waiting all week to find out which clinical trial Adrienne will start. So as not to be too annoying, we've been taking turns calling each day and each day, they said they'd call by the next morning. There were a few issues that complicated things. Many trials exclude patients who have had allo (donor) transplants, some exclude patients who have had an auto transplant, and Adrienne has had both. The other issue turned out to be her heart heart and lung damage from previous treatments since one of the drugs has shown heart and lung damage in mice.

Adrienne will be getting a drug called SB-743921, which is a type of kinesin spindle protein (KSP) inhibitor. It is "a novel small molecule therapeutic targeting human mitotic kinesins for applications in the treatment of cancer and other diseases." Don't worry, we don't really get it either but the basic idea is that it inhibits a protein that cancer cells need to divide, and therefore grow. This is given as an IV treatment every two weeks. Adrienne will try it and we'll decide if she should get a port later. Right now, she's enjoying being port free. She also has to get a bone marrow biopsy for the trial, not pleasant, but not too awful either. We've requested sedation since they don't generally sedate adults for the procedure.

It's getting really hot in New York, just in time for the holiday week. The heat combined with the cardiac meds really bother Adrienne as they make her blood pressure drop so she's doing everything she can to stay indoors, though she can't avoid the outdoors altogether. At least she has air conditioning in her dorm.

A Plan - Sort Of

Adrienne saw her doctor today. The PET scan doesn't show anything new, which is good, but the tumors are certainly bigger (2.6 x 3.7 x 3.1 cm in the lung and 2.1 x 2.8 x 3.4 cm in the spleen, no change in the epigastric node). We had been talking about a trial with a drug called PDX combined with gemcitabine but the doctor is concerned about side effects of this regimen in light of the fact that she doesn't have any B symptoms. Now we are waiting for approval for one of two other clinical trials where the drugs have little or no side effects. We should have an answer today or tomorrow. In the meantime, Adrienne will go off the valproic acid since it obviously isn't helping. If she starts itching, she's supposed to call the doctor and get something that won't make her sleepy like Benadryl does.

Otherwise, Adrienne is doing well. She recovered from her respiratory infection of last week and has some fun social activities planned for this week. She and her roommate get along great, which is wonderful after her disappointing roommate experiences at CMC. I think we were all slightly concerned that she would find New York big and impersonal but she really enjoys it. I guess she really is a city girl at heart.

A few people have asked if Adrienne is transferring to Columbia. Originally, she had hoped to go to Prague for the fall semester but, given the status of her disease, it didn't seem like a good idea. After seeing the doctor in New York and discovering that she could do a semester "abroad" at Columbia through the off campus study office, she decided to apply. Technically, she's still a CMC student and all of her Columbia credits will count toward graduation there. It'll be interesting for her to attend a big city university after being at a small liberal arts college.

Tough Weekend

Adrienne was sick all weekend, probably with a viral infection, so she spent most of it in bed. She's definitely feeling better now. I asked her to call the doctor to make sure it wouldn't affect the PET scan tomorrow, and they said it would be fine. We'll probably wait until she sees the doctor on Monday to get results. In the meantime, we're discussing the treatment options on the table.

Here's a great picture of Adrienne from CMC. Her hair is even a bit longer than this now since she's trying to grow it longer.

Oops, More Tests

Last week, when I posted about Adrienne's CT, I didn't realize that I wrote down (heard) the numbers wrong. The node in her lung has in fact grown quite a bit in four weeks, from 2.6 cm to 3.3 cm (I thought the nurse said 2.3 cm), and the node in the spleen went from 2.3 cm to 2.6 cm. The doctor is wary of putting her on an aggressive treatment since she doesn't have any symptoms and we are too, but this situation makes us very nervous. Adrienne will have a PET scan next week and see the doctor in two weeks when we'll make treatment decisions. In the meantime, we are having City of Hope send CDs of her scans from the last six months. There are still a few options on the table but we need to balance the side effects with the potential benefit since every option has some chemotherapy component to it.

Adrienne is still having a ball in NYC. Last Friday, she met a bunch of Columbia students at a party at her apartment (her roomate is a Columbia student) and on Sunday, she had dinner with a whole load of cousins on my dad's side of the family. I can't believe that my Uncle Joe, my dad's brother, is 87. My dad would have been 74 in May. My cousin Andy's wife is due to have a baby in about 10 days and Adrienne is ready for some newborn babysitting. Andy and his wife, Lisa, work at Dateline at NBC and Adrienne has been promised a tour of the studios.

Don't Try This at Home

QUICK UPDATE: Adrienne had her CT scan yesterday. She has some progression in the spleen but everything else looks stable. She sees the doctor on Monday to decide next steps but it sounds like there are a few options on the table.

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I never expected that we'd see so much wildlife in the desert. We have rabbits, quail, snakes, and lizards, all pretty harmless. We even found a baby duck in the pool the other day. Yesterday, I met another of our "neighbors." When reaching down to pick up what I thought was a leaf dragged in from the garage, I felt a pinch like a needle prick on my left index finger. Then it really started to hurt. I turned on a light, and sure enough, it was a scorpion. After stepping on it and putting it down the garbage disposal, I went to my neighbor's and called Curt. As I suspected, the scorpions in Nevada aren't deadly and you just have to wait it out. I don't even know how to describe how bad the pain was, even vicodin didn't touch it. I was told it would only last a few hours. After 10.5 hours with my hand in ice, it finally felt good enough that I could go to sleep. This morning, it's a bit sore and my lower lip is numb, but otherwise I'm fine. Needless to say, I'll be more careful in the future about touching anything on the floor.

Adrienne is enjoying New York and her job. She met some other CMCers last week who live there and they've been having a good time, though Adrienne says she just can't stay out on work nights because she's too tired. Tomorrow she has a CT and then she sees the doctor on Monday to figure out the next steps. I'll know more early next week.