REPORT FROM THE CHEMO WARS: HOPE PLACED IN NEW GROUP OF CHEMICALS

Imagine if someone came to you and said, “You think you are healthy. You think you are feeling just fine, but I know from tests that I have had conducted on you that you are really carrying around a disease inside you that eventually will shut down some of your major organs while causing major discomfort and considerable pain and then will kill you.

“Now in order to save you what I want to do is make you very sick and even threaten your life. You can count on it making you feel nauseous and stupid and very tired at times, and you’ll lose your hair. And, by the way, you need to know that I make no guarantees that what I am about to do will in fact save you. It might fail, and you’ll die anyway.”

“Forget it!”

Would you consent to going through the extreme, life-threatening procedure? Or would you say, “Forget it. I’ll take my chances by doing nothing. And I’ll save myself a lot of discomfort and pain in the process.” That is until the ultimate discomfort and pain, of course.

This is the kind of choice that a number of cancer experts presented me with back in 2001-2002, an option that I chose, and this is the proposition that has once again been put to me in 2007-2008 by another group of experts. That is the kind of proposition that our health care system with its advanced diagnostic procedures is now routinely able to present to us, the kind of decision that was never possible before in human history.

Complicated for the Mind

In being able to formulate decisions of this type, our medical science has fundamentally changed the very nature of the way we live our lives. Momentous decisions are now put in the hands of our health care providers and in our own hands as patients. All of which helps to provide one of a slew of reasons why life in the 21st Century becomes ever more demanding and complicated for the mind.

Okay, so that’s where I am in my latest round of medical treatments for my fatal disease. I have chosen to go down a similar road that I went down in 2002. That road brought me to Johns Hopkins University Hospital in Baltimore, Maryland, and to an autologous bone marrow transplant. That road brought me five years of remission from my MCL or Mantle Cell Lymphoma.

Wake Forest University

Now I have relapsed, and I have chosen to go down a similar but not an identical road. For one thing, I am going down this road with Wake Forest University Baptist Hospital in Winston-Salem, North Carolina. For another, my oncologist is now a bright young doctor named Denise Levitan. Then too I am being treated with a whole new group of chemicals, at least for this initial phase of my treatment. I am being treated with a suite of chemicals known by the acronym of “Cold Ice.”

What happened to Velcade? A few postings ago, I was filled with not a little optimism about a product known by the generic name of Bortezomib, trade name of Velcade, a proteasome inhibitor. As I explained back then, a proteasome inhibitor has the job of keeping biological mistakes from living, which is what those of us trying to survive cancer want to happen. We want the body’s cancer mistakes to die.

Yes, I went through eight treatments with Velcade as part of a two-drug cocktail. Specifically I received eight Velcade treatments and two Rituxan treatments over a period of six weeks. What do I have to show for it? Nothing, I’m afraid. When I had a CAT scan at the end of my treatment it showed that the lymph node in the mesentery region of my abdominal cavity that we are using as the barometer of my disease had not shrunk at all. In fact, it had grown slightly. Bad news.

Four-Drug Cocktail

And that brings me to Cold Ice. Cold Ice is a four-drug cocktail that happens to include Rituxan. “Why do you want to continue to use Rituxan even though it did not do a thing for me when used with Velcade?” I asked my oncologist. “For its complementary effects,” she responded. “We still like the way it interacts with other drugs.” Also as previously explained in this forum, Rituxan, generic name Rituximab, is a monoclonal antibody that is supposed to do its thing by targeting for destruction a specific antibody in a lymphoma mass. As we now know, it doesn’t always do what we want it to do, but I do hope it works this time. My tolerance for failures is limited.

What is Rituxan supposed to work with this time? These three: Ifosfamide, Carboplatin, and Etoposide, also known as VP-16. The three compose the ICE in the acronym while presumably the “Cold” portion is the Rituxan. All three chemicals are DNA “messer-uppers,”—if I may be forgiven a very unscientific term--either because they force the body to produce easily killed lymphoma cells with corrupt DNA or they interfere with the efforts of the cancer cells to repair damaged DNA and thus save themselves. Remember once again that the objective in our cancer wars is for cancer cells to die.

Only If Remission

Once the Cold Ice puts me into remission –and only when it puts me into remission—can I then proceed to finish the process. That process is finished this time around with an autologous bone marrow transplant. The latest studies for autologous bone marrow transplants for relapsed victims of MCL, which I am, remain somewhat encouraging. In an upcoming Mind Check, I’ll have more to say about autologous bone marrow transplants as well as their counterpart allegenic BMT.

Once again, however, we are not talking about a cure, but a prolonging of life.

To see a sampling of the other writing of Stephen Alan Saft, also known as S.A. Saft, see the website http://www.sasaftwrites.com.

Copyright © 2008 by Stephen Alan Saft