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Old 09-07-2006, 04:30 PM   #1
hope
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Unhappy doctors have given up on me

Well I'm still not doing well. My right lung tumors are still progressing and I am on chemo. I take a low dose Xeloda (1500mg/day) due to severe side effects of Xeloda, weekly Herceptin, and Zometa. I have a exteme fatigue and shortness of breath eventhogh I am on oxygen but my oxygen saturation is always around 98-100% left lung remains clear. I recently got a plurex catheter drain in my right lung to help with my plural effusion before that I was going to the pulmonologist every 10 days to drain 1.5 L of fluid so the catheter has helped that somewhat. I am currently approved for the EAP study of Lapatinib but it is tied up in the clinical trials office at my cancer center waiting to be approved. Last I heard that it would go to the regulatory affairs committee next week for approval but won't be able to dispense until end of Sept. They all know at the cancer center I go to that I am waiting for this drug and this is my last chemo I can take as I failed every chemo approved for metastatic breast cancer and my oncologist will not repeat chemos or use chemos off lable.

So the problem right now lies with my oncologist. My onc. said that I can take my chemo or not its my choice. They do not know what to do at this point until I can get on Lapatinib. I would like to know what you would do in this situation? Do I contiue my chemo or not. Obviously my chemo is not working but I can't understand why my onc is leaving this up to me. I am not a doctor! I am still fighting for my life and my onc knows about this. Also my liver enzymes (AST,ALT and Alkaline phos) are increasing from 30 to 126 (AST), 39 to 70 (ALT) and 157 to 489 (Alkaline phos) in the last two weeks. These are big increases to me yet they refuse to give me a ultrsound on my liver so I don't know whats going on there. I haven't had any liver metastasis. If worse comes to worse I can change oncologists but I am very weak now and to do that is lot of work and it might even jepordize me getting Lapatinib on the EAP program. Thanks for letting me vent. Hope
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Dx in Oct. 2002 Her3+++(at dx) ER/PR neg. stage 4 with mets to lung, bones, and brain
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Old 09-07-2006, 04:49 PM   #2
al from Canada
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change, change, change....

Hope, my heart goes our to you. It sounds like your onc is failing you more than your body is.........change doctors!! For your onc to say quit chemo if you want means he's kissing you off, lapatinib or no lapatinib. Navelbine has been shown to be very effective with herceptin for lung mets and has a resistance recovery time of about 6 months, ie, if you've has it before past 6 months ago then it may work again just as effectively again. No scans with rising liver counts?..........I think it is time to change and please do it before you are too tired to. What about Genentec and pertuzumab?

Anything I can do.........Al
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Old 09-07-2006, 05:32 PM   #3
Sandy H
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Hope, you may have to get ruley here as I did. I told them it doesn't make sense to me to have to wait for 10 weeks to get this drug. Perhaps, Joe can help you here. I got more then ruley and I won't go into it but I will call it fighting for your life. I was told several times,"you can sure get your point across!" I told them that is what this disease does to us. I would fight them to the bitter end. They will get it for you. Good luck and God Bless you. Sending you a big hug, Sandy
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Dx. 03/01, Rt. IBC
AC/Taxatere
Rt. MRM-with graft Lt. simple
5 rads-skin mets
Herceptin, taxol, carboplatin (taxol seem to be the magic drug)
Navelbine & xeloda (did not work)
topical miltex for skin mets
Tykerb/xeloda
thoracentesis x 2 left lung fluid shows cancer cells
Port removal (4 years) with power port replacement
Doxil
Updated 05-07 Scans show no bone or organ involvement we shall see!




I shall not pass this way again. Any good I can do or any kindness that I can show let me not defer or neglect it for I shall not pass this way again.
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Old 09-07-2006, 05:32 PM   #4
Barbara H.
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Hi Hope,
My thoughts are with you and I agree with Al. Do what you need to while you have some energy.
Best wishes,
Barbara H.
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Old 09-07-2006, 06:03 PM   #5
RhondaH
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Hope...

PLEASE don't give up. I'll keep praying for you. Take care and many huggs your way.

Rhonda
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Rhonda

Dx 2/1/05, Stage 1, 0 nodes, Grade 3, ER/PR-, HER2+ (3.16 Fish)
2/7/05, Partial Mastectomy
5/18/05 Finished 6 rounds of dose dense TEC (Taxotere, Epirubicin and Cytoxan)
8/1/05 Finished 33 rads
8/18/05 Started Herceptin, every 3 weeks for a year (last one 8/10/06)

2/1/13...8 year Cancerversary and I am "perfect" (at least where cancer is concerned;)


" And in the end, it's not the years in your life that count. It's the life in your years."- Abraham Lincoln
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Old 09-07-2006, 06:20 PM   #6
Tom
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Angry Ditto !

Dear Hope,

Al and Sandy hit it on the head. Time to change the sheets, because the old ones are getting stinky. Also time to let the dogs out, as they say. Show them that you can bark, and WILL bite if necessary. This is your parade they are raining on, and it's time to make the doughnuts.

Well, since I can't think of any more cliches right off hand, just take your argument to them while you still have the fire in your belly to state your case. Let them know that you're tired of everybody sitting around jerkin' their gerkin, and that you need a short term plan to stay afloat until the lapatinib comes through. I know there must be hundreds of women scrambling for it, but that doesn't make your case any less important.

Remind them that the more guinea pigs they have in the EAP, the more "free" data they will have going into their FDA approval request. Granted, the information may not be "pure" enough for a true clinical trial, but we all know that anecdotal evidence and word of mouth go a long way in cancer research. Let us know what you have planned next.

Tom
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Old 09-07-2006, 07:33 PM   #7
Cathya
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Hope;

I do so agree that it is time to switch onc's or at least to have someone forceful there with you at your appointments to make your demands and needs known. Do you have a trusted advocate who will talk for you, bring you where you need to go, fight for you when you are too tired to fight for yourself. It is time to make known your desires to this trusted individual as you have said that you are tiring. This does not mean it is time to give up, it just means that you need help. I don't know your circumstances....do you have a spouse, parent or child or friend who can help you now? Are you located near MD Anderson where there are the most clinical trials and very imaginative onc's? There are many other similar hospitals as well. What about Avastin? What can we do? We're here for you......who is there for you?

Cathy
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Cathy

Diagnosed Oct. 2004 3 cm ductal, lumpectomy Nov. 2004
Diagnosed Jan. 2005 tumor in supraclavicular node
Stage 3c, Grade 3, ER/PR+, Her2++
4 AC, 4 Taxol, Radiation, Arimidex, Actonel
Herceptin for 9 months until Muga dropped and heart enlarged
Restarting herceptin weekly after 4 months off
Stopped herceptin after four weekly treatments....score dropped to 41
Finished 6 years Arimidex
May 2015 diagnosed with ovarian cancer
Stage 1C
started 6 treatments of carboplatin/taxol
Genetic testing show BRCA1 VUS
Nice! My hair came back really curly. Hope it lasts lol. Well it didn't but I liked it so I'm now a perm lady
29 March 2018 Lung biopsy following chest CT showing tumours in pleura of left lung, waiting for results to the question bc or ovarian
April 20, 2018 BC mets confirmed, ER/PR+ now Her2-
Questions about the possibility of ovarian spread and mets to bones so will be tested and monitored for these.
To begin new drug Palbociclib (Ibrance) along with Letrozole May, 2018.
Genetic testing of ovarian tumour and this new lung met will take months.
To see geneticist to be retested for BRCA this week....still BRCA VUS
CA125 has declined from 359 to 12 as of Aug.23/18


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Old 09-09-2006, 03:11 PM   #8
Kaye
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Hope, my best thoughts are with you--don't know if this would at all be applicable in your case but th0ught I'd share in case it might be.
“Unusual three-drug combo inhibits growth of aggressive tumors”

“An experimental anti-cancer regimen combined a diuretic, a Parkinson’s disease medication and a drug ordinarily used to reverse the effect of sedatives. The unusual mixture inhibited the growth of aggressive prostate tumors in laboartory mice in research conducted at Washington University School of Medicine in St. Louis.

Although their drug choices may seem capricious, the researchers weren’t randomy pulling drugs from their shelves. They made their discovery using sophisticated methods for delving into the unique metabolism of cancer cells and then choosing compounds likely to interfere with their growth.

‘This study, led by Joseph Ippolito, a very talented M.D./Ph.D. student, demonstrates the importance of looking at tumor metabolism,’ says senior author Jeffrey I. Gordon, M.D., director of the Center for Genome Sciences at the School of Medicine. ‘Using a broad array of technology, we’ve obtained a view of the tumor cells’ metabolome (the set of small-molecule metabolites found within cells) and revealed aspects that were not expected and could be exploited.’

The findings, published in a recent article in the Proceedings of the National Academy of Sciences, expand upon earlier work by the research group, which demonstrated that aggressive types of neuroendocrine tumors - seen in some types of lung, thyroid and prostate cancers - produce high amounts of a chemical called GABA, a neurotransmitter.

Because of the abundance of GABA in these tumors, the authors previously proposed that the chemical could potentially serve as a marker for poor-prognosis neuroendocrine tumors. But the latest findings also show that the techniques used to decipher the biochemistry of the tumors can effectively be applied to seek drugs that will affect tumor metabolism.

The techniques link DNA microarray technology - which can pinpoint highly active genes in the tumors - to precise measurements of abundant metabolites and their potential byproducts within intact tumor cells using nuclear magnetic resonance (nMR) spectroscopy and mass spectometry. Software programs take this information and provide testable predictions about how these substances might drive the special metabolism of cancerous cells.

Investigating experimental mice that develop metastatic tumors of the prostate’s neuroendocrine cells, the researchers discovered that the tumor cells relied on molecules that transmit signals betweeen neurons. They found that the tumor cellls respond to GABA as well as to two other neurotransmiitters, glycine and glutamate.

‘The question was, “What are these neural signaling molecules doing in tumor cells found outside the central nervous system?”’ says lead author Joseph E. Ippolito, a member of the University’s NIH-supported M.D./Ph.D. Medical Scientist Training Program.

The reserachers demonstrated that the tumor cells have receptors on their surface that recognize these neurotransmtters and are activated by them. In addition, the tumor cells directly convert GABA and glutamate into sources of energy. Moreover, glycine was involved in a mechanism that increased the amount of fatty acids - an important source of energy - in the bloodstream of the lab mice.

‘We showed that the neurotramsitters GABA, glycine and gluatate not only stimulate proliferation of the tumor cells, but they also are able secure sources of energy for the cells,’ Ippolito says. ‘In a way, the tumor cells eat their own words.’

‘Having identified a key vulnerability in these aggressive neuroendicrine tumor cells, the researchers looked for a way to exploit it. They selected agents already approved for medical use by the Food and Drug Administration.

Two drugs - amiloride, a diuretic and carbidopa, used to treat Parkinson’s disease - exert their effects by inhibiting the very same mechanisms the research group had identified as important for the tumor cells’ energy-gathering reactions.

They combined these two drugs with a third drug, flumazenil, which is ordinarily used to reverse the effects of sedatives. Flumazenil binds to GABA receptors on the surface of nerve cells, and the researchers theorized that it could also inhibit GABA signaling between tumor cells.

‘We propose that this might be a potential therapeutic regimen for patients with aggressive neuroendocrine tumors,’ says Ippolito. ‘Since the drugs are already FDA approved, they could be more quickly used as experimental therapeutics.’

Examination of gene expression profiles of more than 400 human cancers showed that the genes encoding the enzymes vital to these aggressive neuroendocrine tumors were also expressed at high levels in some non-neuroendocrine cancers. This suggests that the three-drug therapy could work for many kinds of cancers, according to the study authors.

‘This approach is very powerful,’ says Gordon. ‘By combining a variety of experiemental and computational methods that monitor the expression of genes encoding enzymes and their biochemical products, we can explore the metabolism of these cells, looking for unusual pathways that might reveal their potenial vulnerabilities. Then we can see if medications already exist - ones whose mechanism of action is known and whose safety has been established - that can be used to target components of these unusual pathways, test them in animal models of human cancer, and if the results look promising, bring them to the patient’s bedside as part of a carefully controlled clinical trial.’

###

Ippolito JE, Merritt ME, Backhed F, Moulder KL, Mennerick S, Manchester JK, Gammon ST, Piwnica-Worms D, Gordon JI, Linkage between cellular communications, energy utilization and proliferation in metastatic neuroendocrine cancers. Proceedings of the National Academy of Sciences 2006 AUG 15; 103(33):12505-10

Ippolito JE, Xu J, Jain S, Moulder K, Mennerick S, Crowley JR, Townsend RR, Gordon JI. An integrated functional genomics and metabolomics approach for defining poor prognosis in human neuroendcorine cancers. Proceedings of the National Academy of Sciences 2005 Jul 12; 102(28):9901-9906.

Funding from the National Instututes of Health and the American Cancer Soceity supported this research.

Washington University School of Medicine’s full-time and volunteer faculty physiciians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and the St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.”
“Conact: Gwen Ericson
ericsong@wustl.edu
314-0141
Washington University School of Medicine”
“Public release date: 7-Sep-2006”
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Old 09-10-2006, 09:15 AM   #9
R.B.
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If you have not thought about diet as an adjunct you might like to look at the omega three six posts.

This one shows for at least one person it may have had significant impact.

http://www.her2support.org/vbulletin...ught+provoking

You may also like to look at the Greek Diet post using the search facility above. Included are threads where they are using omega three infusions with low dosage cox blockers as part of the treatment in trials for various cancers. If your digestion is poor infusion may be a way of trying to kickstart your fats into balance which may or may not help, on the edge but if you really are running out of options.....

Please DO talk to your doctor about dietary changes. Fats have powerful impacts and there is a limited group of people for whom they can cause problems. You could always print out some bits and take them with you.

There are also diet posts under the breast cancer diet.


RB
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