Doctor's Appointment

I had an appointment with my LV oncologist today.  He spent quite a bit of time talking to me, explaining things, and trying to answer my questions.  He also went over my PET scan results from the 14th.  He didn't have the images, which I really wanted to see, but he tried to explain the written findings.

Questions and paraphrased answers

Are we sure that we are treating the right cancer?
We trust the findings of the pathologist.  They are the ones that determine the biopsy results.  All of the chemos that you have had this time Gemzar/Navelbine and the ICE treat a wide variety of cancers.  We have basically been dropping bombs on you...the new treatment (Adcetris) is more targeted.

Why haven't the chemos been working?  Why does my lymphoma look different this time? (Not sure if he exactly answered my second question but the answers related to each other.)
I can't tell you for sure why they aren't working.  But a few cells probably survived the ABVD from your first time with cancer.  Because they survived this effective chemo...they became stronger.  When they came out of lying around dormant they starting growing the new lymphoma.  It is stronger and more resistant to treatment.


What about treatment?
Brentuximab (Adcetris) was recently approved...I think just last year.  I haven't had to give it to any of my patients because they have had results with their chemo and Hodgkin's isn't that common....and usually ABVD works for people the first time.  It is a drug of the future.  It targets the cancer cells specifically.  The antibody that is attracted and attaches to the cancer cell is bonded with a chemo so the chemo goes right into the face of the cancer instead of floating around your whole body killing cancer cells along with good cells.  When a new drug comes out it starts out being used for people with few other options and gradually gets used earlier and earlier in treatment.  I had to talk with the head of your insurance because they weren't going to approve it...it was only supposed to be approved if you had failed remission after the stem cell transplant.  I told the guy that he had a chance to make a difference in your life and he approved it.  The goal is to get the cancer to respond to the treatment and then still send you on for the high dose chemo and transplant.  We are going to give you two treatments and then send you back for another scan.

What about the side effects? PML?
The side effects are like most chemos...lower blood counts, nausea, tiredness, numbness in the hands or feet.  There is nothing we can do for you to prevent or prepare for PML but it is a very rare side effect.   And if it happens it would mean I'm dead.  Well I wouldn't have said it quite like that.  I'm not sure if there is a treatment for PML.

What about my port?  If I'm not able to use it...I want it taken out.
I think that we can use it.  I would like to have them access it today for your treatment if you are ok with it.  Since your arm is no longer swollen it wouldn't appear that you still have a clot.  I think that we should use it.  Sometimes cancer patients blood gets thicker and is more likely to clot.  We are going to keep you on the Lovenox shots rather than Coumadin because it is easier to regulate for someone like you...going through treatment ...and if your counts get low and you need to stop it...you can stop it immediately whereas Coumadin is still in your system for a few days.

The PET results
"new enlarged gastrohepatic, left paraortic and aortocaval lymph nodes, as well as mild uptake in a new left sub pectoralis node, as detailed above, suggestive of progression of malignant disease."  This is all new growth since the PET scan from April 24th.


After speaking with the doctor I decided to go ahead with the treatment they had planned for me to have.  They accessed my port fine and I received my premeds (anti-nausea and Benadryl) and my first dose of Adcetris.  The whole infusion with premeds and Adcetris took about an hour...not very long at all.  I am scheduled for my second treatment on July 17th.