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Quote of the Day:

I still find each day too short for all the thoughts I want to think, all the walks I want to take, all the books I want to read, and all the friends I want to see.
- John Burroughs
Apr 01

Combinatorial Therapy Allows Viruses to Destroy Tumors

Brain Tumor Treatment, Research No Comments »

Web address:
     http://www.sciencedaily.com/releases/2010/04/
     100401173713.htm
  

Combinatorial Therapy Allows Viruses to Destroy Tumors

ScienceDaily (Apr. 1, 2010) — For several years, researchers have been developing a new approach to treating cancer that uses viruses to infect and kill cancer cells while leaving normal cells unharmed. Recent data have indicated that this approach, which is known as oncolytic virotherapy, has potential.

Now, Richard Vile and colleagues, at the Mayo Clinic, Rochester, have found that this approach can be combined with a standard clinical therapy to provide substantial regression and cure of tumors in mice, leading them to suggest that this combinatorial approach could be of tremendous benefit in the clinic.

Tumors that grow to a certain size need to form new blood vessels if they are to continuing growing and spread to other sites. One of the molecules that controls this new blood vessel growth, VEGF, is the target of drugs used to treat several forms of cancer. In this study, the authors found that modulating VEGF signaling, for example by transiently stopping anti-VEGF therapy in mice harboring cancer cells expressing high levels of VEGF, allowed the cells that line tumor blood vessels to be targeted and killed by viruses.

Importantly, as this approach targets the cells lining tumor blood vessels, rather than specific types of tumor cells, the authors suggest that this combinatorial approach to therapy could be used to treat a wide range of cancers.

The research appears in the Journal of Clinical Investigation.

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Sep 29

fMRI – Moved Up to Tomorrow – 9/29/08

MRI No Comments »

My next scan was originally scheduled for October 6th but I have experienced a few focal seizures over the past several weeks that have made us decide to move this up and take a look now.  The last seizure wasn’t real severe but was enough that I took some additional meds to put it away.  This time we are doing something different, too. 

The type of imaging study that is being performed this time is an fMRI, or Functional MRI.  Subjects participating in a fMRI study are asked to lie still and are usually restrained with soft pads to prevent small motions from disturbing measurements. This really isn’t any different from a standard MRI – you’re always given pads around your head and arms.  Anyway, the primary difference with an fMRI study as compared to a standard MRI (both can last 1-2 hours – how fun to be in a “tube” that long, huh!) is subjects may view movies, hear sounds, smell odors, perform cognitive tasks such as memorization or imagination or in my case, press a few buttons and perform other motor function tasks using my left-side (recall I have a right-frontal brain tumor – deficits are contralateral so we want to see impact to the left side).

So, put simply without getting into a lot of scientific jargon, the goal of this is to “map” more or less the areas in and around the tumor that are directly affecting certain motor functions (the movement of my left shoulder, or knee, or fingers for example).  When we know that, we can determine what areas of the tumor could be relatively safe to debulk with limited neurological deficits – at least in theory.  Nothing is without risk.  After all, this is brain surgery.  So, we’re aren’t preparing for surgery here at all but given the seizures we need to see what is going on.  We’ve been watching it every 60 days so this time we just moved it up a bit – no big deal.   

Here is a picture of an fMRI machine to give you an idea of the environment.  Again, getting tubed an hour or two (and sitting absolutley still) is a chore, but I have done ok with it so the technicians have said.

 fmri.jpg

And guess what?  I can’t do anything about what is going on, can I?  Nope.  I pray for the best outcome.  We know that God is in the middle of our lives – Rachael, Aidan (6) and Keegan (1).  It’s certainly hard not to let physical symptoms get to you – I won’t lie.  But when they do, you just have to keep rolling along.

I’ll post results here when I can.  As I mentioned before – the lack of posts means I’m doing good!  I’m enjoying life.  Soccer has been a blast with Aidan.  Being involved, running around a field in soccer clothes (I used to play competitively) and playing with him and all of his team, helping with the coaching and teaching the kids – what a great experience and just a few months ago I was on chemotherapy. 

More in a day or two….

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Jul 16

First Week Back on Chemotherapy – In The Bag

Chemotherapy No Comments »

I finished up the first week back on chemotherapy last night and overall it went very well.  As I mentioned, I think my body wasn’t ready for it on the first night but by night 2 and 3 I was pretty well in sync with my system again – nothing to eat after 7pm, zofran at 8:30 or 9pm and then chemo treatement starts at 9:30pm as I go to sleep.  So overall I’m really happy with the way it went coming off of a 5-week layoff.  I’m also feeling good energy-wise.  I have some of the typical chemo-related fatigue but I don’t feel like I did before when my counts were so low – it was more or less just walking around feeling like I had a bad cold constantly and wanting to sleep! 

So another week on after taking a one week break and round 8 will be history.  If all goes well and I don’t have to pause my therapy for any other reasons, I will be completely done by November.  I will be taking a break for a week or so at the end of August for a vacation up to Victoria, British Columbia.  No, I’m not such a die-hard that I plan to be popping chemo pills as I gaze out of the hotel window taking in a nice view of the Empress hotel and Victoria harbor!  Speaking of vacations, that will be nice and we also have some friends who have a place at Northstar in Lake Tahoe.  She’s great and has been consistently “reminding me” to get up there so that is something that is in the plans too.  After last year and being tied to the house with a 2-mile rubber-band, it’s nice to think about these things and actually plan them out.

I’ll post again over the weekend – I hope everyone is having a good week and again, thank you for all of your continued support…

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Jul 08

Positive Lab Results – Back to Chemo

Chemotherapy 1 Comment »

Finally…After 5 weeks of weekly CBCs, I finally have an ANC (absolute neutrophil count) from today’s blood draw that is acceptable – it’s at 1200, up from 858 last week so this is great news.  The best news of all is I can get back on the program and start chemotherapy tomorrow night.  I still have to contend with some abnormal aspects of my blood work, namely my white and red cell counts that are low but one of the most important counts, the neutrophil %, was up considerably.  By virtue of that increase I’m able to start back on Temodar which was the overall objective all along.

Thanks to everyone who prayed about this.  Going from 1500 down to sub-1000 to 850, I started to think that perhaps this might be the end of the chemotherapy road so-to-speak but I am glad that didn’t happen.  I felt like it was getting into the 9th inning with a runner in scoring position – and finally a double into the gap after a long drought and we scored!

Time to move forward and start back although I will have to say it will be a little odd after being off treatment for 5 weeks.

That’s all for now.

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Jun 25

Low Blood Count – Still Holding Chemo

Chemotherapy No Comments »

Well, I had a CBC run at the lab yesterday in preparation to start back on chemotherapy tonight and I received a call from my neuro-oncologist telling me to wait another week – my marrow hasn’t recovered.  I stopped chemo on Saturday the 14th and was to continue through the 17th.  I would have been off anyway from Wednesday the 18th through Tuesday the 25th but back on again tonight which is why we did the labs.  So, I will effectively be off of chemotherapy for 3 1/2 weeks by the time I get back on providing my lab work comes back ok next week.  As I continue with treatment, it’s taking its toll certainly but when you fold in another cold that also relies upon white blood cells to fight it off, it’s not surprising I find myself waiting.  I also have to consider that I was not even well when the rest of my family became sick (see my post below ”The Infirmary”!) so I was pushing myself anyway to begin with.

This is really the first time I have had to wait because of a really low count.  This just doesn’t happen.  I have generally tolerated Temodar really well.  Regardless, we will wait and next Tuesday I will get a CBC and if all is well I’ll be back on next Wednesday night.  As further detail, when I have a CBC, they take that information and arrive at a calculation called an Absolute neutrophil count or ANC.  The ANC is a measure of the number of neutrophil granulocytes (also known as polymorphonuclear cells, PMN’s, polys, granulocytes, segmented neutrophils or segs) present in the blood. Neutrophils are a type of white blood cell that fights against infection.  The ANC is calculated from measurements of the total number of white blood cells (WBC), usually based on the combined percentage of mature neutrophils (sometimes called “segs,” or segmented cells) and bands, which are immature neutrophils.  A normal ANC is above 1,500 cells per microliter.  An ANC less than 500 cells/µL is defined as neutropenia and significantly increases the risk of infection.   Mine as of now is in the range of 950.  Here is a table that lists the ANC score and the associated risk category (essentially risk of infection) with 0 being the lowest and 4 being the highest.  I’m sitting at the higher end of 3 which is pretty good but not good enough to start back on Temodar which will obviously take the count down again.  We’ll wait a week and see where the ANC is.

ANC

As an aside, I have to post this picture of my son Keegan because I think it’s hilarious.  Cheers.

Keegan

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Apr 24

Neuro-Oncology and Neuro-Radiology Appts

Brain Tumor Treatment No Comments »

I had two appointments this week – one on Tuesday which was a final follow up with my neuro-radiologist and another yesterday with my neuro-oncologist.  On Tuesday, we covered any issues I may be having related to the partial brain radiation that I underwent after surgery.  I haven’t had any issues of course as reported in my blog.  The interesting observation he had based on the string of MRIs that have indicated stablility and no growth is that he has fairly strong level of comfort at this point that there are no grade 4 cells that are part of this tumor.  He also indicated that it is entirely possible that the tumor could be made up of both grade 2 and grade 3 cells but that is purely speculation on his part – only a more invasive biopsy or resection followed by pathology would reveal such a finding.  Typically, grade 3 tumors, or anaplasic gliomas don’t recur or progressive until around year 2 so we’ll just continue the plan.  And again, this is only based on statistics and anyone who has read my blog for any length of time knows exactly where I stand with regard to statistics!  They mean nothing.  I view all of this discussion as extremely positive though.

As far as my appointment with my neuro-oncologist, we mostly talked about a recent issue I have been having with bleeding in my mouth and nose bleeds.  This would all point to a low platelet count, however, my blood work has always been right on target with all levels.  We are doing more blood work early next week that will include additional tests on platelets.  Other than that, I”m doing fine with cycle #7 coming to an end.  5 cycles to go – seems like a long time but when you take in a day at a time it’s really not
bad at all. 

As far as fatigue, I’m feeling that still but not as much.  I’m putting in a bit more time at the office and find that my energy overall is increasing over time. I started a soccer clinic with Aidan on Tuesday nights which is great!  We get out there and practice together and it’s teaching him the fundamentals.  He already had much of this down so far (I used to play competitively) but this is a good primer for the fall when he will start playing in his first organized soccer league.  Keegan is doing great.  He’s 9 months now and growing.  Not quite crawling but he’s flipping open and very vocal.  A fun age for sure. 

Next MRI scheduled for the last week in May and will include a metabolic-type of study.  This will provide some more data than a standard MRI.  If need be, we’ll follow that with a PET scan which I had in March of 2007 that is a very detailed metabolic study of the brain/tumor.

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Apr 08

UCSF Preliminary Info

Chemotherapy, UCSF 1 Comment »

Although I am still waiting for formal documentation, I had a discussion with the Department of Neuro-Oncology at UCSF on Friday evening.  After going through all of my information they are in agreement that the tumor is stable  and that it is in no way worse.  This is great news!  He also indicated that they concur that staying on for another six months would be the right course given my tolerance of Temodar, the stability of my tumor and the fact that my blood work is allowing my body to withstand continuing treatment.  They agree that stopping at a year makes sense, primarily due to the side effects – namely leukemia. 

I asked what course should be taken at a year – of course that is the million dollar question!  They recommend that I stop and if there is growth after that, surgical intervention is likely the best course given the location (primary motor cortex) and the fact that I had a 0% resection in my last surgery.  As long as I am neurologically in tact, which I have been throughout, that is the last thing on my mind and on the list. 

I will have a comprehensive report hopefully tomorrow or Thursday but this gave me all I needed to continue Temodar – cycle 7 started last night.  On we go.  I’m sure there will be some details in the report that will give me more information and I’ll share that here but at a high level, this is what I was after.

Again, second opinions are important.  This one came in consistent with my Neuro-Oncologist’s recommendation.  The interpretation of my MRI scans, too, were consistent.  Great – I have the assurances I need to move forward and it I feel 100% confident that I am moving on with a treatment plan that is the best for me, my lifestyle and my family.

More to come….

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Apr 04

UCSF MRI and Neuro-Oncology Review

MRI 1 Comment »

Some good information should be available on Monday from UCSF.  For those of you that are not aware, The University of California, San Francisco has a Brain Tumor Center and it is one of the best in the country – certainly on par with Duke, Mass General, UCLA and others. Dr. Mitchel Berger, the head of the Department of Neurosurgery is performing a film review of my most recent set of MRIs which is something I have done on a number of occassions.  You may recall that he along with Dr. Peter Black at Mass General both agreed that I should have surgery back last June which was contrary to the opinion I was given here at the brain tumor center.  I have relied upon Dr. Berger ever sense from a radiological perspective to interpret my scans to ensure I have this second checkpoint.

In addition, I have been on the phone with the UCSF Department of Neuro-Oncology.  I am seeking another opinion with regard to my go-forward chemotherapy strategy.  For this case review, I have sent them just about everything.  MRI films, pathology, operative reports, 1p19q gene deletion test results, recent lab work, recent dictations from my Neuro-Oncology appointments, etc.  This review will allow me to have another opinion now that I have finished the 6 months of pulse therapy using Temodar which is the standard of care.  After 6 months, there isn’t a lot of information in terms of the right course to take – do you stay on chemo?  How long?  The same type?  Lots of questions.  Some with brain tumors may not know that in many cases you can contact brain tumor centers and facilitate these types of reviews with some footwork and organization.  It is WELL worth the effort and logistical challenges. 

So, on Monday or Tuesday of next week I should have opinions / impressions related to my scans (growth, stable, etc.) – and the verdict here has been stable all along and back in October of last year Dr. Berger concurred that all was quite stable.  I will also have the complete case review from a Neuro-Oncology perspective which will provide me with great information moving forward.

I was able to get some information through some connections from Dr. Jonathan Finlay who is at UCLA.  His response, to me, was shocking – he said the standard is to stop at 1 year which is consistent with my understanding but that he personally has his pediatric and adult patients continue INDEFINITELY as long as they have residual tumor present on MRI.  Wow.  Long term risks such as leukemia come into play with these drugs but I’m sure he views the long terms as the lesser of two evils so-to-speak, particularly if you’re dealing with grade 4 tumors.  So, we’ll see what UCSF says.

More to come next week.

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