First chemo on the ET-743+Doxil trial (4/24/03)
Tom and I left the house at 6:10; we made it to Fox Chase at 8 on the dot. I went in and went through the admitting process while Tom parked the car. I had to repeat one base-line test on my way to my room (the EKG). Then, the resident wanted to give me a physical and check out my lungs and belly (I have been having belly pain for 5 days or so). There was nothing in the exam that would cause a delay, so she had the nurses access my port (for receiving chemo) and start a line at the elbow for my very frequent PK (pharmacokinetic sampling to see how much of the drugs are in my system) blood draws. A CBC and some other blood work was taken; chemo wouldn't start until we reconfirmed that the liver function was good and that my WBC were okay. It took over 45 minutes for the blood work to come back.
In earlier Phase 1 trials for ET-743, there were liver related deaths. They have since found that by pre-treating with a steroid, the liver problems don't happen. So, I had to receive some IV steroids. And, then wait a bit. Finally, at 12:30 or so, they started the Doxil. Now, 10% of the people who receive Doxil are hyper-sensitive to the fat bubbles that the doxorubicin is wrapped in. I was one of those 10%; within the first 90 seconds, I had severe abdominal cramping, problems breathing, chest tightness, problems breathing, increased coughing, problems breathing, dry heaves, problems breathing, and a flushed face. The nurses who were observing me immediately stopped the infusion, and attempted to withdraw the drug from my vein. It took 5 minutes or so for the reaction to calm down. The doctor was called in, and a few other nurses came to the room to see if they could help. I was rather popular! The doctor ordered more pre-meds, giving me Bendyrl (50 mgs) and Tagament (300 mgs). This took another hour to infuse. We also started the Doxil at a slower rate. I didn't have problems with the second time it was started.
At 4:30, I was finished with my Doxil, and they started the ET-743 infusion. The drug is light-sensitive, so they put a brown plastic bag over the bag on the pole. It was a 3-hour infusion.
The doctor and I spoke about what do with the belly pain I have been having. We think it is due to the anti-biotic that I took for the pneumonia (which she is convinced that I have due to the CT chest scans), but my oncologist at Columbia is a big proponent of doing regular CT scans of the pelvic region and abdomen. The trial coordinator told us that if I had a scan, even the day after receiving the drug, and if the scan showed mets that we didn't know about before receiving the drug, I would be kicked off the trial since I would have had disease progression. This seems stupid, and rules of this sort probably contribute to lower trial participation rates than otherwise would be seen. So, the doctor talked with the PI of the trial, and found out that I can get other scans up to 7 days after the first cycle without having my participation in question. Now, we'll get have to see if CT scans can be scheduled that quickly!
A friend from college, Tom, came to
visit during his lunch hour.
It was a good thing that Tom's visit was before I was treating with the Bendyrl; that make me very sleepy. Tommy and I played a few hands of Skipbo, but he spent most of the day going for walks around the hospital. We both like Fox Chase; it's isn't as rushed as Columbia, and seems more personal than MSK.
Tom ate both my hospital lunch and dinner. For lunch, I had curried chick peas and rice that we brought from home, and, for dinner, I had a Philly cheese steak sandwich that Tom went out and got for me. Some part of the chemo didn't agree with me since after eating dinner, I vomited it up. This was an unexpected event; this isn't a side effect that they have seen yet on this trial. Now, I'm the first person on my cohort (i.e., the first receiving the dosing that I did), so maybe this will be more of a problem. After calling the doctor, the nurse gave me an IV anti-emetic (Zofran, 8 mg). I'm not sure of the reason for that; I didn't have nausea, and I didn't have anything left in my stomach. At least I don't have to worry about the calories from the steak sandwich!
One of the nicest things about this trial is that there are no forced fluids, which there has always been on my in-patients chemos. So, I have been able to move around freely since 8:30pm without having to plug and unplug the pole.
The out-patient room on the in-patient floor (where I will be in 3 weeks receiving my 2nd cycle of chemo) has a nice library of DVDs and VHS tapes. Tom and I watched a movie before settling in for the night (Overboard).
We went for a walk on 4/25/03 around the hospital area. There is a wonderful
courtyard.
This is the building that my room was in.
