We just got home from the hospital. Brody had his labs checked this morning to determine if his body was ready for chemo yet. Today would normally be the first day in his next cycle. His oncologist wanted his serum to be less than 1.0 before he would start chemo again. He also planned to only give Brody 3 days of his chemo rather than 5 days he would normally receive due to kidney function concerns. And, he planned to no longer give one of Brody's chemo medications (bevacizumab) due to side effect concerns. Bevacizumab blocks angiogenesis (formation of new blood vessels) which helps prevent tumors from growing. They need new blood vessels to grow. This medication has really helped slow the growth of Brody's tumor. But, it can prevent proper wound healing. The medication is suspected to have contributed significantly to Brody's current kidney function problems. His kidney was likely damaged from his stent and/or surgery to replace the stent. He lost a lot of blood over Easter weekend in his urine. His kidney function has been compromised since this episode. The bevacizumab can certainly complicate healing from damage to the kidney caused by the stent in his ureter. Brody needs the stent. His urterer is compressed by his tumor. The stent keeps it open so that urine can still flow from his kidney to his bladder. The stent can irritate the kidney and cause tissue damage and bleeding. The bevacizumab makes it more difficult to heal from these episodes. In addition, it's possible Brody may need surgery soon to his spinal column to remove the tumor from the spinal column. He would need to be off of the bevacizumab for at least 28 days before such a surgery. Unfortunately, we may not have 28 days notice that this surgery needs to happen. The surgeon would need to act quickly if his tumor starts to progress in the spinal column. So, basically Brody is no longer able to continue with the same chemo regimen that has been keeping his tumor stable (at least not getting bigger).
Fortunately, Brody's kidney function labs were much better today. His serum creatinine was 1.04. He needs to have a serum creatinine of 1.05 or less to meet kidney function requirements to enter the HSV trial. So he just barely made it and we are super excited that he met this criteria! The other criteria Brody needs to meet is that his disease is currently "progressive." I contacted Dr. Cripe at Nationwide Children's Hospital today to let him know that Brody's kidney function now meets the study requirements and that he is no longer able to continue with the same chemo regimen that had been stabilizing his disease. He was excited for us that Brody's kidney is doing better and he is getting us scheduled to start the enrollment process into the HSV trial. Brody will likely be scheduled next week for baseline scans and tests. The first HSV treatment would need to be at least 28 days after his last chemo dose. His last chemo dose was on April 30th. So Brody could possibly receive his fist HSV dose next week or the following week if he is accepted into the trial. We will not know until after the enrollment process if he will be accepted into the trial. Dr. Cripe stated on the phone that he may have to wait until after the tumor has shown growth again before he can enter the trial. If the scans next week show that the tumor has gotten any bigger this may be enough to show progression of the disease. So at this point, the size of the tumor in the scans next week are the big determining factor as to whether Brody will enter the HSV trial or not. If the tumor has not gotten any bigger, then he may not be able to enter the trial and will need to continue with his modified chemo regimen instead.
If we are not able to enter the HSV trial yet, I fear Brody's kidney function deteriorating over time with continued exposure to chemo and then him not being able to enter the trial later on due to kidney function problems. And, then also that his tumor starts to progress rapidly and then possibly that the HSV trial may not be open at that time to enter.
It's likely that HSV will be more effective at higher doses. If Brody enters the trial now, he would be the last patient entered for the current dose being given. If Brody and other patients do well with regards to safety with the current dose, then the next time the trial opens up, a higher dose of HSV would be given. If it turns out that Brody cannot enter the HSV trial now, maybe it works out later on down the road that he enters into it later at a higher and maybe more effective dose of HSV.
For now, we have to let the cards fall where they fall and proceed based on what cards we have been dealt.
Please continue to keep us in your prayers. Pray for a miracle healing of our sweet little boy.
Here is a link with information on the HSV trial. There is a video on the page too of Dr. Cripe talking about the trial (it plays after a short commercial....there was an automatic video ad for something else on the page too....you can close that one and then open the other video to see Dr. Cripe explain things).
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.