Friday, May 18, 2012

Treatment Evolution

I still haven't heard back from any of the doctors... so still no pain management... I actually think I'm going to reach out to Dr. Albritton (from Cook Childrens) today and ask her if she has any suggestions.  She told me to let her know if there was ever anything she could do for us. Hopefully she knows of some back doctors who take Medicaid here in the Fort Worth area.

Tanner is hanging in there and, other than the back spasms, seems to be doing well... Still very much in love with Cearra and just living life.

I receive the MMRF newsletter and thought I would share a couple of the abstracts from the one I received this past week:

Novel therapeutics in multiple myeloma:
Most myeloma patients still experience recurrent relapse and eventually become resistant and/or intolerant of effective agents such as corticosteroids, alkylating agents, immune modulators (lenalidomide and thalidomide) or proteasome inhibitors such as bortezomib. Once this happens average survivals are less than one year. Progress has been made for such patients, however, with the demonstration of clinical benefit of novel proteasome inhibitors (carfilzomib) and immune modulators (pomalidomide). Pomalidomide when used with dexamethasone has activity in 30-60% of patients depending on disease stage. Carfilzomib is an irreversible proteasome inhibitor with favorable toxicity profile (minimal neuropathy) and response rates of 17-54% depending on the disease stage treated. Novel targets are also being explored. Histone deacetylase inhibitors such as vorinostat and panobinostat are in phase II testing although results from a randomized trial combining vorinostat with bortezomib were disappointing. Other small molecules or monoclonal antibodies with novel targets such as kinase inhibitors(AKT, CDK5) and cell surface receptors (e.g. elotuzumab) are undergoing active investigation.

Every time we go and see Dr. Berryman in Dallas, he talks to us about how MM is a "relapsing" cancer and that he doesn't know how long they are going to keep Tanner on "maintenance" treatment.  He explains that as long as he is tolerating treatment so well, they see no reason to stop chemo any time in the near future and he goes on to explain that new medications are going to be available by the end of the year - which will be beneficial if Tan ever becomes resistant to the maintenance he's been on for the last 2-1/2 years.

Multiple myeloma: treatment evolution:
Melphalan-prednisone (MP) was introduced for the treatment of MM in late 1960s. In the subsequent 30 years, the treatment improvements remained stagnant, since more complex chemotherapy combinations, such as vincristine, doxorubicin, and dexamethasone (VAD), or with the addition of BCNU (VBAD) or melphalan and cyclophosphamide (VCMP), only led to small increases in the overall response rate but without differences in survival, as assessed in a large meta-analysis that included over 6000 patients. The next step forward was the use of high-dose melphalan followed by stem cell support (autologous stem cell transplant - ASCT) for young myeloma patients, which resulted in a significant improvement in disease free survival and overall survival. However, for elderly patients MP remained as the standard of care. From year 2000, a revolution in the treatment armamentarium of MM has emerged with the availability of new agents with singular mechanism of action such as thalidomide and lenalidomide (Revlimid®), both immunomodulatory drugs and the proteasome inhibitor bortezomib (Velcade®).

The high dose melphalan followed by stem cell transplant with subsequent thalidomide - Revlimid treatment discussed in the abstract above is the treatment that Tanner received in Arkansas...the treatment that his insurance company denied coverage for stating that it was "not standard".  Thank goodness Dr. Barlogie proceeded with care for Tanner with this cutting edge treatment - even knowing that payment was being denied. He never hesitated and never delayed in his care of Tanner no matter what the insurance company said. He had to have known that there was very little chance they would ever be able to collect the hundreds of thousands of dollars in bills that were being built up... even if I make payments the rest of my life... but he never ever hesitated...

He is truly one of mine and Tanner's heroes...

Love knows no limit to its endurance, no end to its trust, no fading of its hope, it can outlast anything. Love still stands when all else has fallen...


  1. Angie: So sorry that Tanner is having so much pain. Bob also has another Compression Fracture (in the T11) and I think he's in more pain than when it was in the L1.

    He has a Pain Mgmt Specialist, and I hope you can find one....soon....for Tanner. I don't know how he would live without having Dr. S. on his team.

    I was in Arlington over the weekend for our granddaughter's graduation, but just didn't have time to try and connect with you. Maybe one day!!


    1. Thank you Sarah! I think of you and Bob often. I'm sorry Bob is having pain again. I mentioned him to Dr. Berryman when we were talking about Tanner's back pain during his last consultation in Dallas.

      I too hope to meet you some day!