Mets Day 915 Consultation with my scientific oncologist

Mets Day 915 Consultation with my scientific oncologist

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Today I met with my scientific oncologist, Dr. Aragon-Ching of GW's Medical Faculty Associates. She and I had traded emails and spoken by cellphone last week. The purpose of contemporary-day assembly used to be to additional discuss whether I would have to nevertheless reside on Lovenox long term, or in spite of the whole lot switch over to an oral anticoagulant. I additionally thought of as necessary to get her thoughts on my scientific trial alternate options.

Prior to my assembly along with her, I did several studies on whether Lovenox can assist suppress growth of my cancer. Along the form, I got an education on the use of low molecular weight heparins (LMWHs) to battle venous thromboembolism (VTE). VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Patients with cancer — indeed metastatic cancer, and who have had chemotherapy — are at increased risk for VTE. A awesome overview of VTE, and the expanding use of oral anticoagulants, is on hand right here.

The question I used to be watching into is whether LMWHs equivalent to Lovenox can assist inhibit the growth of my metastatic bladder cancer. Lovenox is an injected form of LMWH, with the generic name of enoxaparin sodium. I'm currently injecting myself with 100 and twenty mg of Lovenox twice an afternoon. If there is evidence that enoxaparin can assist slow the spread of my cancer, then I'm willing to continue with the shots. If now not, I'd prefer switching to rivaroxaban (Xaralto).

In the 2009 book, Coagulation and Cancer, by G.F. Pineo and R.D. Hall, the authors write, "Some LMWH compounds were robust in the suppression of tumor cellular growth, metastases (nandroparin, tinzaparin, enoxoparin), and antiogenesis (tinzaparin, dalteparin, and enoxoparin), when fondaparinux (as selective side Xa inhibitor) used to be now not." Id. at 266, endnotes omitted. Elsewhere in the financial disaster, the authors cite other reports that support the thought that LMWHs could possibly also inhibit tumor growth. Id. at 261. The authors conclude:

Over the years it has become greater and greater obvious that the thrombotic manner plays a substantial role in cancer cellular advancement, proliferation, migration and metastasis resulting in the hope that suppression of the coagulation cascade could possibly have a a reputable suggestion  on the cancer. Data from scientific trials at the starting aimed towards the treatment of venous thromboembolism in cancer patients and later directly in cancer patients who failed to have thrombosis provided evidence that LMWH could possibly recover survival in the patients who had a reputable selection of elementary tumor sites . . . .
Id. at 270. Unfortunately, the excepts of the book that I used to be succesful of pull up on Google books omitted the pages with the critical endnotes, so I couldn't readily locate the reports cited for the ones propositions.

Duly arranged, I met with Dr. Aragon-Ching. She said that the evidence that Lovenox can inhibit metastatic interest is form of confined. She said that she would now not give thousands weight to that alternative in making the decision of whether to continue making use of Lovenox, or switching to Xaralto. She acknowledged that Xaralto used to be a comparatively new drug for DVT and PE, nonetheless used to be completely happy that Xaralto used to be as robust as Lovenox. She said that NIH would recommend that I reside on Lovenox, since they do scientific trials for a living, and Lovenox is easily-acknowledged for its lack of interactions with most medication. Because Xaralto is a greater moderen drug, there is truly now not as thousands evidence nearly its lack of interactions, even if she said that it'd be as protected and robust as Lovenox. She cautioned that I have the Lovenox injections for 4 weeks, then switch over to Xaralto, unless I used to be to enter a scientific trial. She launched that, if I went on Xaralto and then later entered a scientific trial, I could possibly switch again to Lovenox with out problems.

Dr. Aragon-Ching additionally said that I would have to nevertheless now not go on coumadin. It does now not work as well, has too many side consequences, and is too weight loss plan-dependent. It's truly an older drug that has been superseded by more recent medication.
On the discipline of scientific trials, Dr. Aragon-Ching said that the key situation used to be whether my nodes were substantial adequate to meet the scientific trial threshold. I realized that the factors for lymph node sizes in scientific trials are set forth in a document referred to as "Response Evaluation Criteria in Solid Tumors" (RECIST). The 2009 edition of the RECIST standards — edition 1.1 — requires that lymph nodes be now not lower than 15 mm on their brief axis before they could be judicious a "target lesion" for applications of a scientific trial. As mentioned in a little bit of writing summarizing the new instructions:

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