On March 31, we started chemotherapy. The word brings fear and loathing to some of those who must face it. There are good reasons for this fear. Chemotherapy is apparently harder on adults than children. Of course, we typically do not hear from children about Chemo.
Sick-Kids is part of COG (children’s oncology group) that shares information across US and some european countries. COG follows 21 day chemotherapy cycles. It involves 5 days of chemotherapy followed by 16 days recovery period. COG procedure for stage 4, high risk consists of induction phase and consolidation phase. Some European organizations follow 10 day cycles with the same total amount of drugs. While there has been some rumblings of better outcome, oncology team at sick-kids feel that the results are inconclusive.
Maya’s procedure is (ANBL0532)
In induction phase, the chemotherapy is used to stop and retard tumor growth. Different types of chemo is used in conjunction to meet this goal. 21 day cycle is used to provide maximum period of recovery time without providing enough time for the tumor to regrow as well.
After the first two cycles, Maya will participate in peripheral blood stem cell harvest. The harvest is made in preparation for stem cell transplant in the consolidation phase. The stem cells are harvested after the second cycle to reduce the amount of cancer cell that may be floating in Maya’s blood. Harvesting will take anywhere from 1 – 3 days. Maya will have a femoral vein catheter inserted in one of her legs. While the catheter is in place, Maya will be bed bound.
There will also be another CT scan to see if the tumor has reduced as well.
After her 5th cycle, Maya will undergo a tumor resection. Surgeons will remove the tumor from her primary site. The tumor resection is left until after the fifth cycle in hopes that the tumor has reduced in size or died off to a larger extent.
By the time that 6 cycles of chemotherapy has been administered, under ideal condition most if not all of the cancer should have disappeared. The main goal of consolidation phase is to ensure that all trace of cancer is removed from the body. Firstly, Maya will undergo a high dose chemotherapy using three chemo-cocktails. The dosage will be much higher (3 times higher) than what she has received until now. Maya will have partial hearing loss and she will be infertile. It is also possible that she will have compromised organ function or organ failures. Bone marrow will have died off and she will require bone marrow transplant that has been harvested earlier in the process.
Radiation therapy will also be administered as well. While NeuroBlastoma is responsive to radiation therapy, receiving radiation increases the chances that secondary cancer may develop in future.
Maintenance therapy attempts to address the issue of recurrence. After all, all cancer patients have produced the cancer cells. Undetectable amounts of NeuroBlastoma may exist in the body and come back as relapse NB. Relapse is more difficult to cure.
Accutane (13 cis retinoic acid) is a Vitamin A derivative has shown to mature some NB cells thereby making it non cancerous.
The big advancement has come from “immunotherapy”. At sick-kids, they use the chimera antibody derived from both mouse and human. This antibody attaches to the NB cell (on ganglioside, GD-2) and thereby alerts the immune system to attach and destroy the cancer cell.
While the process has been mapped out quite clearly, it does not mean it is rigid. Along the process, based on Maya’s response, the process will be adjusted to ensure maximum benefit with minimal adverse side effects. For example, if it is determined that Maya’s hearing is being significantly impacted, the dosage of the chemo, which causes hearing loss will be reduced.
This is serious. As Dr Paul Gibson has put it, “We’re in for complete cure”.
Sick kids are open to alternative therapy. However, they do insist that they are aware of the alternative treatment that is being administered. Quite rightly, sick-kids does not want the alternative treatment to have an adverse effect or reduce the potency of the treatment that sick-kids is providing.
We are interested in alternative therapy and if you have any suggestions please feel free to pass this information along to us.