the path - part I

While I don't want to reduce this blog to just a "medical record", I do realize that some facts and information are required.  Here they are.  My dad will move forward with a two-pronged approach.  This post will encompass the first part.  He will first fight the cancer with a chemotherapy combination called FCR (see below for what that stands for).  The protocol was developed at MDACC so this group really did write the book on this disease's therapies.  It's a relatively newer protocol but the trio of drugs has been shown to outperform other modalities and is rapidly becoming the standard of care.

Fludarabine - a synthetic agent which mimics one of the building blocks of DNA thereby blocking DNA replication.  Basically, rapidly dividing cells like tumor cells need to rapidly replicate DNA.  The cell takes up this building block but it's like building a house with a defective foundation.  The DNA collapses and results in killing the cell.  It will be given intravenously (IV) on Days 2, 3 and 4.

Cyclophophamide - a cousin of mustard gas used in WWI (that's how the concept of chemotherapy was born).  It nonspecifically drops a molecular bomb on DNA.  Again, most cells have DNA and must replicate their DNA to divide so it hits the cells that divide rapidly the most.  It will also be given IV on Days 2, 3 and 4.
A note - both agents above hit the healthy bone marrow just as hard as the tumor cells so that will suppress his immune system, exacerbate his anemia, and further knock down his platelets.  These make him more susceptible to infections and bleeds.

Rituximab - finally a drug that's more targeted.  It's an antibody just like the antibodies your body would make against foreign invaders like the cold virus or a bacterial infection.  This antibody, however, doesn't recognize foreign invaders.  It recognizes traitors, ie the cancer cells.  It targets a molecule that is specifically on the white blood cells in the bone marrow and does two things.  It directly tells the cell, you've had enough, it's time to committ programmed cell death (apotosis).  Or, it binds to the cell and advertises for the immune system to come destroy it.  Since it's more targeted, less side effects.  But, since it is a biological product, there is always the risk of anaphylactic shock.  Consequently, the first dose will be given very, very, very slowly.  That's the drug he gets on Day 1 and it lasts 8-10 hours.  They also concurrently give a steroid and benadryl to reduce the risk of an immune/allergic reaction.

A cycle lasts roughly 28 days and is defined as treatment on Days 1, 2, 3 and 4.  He then he gets some time off to recover.  Approximately 28 days after the initial day, we will see where his blood counts are.  Provided his blood counts have improved to the point where's he strong enough, he will begin the second cycle of chemotherapy again receiving the FCR and then waiting 28 more days.  Throughout the chemo, he will be receiving multiple supportive meds - antibiotic (bactram) to reduce bacterial infections, antiviral (Acyclovir) to reduce viral infections, and antiemetics (good ol' ABH developed by MDACC) to reduce nausea.  Pain is managed with narcotics right now but we're hoping that need will be reduced with the chemo.  He will receive 3 cycles of this regimen (~3 months) and at that point his bone marrow will again be sampled to see how prevalent the tumor cells are.  Based on those results and the good ol' fashioned approach of "how do you feel", they will decide what to do next.  I'll go over that in the next post.