We just got back from Houston and are glad to be home.  Maggie had CT scans early this morning to wrap up our visit at MD Anderson.  We return for our 8AM appointment on the 17th for the first part of our trial.

The CT scan went as it typically does at MD Anderson.  Get there early.  Drink the barium.  Throw it all up in the CT machine.  Ah, fond memories of the last times.  Maggie always warns them and yet techs always seem so surprised.

The trial we’ll be doing is called “A Phase I Study of Hepatic Arterial Infusion of Oxaliplatin in Combination With Systemic Fluorouracil, Leucovorin and Avastin for Patients with Advanced Solid Tumors Metastatic to the Liver.”  Obviously these folks need to invest in a good editor or marketing department because that name won’t sell many books.  Heck, I don’t know if it’ll even fit on the cover of a book.  Regardless, were you to be riveted by the name you can read more about it here.

Basically, they are going to load Maggie up with four different drugs at the same time, officially called The Whammy.  The oxaliplatin will go straight into her liver via a tube they will be inserting into her thigh.  Installing the tube, so they say, is a minor ordeal.  They’ll feed it up through the big blood vessel in her groin (the hepatic artery) using a CT machine to guide the effort until it reaches her liver.  They will do this each time we do an infusion.  I’m hoping they install a cork or something so they won’t need to cut open her leg each time.  I’ll suggest that to them, just in case.

They hope that the high doses of oxaliplatin straight to the liver will increase its effectiveness in killing off the tumors.  Dr. Kurzrock confirmed that, as we’ve been told before, the ones in the liver are of most concern in that if they begin to interfere with her liver functionality we will have a real problem.  So, smaller is better.  Nonexistent would be preferable.

But we can’t forget about the other tumors that are out and about, wreaking havoc.  Dr. Kruzrock says that while the liver will bare the brunt of the attack, the oxaliplatin will still make it out of the liver to offer up a good all-over-body scrub.  Additionally, she’ll be getting fluorouracil (5-FU), leucovorin and Avastin as a regular IV infusion.  None of the drugs are new to us but hopefully because of the new way they are infused they’ll be especially helpful this time around.

In case you are curious, here’s what each do, roughly:

• Oxaliplatin interferes with the growth of cancer cells (which slows their growth and spreading), eventually destroying them.
• 5-fluorouracil (5-FU) interferes with the growth of cells that reproduce rapidly.
• Leucovorin strengthens the effect of 5-FU by reducing tumor cell resistance to the 5-FU
• Avastin interferes with blood flow to the tumors, which may cause tumors to be “starved” of the oxygen and nutrients they need to grow.

The goal of this Phase I trial, like all Phase I trials, is to see how much of each drug they can pump into someone without killing them.  Ok, that’s a bit harsh but it’s about right.  A key part in a successful treatment is figuring out the proper dosage and though the use of clinical trials is how they figure it out.  Fortunately, I suspect we’ll be getting the most bang we can under the most watchful eye we can get.  Unfortunately, all this fun will likely come with some pretty strong side-effects.

Maggie’s liver has grown substantially over the last few weeks.  We can easily feel it outside her rib cage.  The pain Maggie’s feeling, from what we understand, is the stretching of the sack that covers the liver.  The liver itself feels no pain.  Apparently that sack sure does.  Yesterday was miserable.

Today Maggie’s feeling better.  She took an oxycodone around 10AM this morning in addition to her two fentanyl patches she’s wearing.  Riding in the car is tough with the jostling about and, of course, HW290 to Houston isn’t known for it’s glassy-smooth surface.  All I have to say is thank goodness for books on tape.  Maggie and I both listened to books on our iPhones on the way there and back.  Audible.com.  Love it!

But, for now, we are done with the car ride.  One quick soak in the bath and she’s happy again.  And now she’s on the phone to a few clients to help them solve their ever-present issues.  Always the helping hand, that one.