THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: March 13, 2008 08:30 AM Thursday;
Rod Welch
Millie 2nd treatment 1st cycle cetuximab Carboplatin for 4th relapse IBC.
1...Summary/Objective
2...Labs Blood Test
3...Coagulation Control INR 2.2 Normal Stable PT 25.5 High
4...CA 15-3 59 Declines 4 Points May Signal Improvement
5...Chemotherapy Orders...
....Antimetics:
....Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
....Laboratory work:
ACTION ITEMS..................
Click here to comment!
1...We need clarification of whether today begins 1st treatment of new
CONTACTS
SUBJECTS
Cetuximab 12th Cycle 3rd Treatment 18th Total Treatment Chemotherapy
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 46 0000. ref SDS 43 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Continue 15th cycle on clinical study with cetuximab. Today is the
040902 - 2nd treatment of the 15th cycle, and for the 1st cycle with cetuximab
040903 - and Carboplatin together. Since last week, the doctor deferred
040904 - treatment with Carboplatin, today is the 1st treatment with
040905 - Carboplatin together with cetuximab for treating the 4th relapse of
040906 - IBC, per Doctor Rugo's determination on 080306. ref SDS 45 NW3N The
040907 - first treatment on the clinical study began on 070201. ref SDS 3 G68I
040909 - ..
040910 - Millie received the order for the new treatment.
040912 - ..
040913 - We need clarification of whether today begins 1st treatment of new
040914 - cycle, and so examinations with medical team should shift 1 week to
040915 - correlate with changing treatments today, and assessments every 4
040916 - weeks. Alternatively, we could continue the current schedule, and
040917 - just report the 1st cycle with 3 treatments rather than 4??
040918 -
040919 -
040920 -
0410 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Labs Blood Test
050403 -
050404 - Follow up ref SDS 46 FW5N, ref SDS 38 546N. ref SDS 30 BD6I.
050405 -
050406 - Adding Carboplatin to the treatment protocol now requires weekly blood
050407 - tests to evaluate primarily NEUTS (ANC at Kaiser) for determining if
050408 - the immune system is strong enough for safe chemotherapy treatment,
050409 - reported on 070201, ref SDS 3 XR40, and citing the clinical study
050410 - protocol received from UCSF on 070116. ref SDS 2 5U7Z
050412 - ..
050413 - Interim blood tests are less extensive than tests to evaluate starting
050414 - a new cycle every 4th week.
050416 - ..
050417 - Yesterday, on 080312 Millie notified Jackie to order interim blood
050418 - tests without INR, CA 15-3, and other elements that are only needed
050419 - monthly, since today is an interim blood test. ref SDS 47 EX5H
050421 - ..
050422 - During treatment, Catherine submitted results of the test. The prior
050423 - test on 080214 was an interim evaluation, ref SDS 39 QD9I, that
050424 - followed up the regularly scheduled test on 080207. ref SDS 38 439L
050425 -
050440 - ..
050441 - Log#: 080313 08:45
050442 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
050443 - Type Results Units Normal ACRO Type Units Normal
050445 - ..
050446 - CBC with DIFF & PLT CT CBCD
050447 - ..
050448 - WBC COUNT 4.4 x10E9/L 3.4 - 10 WBC WBC x10-3 K/uL 3.4 - 10.0
050449 - RBC COUNT 4.45 x10E12/L 4 - 5.2 RBC RBC x10-6 M/uL 3.60 - 5.70
050450 - HEMOGLOBIN 14.0 g/dL 12 - 15.5 HGB Hemoglobin g/dL 11.5 - 15.0
050451 - HEMATOCRIT 40.8 PERCENT 36 - 46 HCT Hematocrit % 34.0 - 46.0
050452 - MCV 92 fL 80 - 100 MCV MCV fL 80.0 - 100.0
050453 - MCH 31.6 pg 26 - 34 MCH
050454 - MCHC 34.4 g/dL 31 - 36 MCHC
050455 - PLATELETS 254 x10E9/L 140 - 450 PLT Plt x10-3 K/uL 140 - 400
050456 - ..
050457 - (NEUTS x 1000 = ANC for Kaiser)
050458 - NEUTS 2.05 x10E9/L 1.8 - 6.8 N-A ANC 1500
050459 - Neutrophils Not Reported Neutrophils % 50 - 70
050461 - ..
050462 - LYMPHS 1.66 x10E9/L 0.9 - 2.9 L-A Lymphocytes % 20 - 50
050463 - MONOS 0.36 x10E9/L 0.1 - 0.6 M-A Monocyte % 0 - 11
050464 - EOS 0.23 x10E9/L 0 - 0.4 E-A Esoinophils % 1 - 5
050465 - BASOS 0.09 x10E9/L 0 - 0.1 B-A Basophil % 0 - 2
050466 - 0 - 5
050467 - ..
050468 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
050469 - Type Results Units Normal ACRO Type Units Normal
050470 - ..
050471 - ELECTROLYTE PANEL LYTE
050472 - SODIUM 138 mmol/L 134 - 143 NA Sodium mEq/L 137 - 145
050473 - POTASSIUM 4.0 mmol/L 3.4 - 4.9 K Potassium mEq/L 3.5 - 5.3
050474 - CHLORIDE 103 mmol/L 98 - 107 CL
050475 - CARBON DIOX TOTAL 24 mmol/L 23 - 32 CO2
050476 - ANION GAP 11 3 - 14 ANGA
050477 -
050478 -
050479 -
050480 -
0505 -
SUBJECTS
Default Null Subject Account for Blank Record
1503 -
150401 - ..
150402 - Coagulation Control INR 2.2 Normal Stable PT 25.5 High
150403 -
150404 - Follow up ref SDS 46 SE6N.
150405 -
150406 - INR was not tested today, because the test is every 4 weeks to start a
150407 - new cycle.
150408 -
150409 -
150410 -
150411 -
1505 -
SUBJECTS
Default Null Subject Account for Blank Record
2403 -
240401 - ..
240402 - CA 15-3 59 Declines 4 Points May Signal Improvement
240403 -
240404 - Follow up ref SDS 46 .
240405 -
240406 - Received results today on CA 15-3 59 for the blood test last week on
240407 - 080306. ref SDS 46 A16M
240409 - ..
240410 - Seems to align with report yesterday of subsiding IBC inflammation and
240411 - rash. ref SDS 47 RU4U
240412 -
240413 - [On 080314 letter to UCSF notes cancer marker falls prior to
240414 - starting new treatment adding Carboplatin to cetuximab the day
240415 - before on 080313. ref SDS 48 DE4N
240416 -
240417 -
240418 -
240419 -
240420 -
2405 -
SUBJECTS
Chemotherapy Orders 1st Cycle 2nd Treatment Clinical Study Drug Tria
3003 -
300401 - ..
300402 - Chemotherapy Orders...
300403 -
300404 - Millie received a new chemotherapy order today by Doctor Rugo, and
300405 - prepared by Brigid during the meeting last week on 080306. This order
300406 - prescribing Carboplatin chemotherapy treatment added to Cetuximab
300407 - alone prescribed initially on 070201. ref SDS 3 4N5M
300408 -
300414 - Auth# Stor BCC LOC
300415 - Visit: 14045398 DOS 20080313
300417 - ..
300418 - Date: 20080307
300420 - ..
300421 - Study Order for CC#05752: Phase II Trial of Cetuximab alone and
300422 - in combination with Carboplatin in ER-negative, PR-negative,
300423 - HER2-negative Nonoverexpressing Metastatic Breast Cancers.
300425 - ..
300426 - Arm: 2 - Cetuximab + Carboplatin
300428 - ..
300429 - Dates to be given: 080313
300431 - ..
300432 - Height: 62 inches
300434 - ..
300435 - Weight: 139 pounds
300437 - ..
300438 - Diagnosis: breast cancer (IBC)
300440 - ..
300441 - ICD-9 codes: 174.4
300442 -
300443 - [On 080403 codes assigned to Chemotherapy Order for the next
300444 - cycle are much different from codes assigned today. ref SDS 49
300445 - RV5H
300447 - ..
300448 - Allergies NKDA
300450 - ..
300451 - Cycle: 15
300453 - ..
300454 - Days: 8, 15
300455 -
300457 - ..
300458 - Antimetics:
300459 -
300460 - x Dexamethasone 10 mg IV (Decadron)
300461 - x Ondansetron 8 mg IV (Zofran)
300462 -
300464 - ..
300465 - Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
300466 -
300467 - May administer Carboplatin if vital signs are unremarkable one
300468 - hour after cetuximab infusion..
300469 -
300470 - ** Please note start and stop times **
300472 - ..
300473 - Carboplatin (commercial supply) AUC 2 = 230 mg
300474 -
300475 - [On 080403 Chemotherapy Orders calls for 250 mg
300476 - Carboplatin. ref SDS 49 4F56
300478 - ..
300479 - IV over 30 minutes weekly x 3 doses followed by 1 week rest.
300481 - ..
300482 - [hand writting...]
300483 -
300484 - Carbo dose to remain the same unless CR >= 1.3
300486 - ..
300487 - [...where CR = "Creatinine"]
300488 -
300489 - Carboplatin dose in mg = (desired AUC)(GFR+25)
300490 -
300491 - GFR (estimated) =
300492 -
300493 - (140-age in years)(weight in kg)(for females x 0.85)
300494 - ----------------------------------------------------
300495 - (Cr in mg/dL)(72)
300496 -
300498 - ..
300499 - Laboratory work:
300500 -
300501 - x CBC with differential and platelets
300502 - x Creatinine, magnesium every 4 weeks
300503 - x BUN, AST, Alk phos, Alt, Total bilirubin, eletrolytes every 8 weeks
300504 -
300505 - [On 080404 Magnesium was omitted from labs for 080403, and
300506 - corrected the next day on 080404. ref SDS 50 OA8K
300508 - ..
300509 - On 070201 chemotherapy order for cetuximab alone appears identical to
300510 - requirements for laboratory blood tests. ref SDS 3 5594
300512 - ..
300513 - Chemotherapy Orders continues...
300514 -
300515 - If ANC >= 1.5 x 1000/L, platelets >= 75 x 1000/L give 100% of dose
300517 - ..
300518 - If ANC < 1.5 x 1000/L, platelets < 75 x 1000/L....
300519 -
300522 - ..
300523 - x See cetuximab orders. [received on 070201. ref SDS 3 II5G]
300525 - ..
300526 - x Physician has discussed risks/benefits of chemotherapy with the
300527 - patient. Consent, form obtained.
300528 -
300529 - x Yes O2 [oxygyn] by nasal cannula at 2 liters/min prn for chest pain or SOB
300531 - ..
300532 - x Yes Diphenhydramine 50 mg IV prn x 1 unticaria pruntis, SOB
300533 - (this is Benadryl)
300535 - ..
300536 - x Yes Hydrocrotisone 100 mg IV prn x 1 unticaria pruntis, SOB
300538 - ..
300539 - x Yes Aubterol inhaler 2 - 4 puffs prn SOB or chest tightness
300541 - ..
300542 - x Yes Epnephnna nhaler 2 - 4 puffs prn SOB or chest tightness
300544 - ..
300545 - Physician Signature
300546 -
300549 - Date: 080306
300551 - ..
300552 - Nurse Signature:
300553 -
300556 - Date: 080313
300557 -
300558 -
300559 -
300560 -
300561 -
300562 -
3006 -