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 -