CONTACTS 

SUBJECTS
Cetuximab 12th Cycle 3rd Treatment 18th Total Treatment Chemotherapy

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 50 0000. ref SDS 48 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Continue 15th cycle on clinical study with cetuximab.  Today is the
040902 - 3rd treatment of the 15th cycle, and for the 1st cycle with cetuximab
040903 - and Carboplatin together.  Since the doctor deferred treatment with
040904 - Carboplatin for the 1st treatment on 080306, last week was actually
040905 - the 1st treatment of the 1st cycle with Carboplatin together with
040906 - cetuximab for treating the 4th relapse of IBC, per Doctor Rugo's
040907 - determination on 080306. ref SDS 47 NW3N  It turned out that Millie's
040908 - blood counts were too low for treatment today, she was not treated
040909 - with Carboplatin, and received only cetuximab.  The first treatment on
040910 - the clinical study began on 070201. ref SDS 4 G68I
040911 -
040912 -
040913 -
040914 -
040915 -
040916 -
0410 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - Labs Blood Test
050403 -
050404 - Follow up ref SDS 50 FW5N, ref SDS 48 FW5N.
050405 -
050406 - Adding Carboplatin to the treatment protocol now requires weekly blood
050407 - tests to evaluate primarily NEUTS for determining if the immune system
050408 - is strong enough for safe chemotherapy treatment, reported on 070201,
050409 - ref SDS 4 XR40, and citing the clinical study protocol received from
050410 - UCSF on 070116. ref SDS 3 5U7Z
050412 -  ..
050413 - During treatment, Catherine submitted results of the test.
050414 -
050429 -     ..
050430 -    Log#:                   080320 08:15
050431 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
050432 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
050433 -     ..
050434 -    CBC with DIFF & PLT CT                                     CBCD
050435 -     ..
050436 -    WBC COUNT               3.5    x10E9/L     3.4  -   10     WBC   WBC x10-3        K/uL     3.4  -  10.0
050437 -    RBC COUNT               4.42   x10E12/L      4  -   5.2    RBC   RBC x10-6        M/uL    3.60  -  5.70
050438 -    HEMOGLOBIN             13.9    g/dL         12  -   15.5   HGB   Hemoglobin       g/dL    11.5  -  15.0
050439 -    HEMATOCRIT             40.7    PERCENT      36  -   46     HCT   Hematocrit       %       34.0  -  46.0
050440 -    MCV                    92      fL           80  -   100    MCV   MCV              fL      80.0  -  100.0
050441 -    MCH                    31.6    pg           26  -   34     MCH
050442 -    MCHC                   34.3    g/dL         31  -   36     MCHC
050443 -    PLATELETS             240      x10E9/L     140  -  450     PLT   Plt x10-3        K/uL     140  -  400
050444 -    ..
050445 -     (NEUTS x 1000 = ANC for Kaiser)
050446 -    NEUTS                   1.28   x10E9/L     1.8  -  6.8     N-A   ANC                      1500
050447 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70
050448 -
050449 -            [...below, review concern about low blood counts
050450 -            ref SDS 0 SE5R, prevents treatment. ref SDS 0 1Q6J
050452 -     ..
050453 -    LYMPHS                  1.65   x10E9/L     0.9  -  2.9     L-A   Lymphocytes       %        20  -  50
050454 -    MONOS                   0.35   x10E9/L     0.1  -  0.6     M-A   Monocyte          %         0  -  11
050455 -    EOS                     0.18   x10E9/L       0  -  0.4     E-A   Esoinophils       %         1  -  5
050456 -    BASOS                   0.09   x10E9/L       0  -  0.1     B-A   Basophil          %         0  -  2
050457 -                                                                                                 0  -  5
050458 -     ..
050459 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
050460 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
050461 -     ..
050462 -    ELECTROLYTE PANEL                                          LYTE
050463 -    SODIUM                136      mmol/L      134  -  143     NA    Sodium            mEq/L   137  -  145
050464 -    POTASSIUM               3.9    mmol/L      3.4  -  4.9     K     Potassium         mEq/L   3.5  -  5.3
050465 -    CHLORIDE              104      mmol/L       98  -  107     CL
050466 -    CARBON DIOX TOTAL      26      mmol/L       23  -  32      CO2
050467 -    ANION GAP               6                    3  -  14      ANGA
050468 -     ..
050469 -    UREA NITROGEN           9      mg/dL         8  -  23      BUN   BUN               mg/dL     7  -  17
050470 -    CREAT with eGFR
050471 -    CREATININE              0.44   mg/dL      0.42  - 1.06     CR    Creatinine        mg/dL   0.6  -  1.2
050472 -
050473 -      Note: Creatinine assay changed to IDMS standardization on
050474 -      February 4, 2008 causing decrease in results of approximately
050475 -      0.09 mg/dL
050477 -    ..
050478 -   eGFR if Caucasian     >60    mL/min                      GFRC
050479 -   eGFR if African Amer  >60    mL/min                      GFRA
050480 -
050481 -      eGFR corrected for 1.73 sq meters of body surface area
050482 -      Note:  eGFR is only an estimation. Please see online Lab Manual
050483 -      for potential limitations.
050484 -      Performed at Mt Zion Clin Lab, 1600 Divisadero, San Francisco,
050485 -      CA  94115
050486 -
050488 -  ..
050489 - Catherine checked with Brigid about sudden drop in blood counts,
050490 - primarily NEUTS 1.28 below the level of safety, 1.8, for treatment
050491 - today, per above, ref SDS 0 QY6H, as called out in treatment
050492 - instructions received on 080313. ref SDS 50 4F8W  Concern about low
050493 - blood counts in a letter to Kaiser on 080307, ref SDS 49 HS6R, was
050494 - presented earlier on 080219 in a letter to UCSF, ref SDS 42 1K4P,
050495 - citing review with the doctor on 080207, ref SDS 38 E14H, because
050496 - patient history has shown difficulty recovering blood counts between
050497 - chemotherapy treatments reported in case study on 060810. ref SDS 2
050498 - HV45
050500 -  ..
050501 - UCSF decided to skip treatment with Carboplatin today, the
050502 - chemotherapy arm of the clinical study.  There seemed to be an
050503 - explanation that clinical study requirements prevent prescribing
050504 - Nupigen to increase blood counts for getting treatment.
050506 -  ..
050507 - Patient history shows Millie has received Nupigen (self-administered
050508 - at home) on 3 occassion since 2002, and has routinely received
050509 - chemotherapy with low blood counts, reported in case study on 060810.
050510 - ref SDS 2 HV45
050512 -  ..
050513 - Reducing frequency of getting chemotherapy may extend the period of
050514 - effectiveness by stretching out the mutation process.
050515 -
050516 -            [On 080403 UCSF prescribes Neupogen to increase blood
050517 -            counts for safe weekly treatments with Carboplatin
050518 -            chemotherapy added to cetuximab. ref SDS 51 I33G
050520 -             ..
050521 -            [On 080904 case study neutropenia Millie's patient history.
050522 -            ref SDS 52 8O7I
050523 -
050524 -
050525 -
0506 -

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 50 SE6N, ref SDS 48 SE6N.
150405 -
150406 - INR test was not performed today.
150407 -
150408 -
150409 -
1505 -

SUBJECTS
Default Null Subject Account for Blank Record

2403 -
240401 -  ..
240402 - Follow up ref SDS 48 .
240403 -
240404 -
240405 -
240406 -
240407 -
240408 -
240409 -
240410 -
240411 -
240412 -
240413 -
2405 -