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 49 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - The first treatment on the clinical study began on 070201 with
040902 - cetuximab alone, ref SDS 4 G68I, and continued for 14 cycles.
040904 -  ..
040905 - Continue 15th cycle on clinical study with cetuximab.  Today is the
040906 - 4th treatment of the 15th cycle, and for the 1st cycle with cetuximab
040907 - and Carboplatin together.  Since the doctor deferred treatment with
040908 - Carboplatin for the 1st treatment on 080306, and since last week
040909 - Millie's blood counts were too low for treatment, she was not treated
040910 - with Carboplatin.  Since today is the 4th treatment and the case study
040911 - protocol schedules Carboplatin to be skipped, this was followed today,
040912 - rather than attempt to catch up on the volume of treatment with
040913 - Carboplatin.  Therefore for the 1st cycle Millie received only 1
040914 - treatment with Carboplatin rather than the prescribed 3 treatments.
040915 -
040916 -
040917 -
040918 -
040919 -
040920 -
040921 -
040922 -
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 49 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#:                   080327 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               4.7    x10E9/L     3.4  -   10     WBC   WBC x10-3        K/uL     3.4  -  10.0
050437 -    RBC COUNT               4.23   x10E12/L      4  -   5.2    RBC   RBC x10-6        M/uL    3.60  -  5.70
050438 -    HEMOGLOBIN             13.4    g/dL         12  -   15.5   HGB   Hemoglobin       g/dL    11.5  -  15.0
050439 -    HEMATOCRIT             38.9    PERCENT      36  -   46     HCT   Hematocrit       %       34.0  -  46.0
050440 -    MCV                    92      fL           80  -   100    MCV   MCV              fL      80.0  -  100.0
050441 -    MCH                    31.7    pg           26  -   34     MCH
050442 -    MCHC                   34.6    g/dL         31  -   36     MCHC
050443 -    PLATELETS             217      x10E9/L     140  -  450     PLT   Plt x10-3        K/uL     140  -  400
050444 -    ..
050445 -     (NEUTS x 1000 = ANC for Kaiser)
050446 -    NEUTS                   2.30   x10E9/L     1.8  -  6.8     N-A   ANC                      1500
050447 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70
050449 -     ..
050450 -    LYMPHS                  1.57   x10E9/L     0.9  -  2.9     L-A   Lymphocytes       %        20  -  50
050451 -    MONOS                   0.49   x10E9/L     0.1  -  0.6     M-A   Monocyte          %         0  -  11
050452 -    EOS                     0.20   x10E9/L       0  -  0.4     E-A   Esoinophils       %         1  -  5
050453 -    BASOS                   0.10   x10E9/L       0  -  0.1     B-A   Basophil          %         0  -  2
050454 -                                                                                                 0  -  5
050455 -     ..
050456 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
050457 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
050458 -     ..
050459 -    ELECTROLYTE PANEL                                          LYTE
050460 -    SODIUM          *L    132      mmol/L      134  -  143     NA    Sodium            mEq/L   137  -  145
050461 -    POTASSIUM               4.2    mmol/L      3.4  -  4.9     K     Potassium         mEq/L   3.5  -  5.3
050462 -    CHLORIDE              102      mmol/L       98  -  107     CL
050463 -    CARBON DIOX TOTAL      24      mmol/L       23  -  32      CO2
050464 -    ANION GAP               6                    3  -  14      ANGA
050465 -     ..
050466 -    UREA NITROGEN    No Report     mg/dL         8  -  23      BUN   BUN               mg/dL     7  -  17
050467 -    CREAT with eGFR
050468 -    CREATININE              0.46   mg/dL      0.42  - 1.06     CR    Creatinine        mg/dL   0.6  -  1.2
050469 -
050470 -      Note: Creatinine assay changed to IDMS standardization on
050471 -      February 4, 2008 causing decrease in results of approximately
050472 -      0.09 mg/dL
050474 -    ..
050475 -   eGFR if Caucasian     >60    mL/min                      GFRC
050476 -   eGFR if African Amer  >60    mL/min                      GFRA
050477 -
050478 -      eGFR corrected for 1.73 sq meters of body surface area
050479 -      Note:  eGFR is only an estimation. Please see online Lab Manual
050480 -      for potential limitations.
050481 -      Performed at Mt Zion Clin Lab, 1600 Divisadero, San Francisco,
050482 -      CA  94115
050484 -  ..
050485 - Blood counts rising significantly today, e.g., NEUTS 2.30, ref SDS 0
050486 - QY6H, compared with NEUTS 1.28 last week on 080320, ref SDS 50 QY6H,
050487 - marks a change in patient history.  For the past year Millie's blood
050488 - counts have rarely, if ever, been over 2.0, and were mostly below the
050489 - target range for safe treatment.  The report on 080306 showing sudden
050490 - rise to 2.75, ref SDS 48 QY6H, was therefore very surprising, noted in
050491 - the meeting with the medical team. ref SDS 47 033B  The drop to NEUTS
050492 - 1.28 well below the target range shows significant effect of
050493 - Carboplatin chemotherapy treatment, which was expected, reported in
050494 - the letter to UCSF on 080219. ref SDS 42 1K4P
050496 -  ..
050497 - Skipping treatment with Carboplatin allowed Millie's energy to
050498 - recover, and so this past week she has increased exercise, for example
050499 - hiking and additional 3 miles.  This may account for the recovery of
050500 - blood counts today, showing NEUTS 2.30. ref SDS 0 QY6H
050502 -  ..
050503 - How can treatments be balanced to allow sufficient exercise for
050504 - keeping blood counts high enought to get enough treatment to be
050505 - effective and also avoid adding additional treatment with Neupogen?
050507 -  ..
050508 - The pharmacy person discussed Millie's case with Catherine, noting
050509 - that the doctor's treatment protocol received on 080313 calls for
050510 - treatment with Carboplatin for only the 1st 3 treatments of the cycle,
050511 - ref SDS 49 4F56, and since today is the 4th treatment in the cycle,
050512 - the pharmacist requested specific authority to prepare and release
050513 - Carboplatin treatment.
050515 -  ..
050516 - Actually, the protocol does not expressly state treatments must run
050517 - concurrent, so it is not clear why treatment cannot be given today, to
050518 - make up for not getting treatment 2 of the other 3 weeks.
050520 -  ..
050521 - Catherine checked with Brigid, as called out in treatment instructions
050522 - received on 080313. ref SDS 49 4F8W  UCSF decided to skip treatment
050523 - with Carboplatin again today, the chemotherapy arm of the clinical
050524 - study.  There seemed to be an explanation that clinical study
050525 - requirements prevent prescribing Nupigen to increase blood counts for
050526 - getting treatment.
050527 -
050528 -        [On 080904 case study neutropenia Millie's patient history.
050529 -        ref SDS 51 8O7I
050531 -  ..
050532 - Patient history shows Millie has received Nupigen (self-administered
050533 - at home) on 3 occassion since 2002, and has routinely received
050534 - chemotherapy with low blood counts, reported in case study on 060810.
050535 - ref SDS 2 HV45
050537 -  ..
050538 - Reducing frequency of getting chemotherapy may extend the period of
050539 - effectiveness by stretching out the mutation process.
050540 -
050541 -
050542 -
050543 -
050544 -
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 49 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 .
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