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: July 31, 2008 08:00 AM Thursday;
Rod Welch
Millie 2nd treatment 6th cycle cetuximab Carboplatin 4th relapse IBC.
1...Summary/Objective
...Taxotere Capecitabine 2nd Relapse IBC Treatment After Mastectomy
...Cetuxiab Alone Clinical Study
...Cetuxiab with Carboplatin Clinical Study 2nd Arm
2...Labs Blood Test
3...NEUTS Decrease Neupogen Continue 2 Treatments Per Week New Cycle
4...Side Effects May Limit Neupogen Treatments Could Limit Chemotherapy
5...Cancer Marker CA 15-3 Results for Test 080724
..............
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CONTACTS
SUBJECTS
Cetuximab 12th Cycle 3rd Treatment 18th Total Treatment Chemotherapy
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS C7 0000. ref SDS C3 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background on Millie's treatment in the clinical study is reported on
040902 - 080508. ref SDS 93 TZ8I
040904 - ..
040905 - Taxotere Capecitabine 2nd Relapse IBC Treatment After Mastectomy
040906 -
040907 - Follow up ref SDS C7 X33O, ref SDS C3 X33O.
040908 -
040909 - Millie had left mastectomy on 051021. Biopsy at that time reported
040910 - no findings of cancer. Approximately 8 months later on 060707 the
040911 - doctor diagnosed IBC relapse and prescribed treatment. ref SDS 3
040912 - PF3O
040913 -
040914 - 1. Cycle 09 and 01 ................... 060721, ref SDS 4 407N
040915 - 2. Cycle 10 and 02 ................... 060814, ref SDS 6 LY6O
040916 - 3. Cycle 11 and 03 ................... 060908, ref SDS 6 407N
040917 - 4. Cycle 12 and 04 ................... 060929, ref SDS 6 407N
040918 - 5. Cycle 13 and 05 ................... 061020, ref SDS 7 407N
040919 - 6. Cycle 14 and 06 ................... 061110, ref SDS 8 407N
040920 - 7. Cycle 15 and 07 ................... 061201, ref SDS 9 407N
040922 - ..
040923 - Cetuxiab Alone Clinical Study
040924 -
040925 - Follow up ref SDS C7 356I, ref SDS C3 356I.
040926 -
040927 - Total Cetuximab
040928 - 8. Cycle 01 and 08 and 01 01.......... 070201, ref SDS 11 SG8I
040929 - 9. Cycle 01 and 08 and 02 02.......... 070208, ref SDS 12 SG8I
040930 - 10. Cycle 01 and 08 and 03 03.......... 070215, ref SDS 13 SG8I
040931 - 11. Cycle 01 and 08 and 04 04.......... 070222, ref SDS 14 SG8I
040932 - 12. Cycle 02 and 09 and 01 05.......... 070301, ref SDS 15 SG8I
040933 - 13. Cycle 02 and 09 and 02 06.......... 070308, ref SDS 17 7T3H
040934 - 14. Cycle 02 and 09 and 03 07.......... 070315, ref SDS 18 7T3H
040935 - 15. Cycle 02 and 09 and 04 08.......... 070322, ref SDS 19 7T3H
040936 - 16. Cycle 03 and 10 and 01 09.......... 070329, ref SDS 20 7T3H
040937 - 17. Cycle 03 and 10 and 02 10.......... 070405, ref SDS 21 7T3H
040938 - 18. Cycle 03 and 10 and 03 11.......... 070412, ref SDS 22 7T3H
040939 - 19. Cycle 03 and 10 and 04 12.......... 070419, ref SDS 23 7T3H
040940 - 20. Cycle 04 and 11 and 01 13.......... 070426, ref SDS 24 7T3H
040941 - 21. Cycle 04 and 11 and 02 14.......... 070503, ref SDS 25 7T3H
040942 - 22. Cycle 04 and 11 and 03 15.......... 070510, ref SDS 26 7T3H
040943 - 23. Cycle 04 and 11 and 04 16.......... 070517, ref SDS 27 7T3H
040944 - 24. Cycle 05 and 12 and 01 17.......... 070524, ref SDS 28 7T3H
040945 - 25. Cycle 05 and 12 and 02 18.......... 070531, ref SDS 29 7T3H
040946 - 26. Cycle 05 and 12 and 03 19.......... 070607, ref SDS 30 7T3H
040947 - 27. Cycle 05 and 12 and 04 20.......... 070614, ref SDS 31 0001
040948 - 28. Cycle 06 and 13 and 01 21.......... 070621, ref SDS 32 0001
040949 - 29. Cycle 06 and 13 and 02 22.......... 070628, ref SDS 33 0001
040950 - 30. Cycle 06 and 13 and 03 23.......... 070705, ref SDS 34 0001
040951 - 31. Cycle 06 and 13 and 04 24.......... 070712, ref SDS 34 0001
040952 - 32. Cycle 07 and 14 and 01 25.......... 070719, ref SDS 35 0001
040953 - 33. Cycle 07 and 14 and 02 26.......... 070726, ref SDS 33 0001
040954 - 34. Cycle 07 and 14 and 03 27.......... 070802, ref SDS 34 0001
040955 - 35. Cycle 07 and 14 and 04 28.......... 070809, ref SDS 36 0001
040956 - 36. Cycle 08 and 15 and 01 29.......... 070816, ref SDS 37 0001
040957 - 37. Cycle 08 and 15 and 02 30.......... 070823, ref SDS 38 0001
040958 - 38. Cycle 08 and 15 and 03 31.......... 070830, ref SDS 38 0001
040959 - 39. Cycle 08 and 15 and 04 32.......... 070906, ref SDS 39 0001
040960 - 40. Cycle 09 and 16 and 01 33.......... 070920, ref SDS 40 0001
040961 - 41. Cycle 09 and 16 and 02 34.......... 070927, ref SDS 41 0001
040962 - 42. Cycle 09 and 16 and 03 35.......... 071004, ref SDS 42 0001
040963 - 43. Cycle 09 and 16 and 04 36.......... 071011, ref SDS 43 0001
040964 - 44. Cycle 10 and 17 and 01 37.......... 071018, ref SDS 44 0001
040965 - 45. Cycle 10 and 17 and 02 38.......... 071025, ref SDS 45 0001
040966 - 46. Cycle 10 and 17 and 03 39.......... 071101, ref SDS 31 0001
040967 - 47. Cycle 10 and 17 and 04 40.......... 071108, ref SDS 46 0001
040968 - 48. Cycle 11 and 18 and 01 41.......... 071115, ref SDS 47 0001
040969 - 49. Cycle 11 and 18 and 02 42.......... 071122, ref SDS 33 0001
040970 - 50. Cycle 11 and 18 and 03 43.......... 071129, ref SDS 49 0001
040971 - 51. Cycle 11 and 18 and 04 44.......... 071206, ref SDS 50 0001
040972 - 52. Cycle 12 and 19 and 01 45.......... 071213, ref SDS 53 0001
040973 - 53. Cycle 12 and 19 and 02 46.......... 071220, ref SDS 56 0001
040974 - 54. Cycle 12 and 19 and 03 47.......... 071227, ref SDS 57 0001
040975 - 55. Cycle 12 and 19 and 04 48.......... 080103, ref SDS 58 0001
040976 - 56. Cycle 13 and 20 and 01 49.......... 080110, ref SDS 61 0001
040977 - 57. Cycle 13 and 20 and 02 50.......... 080117, ref SDS 62 0001
040978 - 58. Cycle 13 and 20 and 03 51.......... 080124, ref SDS 63 0001
040979 - 59. Cycle 13 and 20 and 04 52.......... 080131, ref SDS 65 0001
040980 - 60. Cycle 14 and 21 and 01 53.......... 080207, ref SDS 69 0001
040981 - 61. Cycle 14 and 21 and 02 54.......... 080214, ref SDS 70 0001
040982 - 62. Cycle 14 and 21 and 03 55.......... 080221, ref SDS 34 0001
040983 - 63. Cycle 14 and 21 and 04 56.......... 080228, ref SDS 75 0001
040984 - 64. Cycle 15 and 22 and 01 57 01 00... 080306, ref SDS 78 TZ8I
040986 - ..
040987 - Cetuxiab with Carboplatin Clinical Study 2nd Arm
040988 -
040989 - Follow up ref SDS C7 5B6J, ref SDS C3 5B6J.
040990 -
040991 - On 080207 doctor reports IBC may be spreading. ref SDS 68 GH5H
040992 - Follow up examination on 080219 Doctor Rugo diagnosed progression of
040993 - disease. ref SDS 88 3J4I Photographs show spread of IBC rash,
040994 -
040995 - 2nd
040996 - Arm Cetuximab Carboplatin
040997 - 65. Cycle 01 15 and 22 and 02 58 02 01... 080313, ref SDS 79 TZ8I
040998 - 66. Cycle 01 15 and 22 and 03 59 03 01... 080320, ref SDS 80 TZ8I
040999 - 67. Cycle 01 15 and 22 and 04 60 04 01... 080327, ref SDS 81 TZ8I
041000 - 68. Cycle 02 16 and 23 and 01 61 05 02... 080403, ref SDS 82 TZ8I
041001 - 69. Cycle 02 16 and 23 and 02 62 06 03... 080410, ref SDS 85 TZ8I
041002 - 70. Cycle 02 16 and 23 and 03 63 07 03... 080417, ref SDS 87 TZ8I
041003 - 71. Cycle 02 16 and 23 and 04 64 08 03... 080424, ref SDS 89 TZ8I
041004 - 72. Cycle 03 17 and 24 and 01 65 09 04... 080501, ref SDS 91 5B6J
041005 - 73. Cycle 03 17 and 24 and 02 66 10 05... 080508, ref SDS 93 5B6J
041006 - 74. Cycle 03 17 and 24 and 03 67 11 05... 080515, ref SDS 94 5B6J
041007 - 75. Cycle 03 17 and 24 and 04 68 12 05... 080522, ref SDS 95 5B6J
041008 - 76. Cycle 04 18 and 25 and 01 69 13 06... 080529, ref SDS 98 5B6J
041009 - 77. Cycle 04 18 and 25 and 02 70 14 07... 080605, ref SDS 99 5B6J
041010 - 78. Cycle 04 18 and 25 and 03 71 15 08... 080612, ref SDS A2 5B6J
041011 - 79. Cycle 04 18 and 25 and 04 72 16 08... 080619, ref SDS A5 5B6J
041012 - 80. Cycle 05 19 and 26 and 01 73 17 09... 080626, ref SDS B0 5B6J
041013 - 81. Cycle 05 19 and 26 and 02 74 18 10... 080703, ref SDS B4 5B6J
041014 - 82. Cycle 05 19 and 26 and 03 75 19 11... 080710, ref SDS B7 5B6J
041015 - 83. Cycle 05 19 and 26 and 04 76 20 11... 080717, ref SDS C3 5B6J
041016 - 84. Cycle 06 20 and 27 and 01 77 21 12... 080724, ref SDS C7 5B6J
041017 - 85. Cycle 06 20 and 27 and 02 78 22 13... 080731, ref SDS 0 5B6J
041019 - ..
041020 - Today is the 2nd treatment of the 6th cycle with cetuximab and
041021 - Carboplatin together. This is the 22nd treatment overall with
041022 - cetuximab on the 2nd arm of the clinical study, but is only the 13th
041023 - treatment with Carboplatin due to low blood counts.
041025 - ..
041026 - Diane is the nurse today. Catherine is on vacation until 080821.
041028 - ..
041029 - Diane just returned from vacation in Oregon. Had a great time, living
041030 - in a remote location that was 30 miles from the nearest store.
041031 - Caught Trout from the deck of their cabin. Lots of hiking, great
041032 - trails.
041034 - ..
041035 - Diane submitted today the copy of the Huber needle specification,
041036 - which Catherine made last week and left in the medical chart for
041037 - Millie, after Millie left UCSF following treatment, and in accordance
041038 - with Catherine's letter to Millie on 080724. ref SDS C7 MB3V This
041039 - actually duplicated a copy made and submitted to Millie Thursday
041040 - morning on 080724. ref SDS C7 MV7Y
041041 -
041042 - [On 080821 a nurse had difficulty getting blood to flow through
041043 - the Power Port with Huber needle technology, ref SDS D1 LO5F;
041044 - Diane completed the blood draw, ref SDS D1 A66O; Diane seemed
041045 - to advise that UCSF has standardized on all departments using
041046 - the same Huber needle used for high powered injections of
041047 - contrast medium for CT tests, so that mistakes do not occur
041048 - substituting a less rigorous needle. ref SDS D1 N96I
041050 - ..
041051 - [On 080904 Catherine seemed say that nurses must select
041052 - from a range of different Huber needles available for
041053 - treatment in the Infusion Clinic, per Angiodynamics
041054 - manufacturer's Lifeguard Safety needles listed on 080724,
041055 - ref SDS C7 N79U; Catherine plans to use the needle specified
041056 - for high pressure injections to treat Millie at UCSF on the
041057 - day when the same needle will be used later in the same day
041058 - at Kaiser for a CT test. ref SDS D2 V64G
041059 -
041060 -
041061 -
041062 -
041063 -
0411 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
0504 - 0800
050501 - ..
050502 - Labs Blood Test
050503 -
050504 - Follow up ref SDS C7 FW5N, ref SDS C3 FW5N.
050505 -
050506 - Adding Carboplatin to the treatment protocol now requires weekly blood
050507 - tests to determine if the immune system is strong enough for safe
050508 - chemotherapy treatment, reported on 070201, ref SDS 11 XR40, and citing
050509 - the clinical study protocol received from UCSF on 070116. ref SDS 10
050510 - 5U7Z
050512 - ..
050513 - During treatment, Diane submitted results of the test.
050514 -
050529 - ..
050530 - Log#: 080731 08:15
050531 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
050532 - Type Results Units Normal ACRO Type Units Normal
050533 - ..
050534 - CBC with DIFF & PLT CT CBCD
050535 - ..
050536 - WBC COUNT 4.5 x10E9/L 3.4 - 10 WBC WBC x10-3 K/uL 3.4 - 10.0
050537 - RBC COUNT L 3.77 x10E12/L 4 - 5.2 RBC RBC x10-6 M/uL 3.60 - 5.70
050538 - HEMOGLOBIN 12.9 g/dL 12 - 15.5 HGB Hemoglobin g/dL 11.5 - 15.0
050539 - HEMATOCRIT 37.3 PERCENT 36 - 46 HCT Hematocrit % 34.0 - 46.0
050540 - MCV 99 fL 80 - 100 MCV MCV fL 80.0 - 100.0
050541 - MCH H 34.1 pg 26 - 34 MCH
050542 - MCHC 34.5 g/dL 31 - 36 MCHC
050543 - PLATELETS 226 x10E9/L 140 - 450 PLT Plt x10-3 K/uL 140 - 400
050544 -
050545 - Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
050546 - Francisco, CA 94115
050547 - ..
050548 - (NEUTS x 1000 = ANC for Kaiser)
050549 - NEUTS L 1.92 x10E9/L 1.8 - 6.8 N-A ANC 1500
050550 - Neutrophils Not Reported Neutrophils % 50 - 70
050552 - ..
050553 - LYMPHS 1.79 x10E9/L 0.9 - 2.9 L-A Lymphocytes % 20 - 50
050554 - MONOS 0.50 x10E9/L 0.1 - 0.6 M-A Monocyte % 0 - 11
050555 - EOS 0.23 x10E9/L 0 - 0.4 E-A Esoinophils % 1 - 5
050556 - BASOS 0.07 x10E9/L 0 - 0.1 B-A Basophil % 0 - 2
050557 -
050559 - ..
050560 - <----------------------- U C S F -----------------------> <------------- Kaiser -------------->
050561 - Type Results Units Normal ACRO Type Units Normal
050563 - ..
050564 - CREAT with eGFR
050565 - CREATININE 0.46 mg/dL 0.42 - 1.06 CR Creatinine mg/dL 0.6 - 1.2
050566 -
050567 - Note: Creatinine assay changed to IDMS standardization on
050568 - February 4, 2008 causing decrease in results of approximately
050569 - 0.09 mg/dL
050571 - ..
050572 - eGFR if Caucasian >60 mL/min GFRC
050573 - eGFR if African Amer >60 mL/min GFRA
050574 -
050575 - eGFR corrected for 1.73 sq meters of body surface area
050576 - Note: eGFR is only an estimation. Please see online Lab Manual
050577 - for potential limitations.
050578 - Performed at Mt Zion Clin Lab, 1600 Divisadero, San Francisco,
050579 - CA 94115
050580 -
050582 - ..
050583 - NEUTS Decrease Neupogen Continue 2 Treatments Per Week New Cycle
050584 - Side Effects May Limit Neupogen Treatments Could Limit Chemotherapy
050585 -
050586 - Follow up ref SDS C7 PU6K, ref SDS C3 PU6K.
050587 -
050588 - Blood counts decreased again this week, shown by the Lab report today
050589 - with NEUTS 1.92, ref SDS 0 QY6H, compared with NEUTS 2.32 last week on
050590 - 080724, ref SDS C7 QY6H This is still well above the minimum of 1.5
050591 - for Millie to safely get chemotherapy treatment today. Slight drop in
050592 - blood counts aligns with getting chemotherapy treatment last week with
050593 - Carboplatin, and suggests 2 Neupogen treatments per week may be on a
050594 - declining path of effectiveness, that eventually requires adding a 3rd
050595 - Neupogen treatment for each weekly cycle.
050596 -
050597 - [On 080807 rising blood counts with same 2 treatments per week
050598 - of Neupogen, may signal better prospects for maintaining blood
050599 - counts that enable Millie to continue getting care in the
050600 - clinical study. ref SDS D0 PU6K
050602 - ..
050603 - Side effects of Neupogen reported on...
050604 -
050605 - 080726................, ref SDS C9 9W9I
050606 - 080721................, ref SDS C6 9W9I
050607 - 080713................, ref SDS C0 RM94
050608 - 080629................, ref SDS B3 6Q5J
050609 - 080628................, ref SDS B1 6Q5J
050610 -
050611 - ...show lessening effects, suggesting increased ability to tolerate 2
050612 - Neupogen treatments per week. Hopefully, this indicates ability to
050613 - tolerate adding another weekly Neupogen treatment, increasing the dose
050614 - to 3 per week, if that becomes necessary in another few cycles for
050615 - Millie to continue getting the Carboplatin chemotherapy required by
050616 - the clinical study protcol, and which has been effective preventing
050617 - her cancer to worsen.
050618 -
050619 -
050621 - ..
050622 - Cancer Marker CA 15-3 Results for Test 080724
050623 -
050624 - Follow up ref SDS C7 TR4K. ref SDS B0 PW7I.
050625 -
050626 - CA 15-3 71 was flat again last week; actually slightly down, shown by
050627 - the blood test for 080724 received from Diane today. ref SDS C7 A16M
050629 - ..
050630 - This provided a big relief today from concerns a few weeks ago, when
050631 - it appeared the cancer maker had significantly escalated, reported in
050632 - the record on 080724. ref SDS C7 KE6G
050634 - ..
050635 - The cancer marker was an issue last week on 080725 when Millie
050636 - notified NP of plans to return to work. ref SDS C8 MH7L
050637 -
050638 -
050639 -
050640 -
050641 -
050642 -
050643 -
050644 -
050645 -
0507 -