CONTACTS 

SUBJECTS
Cetuximab Carboplatin Clinical Study 2nd Arm 7th Cycle 1st Treatment

1003 -
1003 -    ..
1004 - Summary/Objective
1005 -
100501 - Follow up ref SDS F4 0000. ref SDS E8 0000.
100502 -
100503 - Millie got a blood draw this morning at 0800 on the 5th floor in the
100504 - Infusion Clinic in time for results to be reviewed by the medical team
100505 - durng the meeting on the 2nd floor at 0830. ref SDS 0 LO4G  There was
100506 - a problem using the Huber needle to draw blood. ref SDS 0 LO5F  Diane
100507 - was able to complete the procedure, similar to difficulties Kaiser had
100508 - doing the CT test last month.  This underscores the need to line up
100509 - skilled personnel for accessing the Power Port for the next CT test in
100510 - a few weeks. ref SDS 0 A66O  Results of the blood test today NEUTS
100511 - 0.99, ref SDS 0 QY6H, reported later during the meeting with the
100512 - medical team prevented Millie from getting Carboplatin chemotherapy
100513 - today. ref SDS 0 PU6K  The study on Neupogen shows rising neutropenia
100514 - has caused Millie to miss a total to 4 chemotherapy treatments.
100515 - ref SDS 0 EP7N
100516 -
100517 -
100518 -
100519 -
100520 -
100521 -
100522 -
100524 -  ..
1006 -
1007 -
1008 - Progress
1009 -
100901 - Background on Millie's treatment in the clinical study is reported on
100902 - 080508. ref SDS A0 TZ8I
100904 -    ..
100905 -   Taxotere Capecitabine 2nd Relapse IBC Treatment After Mastectomy
100906 -
100907 -   Follow up ref SDS F4 X33O, ref SDS E8 X33O.
100908 -
100909 -   Millie had left mastectomy on 051021.  Biopsy at that time reported
100910 -   no findings of cancer.  Approximately 8 months later on 060707 the
100911 -   doctor diagnosed IBC relapse and prescribed treatment with
100912 -   capecitabine and Taxotere, which had been effective in 2005
100913 -   completely eliminating signs of IBC disease. ref SDS 5 PF3O
100914 -
100915 -    1.  Cycle 09 and 01 ................... 060721, ref SDS 6 407N
100916 -    2.  Cycle 10 and 02 ................... 060814, ref SDS 8 LY6O
100917 -    3.  Cycle 11 and 03 ................... 060908, ref SDS 8 407N
100918 -    4.  Cycle 12 and 04 ................... 060929, ref SDS 8 407N
100919 -    5.  Cycle 13 and 05 ................... 061020, ref SDS 9 407N
100920 -    6.  Cycle 14 and 06 ................... 061110, ref SDS 10 407N
100921 -    7.  Cycle 15 and 07 ................... 061201, ref SDS 11 407N
100923 -    ..
100924 -   Cetuxiab Alone Clinical Study
100925 -
100926 -   Follow up ref SDS F4 356I, ref SDS E8 356I.
100927 -
100928 -   After 7 cycles of treatment in 2006, the doctor diagnosed IBC
100929 -   disease was progressing, and so made referral to UCSF for referral
100930 -   in clinical study of Cetuximab and Carboplatin.  Millie was
100931 -   randominzed for treatment with Cetuximab alone, and began weekly
100932 -   treatments at UCSF on 080201.
100934 -                    ..
100935 -                   Total    Cetuximab
100936 -    8.  Cycle 01 and 08 and 01 01.......... 070201, ref SDS 13 SG8I
100937 -    9.  Cycle 01 and 08 and 02 02.......... 070208, ref SDS 14 SG8I
100938 -   10.  Cycle 01 and 08 and 03 03.......... 070215, ref SDS 15 SG8I
100939 -   11.  Cycle 01 and 08 and 04 04.......... 070222, ref SDS 16 SG8I
100940 -   12.  Cycle 02 and 09 and 01 05.......... 070301, ref SDS 18 SG8I
100941 -   13.  Cycle 02 and 09 and 02 06.......... 070308, ref SDS 20 7T3H
100942 -   14.  Cycle 02 and 09 and 03 07.......... 070315, ref SDS 21 7T3H
100943 -   15.  Cycle 02 and 09 and 04 08.......... 070322, ref SDS 22 7T3H
100944 -   16.  Cycle 03 and 10 and 01 09.......... 070329, ref SDS 23 7T3H
100945 -   17.  Cycle 03 and 10 and 02 10.......... 070405, ref SDS 24 7T3H
100946 -   18.  Cycle 03 and 10 and 03 11.......... 070412, ref SDS 25 7T3H
100947 -   19.  Cycle 03 and 10 and 04 12.......... 070419, ref SDS 26 7T3H
100948 -   20.  Cycle 04 and 11 and 01 13.......... 070426, ref SDS 27 7T3H
100949 -   21.  Cycle 04 and 11 and 02 14.......... 070503, ref SDS 28 7T3H
100950 -   22.  Cycle 04 and 11 and 03 15.......... 070510, ref SDS 29 7T3H
100951 -   23.  Cycle 04 and 11 and 04 16.......... 070517, ref SDS 30 7T3H
100952 -   24.  Cycle 05 and 12 and 01 17.......... 070524, ref SDS 31 7T3H
100953 -   25.  Cycle 05 and 12 and 02 18.......... 070531, ref SDS 32 7T3H
100954 -   26.  Cycle 05 and 12 and 03 19.......... 070607, ref SDS 33 7T3H
100955 -   27.  Cycle 05 and 12 and 04 20.......... 070614, ref SDS 34 0001
100956 -   28.  Cycle 06 and 13 and 01 21.......... 070621, ref SDS 35 0001
100957 -   29.  Cycle 06 and 13 and 02 22.......... 070628, ref SDS 36 0001
100958 -   30.  Cycle 06 and 13 and 03 23.......... 070705, ref SDS 37 0001
100959 -   31.  Cycle 06 and 13 and 04 24.......... 070712, ref SDS 37 0001
100960 -   32.  Cycle 07 and 14 and 01 25.......... 070719, ref SDS 38 0001
100961 -   33.  Cycle 07 and 14 and 02 26.......... 070726, ref SDS 36 0001
100962 -   34.  Cycle 07 and 14 and 03 27.......... 070802, ref SDS 37 0001
100963 -   35.  Cycle 07 and 14 and 04 28.......... 070809, ref SDS 39 0001
100964 -   36.  Cycle 08 and 15 and 01 29.......... 070816, ref SDS 40 0001
100965 -   37.  Cycle 08 and 15 and 02 30.......... 070823, ref SDS 41 0001
100966 -   38.  Cycle 08 and 15 and 03 31.......... 070830, ref SDS 41 0001
100967 -   39.  Cycle 08 and 15 and 04 32.......... 070906, ref SDS 42 0001
100968 -   40.  Cycle 09 and 16 and 01 33.......... 070920, ref SDS 43 0001
100969 -   41.  Cycle 09 and 16 and 02 34.......... 070927, ref SDS 44 0001
100970 -   42.  Cycle 09 and 16 and 03 35.......... 071004, ref SDS 45 0001
100971 -   43.  Cycle 09 and 16 and 04 36.......... 071011, ref SDS 46 0001
100972 -   44.  Cycle 10 and 17 and 01 37.......... 071018, ref SDS 47 0001
100973 -   45.  Cycle 10 and 17 and 02 38.......... 071025, ref SDS 48 0001
100974 -   46.  Cycle 10 and 17 and 03 39.......... 071101, ref SDS 34 0001
100975 -   47.  Cycle 10 and 17 and 04 40.......... 071108, ref SDS 49 0001
100976 -   48.  Cycle 11 and 18 and 01 41.......... 071115, ref SDS 50 0001
100977 -   49.  Cycle 11 and 18 and 02 42.......... 071122, ref SDS 36 0001
100978 -   50.  Cycle 11 and 18 and 03 43.......... 071129, ref SDS 53 0001
100979 -   51.  Cycle 11 and 18 and 04 44.......... 071206, ref SDS 54 0001
100980 -   52.  Cycle 12 and 19 and 01 45.......... 071213, ref SDS 57 0001
100981 -   53.  Cycle 12 and 19 and 02 46.......... 071220, ref SDS 60 0001
100982 -   54.  Cycle 12 and 19 and 03 47.......... 071227, ref SDS 61 0001
100983 -   55.  Cycle 12 and 19 and 04 48.......... 080103, ref SDS 62 0001
100984 -   56.  Cycle 13 and 20 and 01 49.......... 080110, ref SDS 65 0001
100985 -   57.  Cycle 13 and 20 and 02 50.......... 080117, ref SDS 66 0001
100986 -   58.  Cycle 13 and 20 and 03 51.......... 080124, ref SDS 67 0001
100987 -   59.  Cycle 13 and 20 and 04 52.......... 080131, ref SDS 69 0001
100988 -   60.  Cycle 14 and 21 and 01 53.......... 080207, ref SDS 73 0001
100989 -   61.  Cycle 14 and 21 and 02 54.......... 080214, ref SDS 74 0001
100990 -   62.  Cycle 14 and 21 and 03 55.......... 080221, ref SDS 37 0001
100991 -   63.  Cycle 14 and 21 and 04 56.......... 080228, ref SDS 79 0001
100992 -   64.  Cycle 15 and 22 and 01 57 01  00... 080306, ref SDS 82 TZ8I
100994 -    ..
100995 -   Cetuxiab 81 and Carboplatin 14 Treatments Clinical Study 2nd Arm
100996 -
100997 -   Follow up ref SDS F4 5B6J, ref SDS E8 5B6J.
100998 -
100999 -   On 080207 doctor reports IBC may be spreading. ref SDS 72 GH5H
101000 -   Follow up examination on 080219 Doctor Rugo diagnosed progression of
101001 -   disease. ref SDS 94 3J4I  Photographs show spread of IBC rash, UCSF
101002 -   prescribed treatment under the 2nd Arm of the study so that Millie
101003 -   now gets weekly treatment with cetuximab and with Carboplatin 3
101004 -   weeks of each 4 week cycle.
101005 -
101006 -             2nd
101007 -             Arm              Cetuximab Carboplatin
101008 -   65.  Cycle 01 15 and 22 and 02 58 02  01... 080313, ref SDS 84 TZ8I
101009 -   66.  Cycle 01 15 and 22 and 03 59 03  01... 080320, ref SDS 85 TZ8I
101010 -   67.  Cycle 01 15 and 22 and 04 60 04  01... 080327, ref SDS 86 TZ8I
101011 -   68.  Cycle 02 16 and 23 and 01 61 05  02... 080403, ref SDS 87 TZ8I
101012 -   69.  Cycle 02 16 and 23 and 02 62 06  03... 080410, ref SDS 90 TZ8I
101013 -   70.  Cycle 02 16 and 23 and 03 63 07  03... 080417, ref SDS 92 TZ8I
101014 -   71.  Cycle 02 16 and 23 and 04 64 08  03... 080424, ref SDS 95 TZ8I
101015 -   72.  Cycle 03 17 and 24 and 01 65 09  04... 080501, ref SDS 98 5B6J
101016 -   73.  Cycle 03 17 and 24 and 02 66 10  05... 080508, ref SDS A0 5B6J
101017 -   74.  Cycle 03 17 and 24 and 03 67 11  05... 080515, ref SDS A1 5B6J
101018 -   75.  Cycle 03 17 and 24 and 04 68 12  05... 080522, ref SDS A2 5B6J
101019 -   76.  Cycle 04 18 and 25 and 01 69 13  06... 080529, ref SDS A5 5B6J
101020 -   77.  Cycle 04 18 and 25 and 02 70 14  07... 080605, ref SDS A6 5B6J
101021 -   78.  Cycle 04 18 and 25 and 03 71 15  08... 080612, ref SDS A9 5B6J
101022 -   79.  Cycle 04 18 and 25 and 04 72 16  08... 080619, ref SDS B2 5B6J
101023 -   80.  Cycle 05 19 and 26 and 01 73 17  09... 080626, ref SDS B7 5B6J
101024 -   81.  Cycle 05 19 and 26 and 02 74 18  10... 080703, ref SDS C2 5B6J
101025 -   82.  Cycle 05 19 and 26 and 03 75 19  11... 080710, ref SDS C5 5B6J
101026 -   83.  Cycle 05 19 and 26 and 04 76 20  11... 080717, ref SDS D1 5B6J
101027 -   84.  Cycle 06 20 and 27 and 01 77 21  12... 080724, ref SDS D8 5B6J
101028 -   85.  Cycle 06 20 and 27 and 02 78 22  13... 080731, ref SDS E2 5B6J
101029 -   86.  Cycle 06 20 and 27 and 03 79 23  14... 080807, ref SDS E8 5B6J
101030 -   87.  Cycle 06 20 and 27 and 04 80 24  14... 080814, ref SDS F4 5B6J
101031 -   88.  Cycle 07 21 and 28 and 01 81 25  14... 080821, ref SDS 0 5B6J
101033 -  ..
101034 - Today is the 1st treatment of the 7th cycle with cetuximab and
101035 - Carboplatin together.  This is the 25th treatment overall with
101036 - cetuximab on the 2nd arm of the clinical study, but is only the 14th
101037 - treatment with Carboplatin due to low blood counts.  Today Millie was
101038 - scheduled for the 15th treatment of Carboplatin to start a new cycle,
101039 - but treatment was withheld due to low blood counts again today.
101040 - ref SDS 0 PU6K
101042 -  ..
101043 - Catherine is the nurse today.  She was late arriving in the clinic,
101044 - so Heather started the blood draw.
101045 -
101046 -
101047 -
101048 -
101049 -
101050 -
1011 -

SUBJECTS
Blood Tests Labs Infusion Clinic Evaluate Safe Chemotherapy 1st Trea

1803 -
1804 - 0750
180501 -  ..
180502 - Labs Blood Test
180503 -
180504 - Follow up ref SDS F4 FW5N, ref SDS E8 FW5N.
180505 -
180506 - Adding Carboplatin to the treatment protocol now requires weekly blood
180507 - tests to determine if the immune system is strong enough for safe
180508 - chemotherapy treatment, reported on 070201, ref SDS 13 XR40, and
180509 - citing the clinical study protocol received from UCSF on 070116.
180510 - ref SDS 12 5U7Z
180512 -  ..
180513 - Catherine was late coming into the office this morning.  Diane was
180514 - busy with another patient in a private room, so Heather started the
180515 - blood draw.  The medical team in the Breast Care Clinic on the 2nd
180516 - floor had already submitted the order for the blood draw, including 7
180517 - vials needed for the study, as requested in Millie's letter to UCSF
180518 - early this morning submitting an agenda for work today. ref SDS F5
180519 - 6Y5K
180521 -  ..
180522 - There were difficulties using Millie's Power Port for the blood draw
180523 - today.  Blood was not flowing through the port and the Huber needle.
180524 - After several attemps to correct the problem, Heather left the room
180525 - and asked Diane to try, since Diane has been treating Millie along
180526 - with Catherine for 18 months.
180527 -
180529 -  ..
1806 -
1807 -
1808 - 0810
1809 -
180901 - Diane asked Heather to finish with her patient, while Diane tried to
180902 - do the blood draw for Millie.  Heather explained that she may not have
180903 - inserted the Huber needle fully into the port.  This was cited as a
180904 - possible problem using Millie's Power Port on 080718, ref SDS D2 LK41,
180905 - when difficulties caused failure of a CT test. ref SDS D2 LK3R
180907 -  ..
180908 - Diane started over with a new Huber needle, and was successful on the
180909 - first attempt accessing the Power Port and getting blood to flow for
180910 - the lab test.  She explained that avoiding and solving port access
180911 - problems is mainly a matter of "feel" from experience working with
180912 - Power Ports regularly.
180914 -  ..
180915 - Millie asked if Heather could have selected the wrong Huber needle,
180916 - and this caused the failure today?  Millie recalled that on 080731
180917 - Diane gave Millie a specification on Huber needles used for CT tests
180918 - at UCSF, and had been left a week earlier by Catherine in the medical
180919 - chart for Millie. ref SDS E2 QY3G  The actual specification reported
180920 - in the record on 080724 says...
180921 -
180922 -            Lifeguard
180923 -            Safety Needle
180925 -             ..
180926 -            The following Lifeguard Safety Infusion Set models may be
180927 -            used for Power Injection of Contrast Media with the Smart
180928 -            Port CT Power Injectable Ports:, ref SDS D8 N79U
180930 -             ..
180931 -            LG-20-100
180933 -  ..
180934 - Millie asked if Heather could have selected the wrong needle today,
180935 - causing blood flow problems, per above? ref SDS 0 LO5F
180937 -  ..
180938 - Diane seemed to say that UCSF has standardized on everyone using the
180939 - same Huber needle in order to avoid mistakes.
180940 -
180941 -            [On 080904 Catherine seemed say that nurses must select
180942 -            from a range of different Huber needles available for
180943 -            treatment in the Infusion Clinic, per Angiodynamics
180944 -            manufacturer's Lifeguard Safety needles listed on 080724,
180945 -            ref SDS D8 N79U; Catherine plans to use the needle
180946 -            specified for high pressure injections to treat Millie at
180947 -            UCSF on the day when the same needle will be used later in
180948 -            the same day at Kaiser for a CT test. ref SDS G4 V64G
180950 -  ..
180951 - This record suggests some nurses are more experienced using Huber
180952 - needle technology with Power Port devices, and that experience level
180953 - has a big impact on performance of this work, which is essential for
180954 - Millie's next CT test in a few weeks.
180955 -
180956 -            [On 080826 Kaiser called and advised that the CT department
180957 -            in Oakland, scheduled by Arlette on 080822, to perform
180958 -            Millie's next CT test, ref SDS F6 N66E, after research
180959 -            showed on 080805 they have experience using Huber needles
180960 -            with Power Port technology to inject contrast medium,
180961 -            ref SDS E4 5U7G, had sent order for Millie's test back to
180962 -            Kaiser in Walnut Creek, ref SDS F7 VU64, which has no
180963 -            experience, reported on 080711, ref SDS C6 JQ55, and failed
180964 -            on the prior CT test performed 080718. ref SDS D2 LK3R
180966 -  ..
180967 - After the blood draw, Millie went to the Breast Care Clinic on 2nd
180968 - floor for a meeting with the medical team at 0830. ref SDS F5 YY3N
180969 -
180970 -
180971 -
180972 -
180974 -  ..
1810 -
1811 -
1812 - 1010
1813 -
181301 - After examination on the 2nd floor, Millie returned to the Infusion
181302 - Clinic on the 5th floor for treatment by Catherine.
181304 -  ..
181305 - During treatment, Catherine submitted results of the test starting the
181306 - 7th cycle.  Scope is the same as for starting cycle 6 on 080724.
181307 - ref SDS D8 075H
181308 -
181323 -     ..
181324 -    Log#:                   080821 08:15
181325 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
181326 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
181327 -     ..
181328 -    CBC with DIFF & PLT CT                                     CBCD
181329 -     ..
181330 -    WBC COUNT      L        2.8    x10E9/L     3.4  -   10     WBC   WBC x10-3        K/uL     3.4  -  10.0
181331 -    RBC COUNT      L        3.66   x10E12/L      4  -   5.2    RBC   RBC x10-6        M/uL    3.60  -  5.70
181332 -    HEMOGLOBIN             12.2    g/dL         12  -   15.5   HGB   Hemoglobin       g/dL    11.5  -  15.0
181333 -    HEMATOCRIT             36.4    PERCENT      36  -   46     HCT   Hematocrit       %       34.0  -  46.0
181334 -    MCV                   100      fL           80  -   100    MCV   MCV              fL      80.0  -  100.0
181335 -    MCH                    33.7    pg           26  -   34     MCH
181336 -    MCHC                   33.9    g/dL         31  -   36     MCHC
181337 -    PLATELETS             206      x10E9/L     140  -  450     PLT   Plt x10-3        K/uL     140  -  400
181338 -
181339 -        Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
181340 -        Francisco, CA  94115
181341 -    ..
181342 -       (posted 080828, ref SDS G2 3T4O)
181343 -    CA 15-3      H*        96      U/mL             <  33     CA153  CA 15-3                        <  39
181344 -
181345 -         Note new reference range [<33 changed from <31] and change in
181346 -         methodology effective March 1, 2008.  Performed using the
181347 -         Siemens Centaur Chemiluminesence method.  CA 15-3 result using
181348 -         the Roche Elecsys assay is 75 U/mL.  Ref range <31 U/mL.  This
181349 -         rebaseline value provided at no additional charge.
181351 -          ..
181352 -         This new note updates explanation of tests prior to 080301,
181353 -         e.g., on 080207. ref SDS 73 A16M
181354 -    ..
181355 -     (NEUTS x 1000 = ANC for Kaiser)
181356 -    NEUTS         L         0.99   x10E9/L     1.8  -  6.8     N-A   ANC                      1500
181357 -    Neutrophils    Not Reported                                      Neutrophils       %        50  -  70
181359 -     ..
181360 -    LYMPHS                  1.38   x10E9/L     0.9  -  2.9     L-A   Lymphocytes       %        20  -  50
181361 -    MONOS          L        0.19   x10E9/L     0.2  -  0.8     M-A   Monocyte          %         0  -  11
181362 -    EOS                     0.13   x10E9/L       0  -  0.4     E-A   Esoinophils       %         1  -  5
181363 -    BASOS                   0.04   x10E9/L       0  -  0.1     B-A   Basophil          %         0  -  2
181365 -     ..
181366 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
181367 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
181368 -    PT            H        30.6    s          12.0  -  14.1    PT    PT, patient       sec     8.9  -  11.1
181369 -    INL NRM Ratio H         2.9                0.9  -  1.1     INR   INR                       2.0  -  3.0
181370 -
181371 -        Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
181372 -        Francisco, CA  94115
181374 -     ..
181375 -    PARTIAL
181376 -    THROMBOPLASTIN  H      37.0    s          22.2  - 34.2     INR   PTT
181377 -
181378 -        Performed at Mt Zion Clinic Lab, 1600 Divisadero, San
181379 -        Francisco, CA  94115
181381 -     ..
181382 -    <----------------------- U C S F -----------------------> <-------------  Kaiser -------------->
181383 -    Type                 Results   Units        Normal        ACRO   Type            Units        Normal
181384 -    ELECTROLYTE PANEL                                          LYTE
181385 -    SODIUM                137      mmol/L      134  -  143     NA    Sodium            mEq/L   137  -  145
181386 -    POTASSIUM               4.3    mmol/L      3.4  -  4.9     K     Potassium         mEq/L   3.5  -  5.3
181387 -    CHLORIDE              103      mmol/L       98  -  107     CL
181388 -    CARBON DIOX TOTAL L    16      mmol/L       23  -  32      CO2
181389 -    ANION GAP         H    18                    3  -  14      ANGA
181390 -     ..
181391 -    UREA NITROGEN          13      mg/dL         8  -  23      BUN   BUN               mg/dL     7  -  17
181392 - *  GLUCOSE                        mg/dL        70  -  199     GLU   Glucose           mg/dL     ?  -   ?
181393 -    AST               H    46      U/L          16  -  41      AST   AST (SGOT)        U/L      14  -  36
181394 -    ALT                    24      U/L          11  -  54      ALT   ALT (SGPT)        U/L      11  -  66
181395 -    BILIRUBIN, TOTAL        1.1    mg/dL       0.3  - 1.3      BILT  Bili Total        mg/dL   0.2  - 1.3
181396 -    ALKALINE PHOSPHATASE   72      U/L          29  - 111      ALKP  Alkaline Ph       U/L      38  - 126
181397 -     ..
181398 - *  PROTEIN, TOTAL                 g/dL        5.8  - 8.0      TP    Protine Total     g/dL    6.3  - 8.2
181399 - *  ALBUMIN                        g/dL        3.4  - 4.7      ALB   Albumin           g/dL    3.4  - 4.8
181400 -    CALCIUM         L       8.4    mg/dL       8.7  - 10.1     CA    Calcium           mg/dL   8.4  - 10.2
181401 -     ..
181402 -    MAGNESIUM               1.8    mg/dL       1.8  -  2.3     MG    Magnesium         mg/dL   1.6  -  2.3
181404 -     ..
181405 -    CREAT with eGFR
181406 -    CREATININE              0.56   mg/dL      0.42  - 1.06     CR    Creatinine        mg/dL   0.6  -  1.2
181407 -
181408 -      Note: Creatinine assay changed to IDMS standardization on
181409 -      February 4, 2008 causing decrease in results of approximately
181410 -      0.09 mg/dL
181412 -     ..
181413 -    eGFR if Caucasian     >60      mL/min                      GFRC
181414 -    eGFR if African Amer  >60      mL/min                      GFRA
181415 -
181416 -      eGFR corrected for 1.73 sq meters of body surface area
181417 -      Note:  eGFR is only an estimation. Please see online Lab Manual
181418 -      for potential limitations.
181419 -      Performed at Mt Zion Clin Lab, 1600 Divisadero, San Francisco,
181420 -      CA  94115
181422 -     ..
181423 - *  Labs today omit following tests...
181424 -
181425 -            GLUCOSE.............................. ref SDS 0 SE9J
181426 -            ALBUMIN.............................. ref SDS 0 GT9I
181427 -            PROTEIN, TOTAL
181428 -
181430 -     ..
181431 -    Labs on 080726 today omitted following tests...
181432 -
181433 -            GLUCOSE.............................. ref SDS D8 SE9J
181434 -            ALBUMIN.............................. ref SDS D8 GT9I
181436 -     ..
181437 -    Labs on 080626 omitted following tests...
181438 -
181439 -            GLUCOSE.............................. ref SDS B7 HS7I
181440 -            PROTEIN, TOTAL
181441 -            ALBUMIN
181442 -            CALCIUM
181444 -  ..
181445 - Case study on 080626 shows these four tests, which have been omitted
181446 - and included in various combinations the past 3 cycles, where
181447 - consistently included for the prevous 15 cycles. ref SDS B7 HS8F
181448 -
181449 -
1815 -

SUBJECTS
Default Null Subject Account for Blank Record

1903 -
190401 -  ..
190402 - Cancer Marker CA 15-3 96 Increases Over 4 Weeks from 71
190403 -
190404 - Follow up ref SDS D8 TR4K, ref SDS B7 PW7I.
190405 -
190406 - Results of the blood test today for the cancer marker were delayed for
190407 - several days.  Received a week later on 080828, the cancer marker
190408 - increased from 71 on 080724, ref SDS D8 A16M, to CA 15-3 96 today, per
190409 - above. ref SDS 0 A16M
190411 -  ..
190412 - This shows a continuing trend of increase, though on the prior cycle
190413 - there was a 1 point decline from 72 to 71.
190415 -  ..
190416 - The test at Kaiser on 080708 shows CA 15-3 141, but the sepcimen was
190417 - slightly hemolyzed, ref SDS C3 L74K, which can affect the result.
190418 - ref SDS C3 05YW  As noted, labs at UCSF a few weeks later on 080724
190419 - yielded CA 15-3 71.  The new test today seems more in line with
190420 - results indicated on 080708.
190422 -  ..
190423 - Findings during examination today of swelling in the left
190424 - supraclavicular area may align with rising cancer marker. ref SDS F5
190425 - 4C6O
190427 -  ..
190428 - Case study today of rising neutropenia showing Millie has missed over
190429 - 20%, i.e., 4 of 18, prescribed chemotherapy treatments due to low
190430 - blood counts, ref SDS 0 EP7N, may suggest that if Carboplatin
190431 - treatments can be regularized with Neupogen, then the current regimen
190432 - can slow or reverse possible progression of disease.
190433 -
190434 -            [On 080827 Millie sets agenda for follow up examination by
190435 -            primary care physician on 080829, and focus of next CT test
190436 -            on 080912. ref SDS F8 509S
190438 -             ..
190439 -            [On 080827 Millie cancels vacation plans due to concern
190440 -            about new lump signaling progression of disease, with
190441 -            requirements to change treatments. ref SDS G0 K377
190443 -             ..
190444 -            [On 080829 Millie notified medical team the primary care
190445 -            physician approved her for going on vacation. ref SDS G3
190446 -            RP7Y
190447 -
190448 -
190449 -
190450 -
190451 -
190452 -
1905 -

SUBJECTS
Absolute Neutrophils Count ANC 6850 Above 1500 NEUTS 6.85 Above 1.5

2803 -
280401 -  ..
280402 - NEUTS 0.99 Decrease 4th Week Unexpectedly Chemotherapy Withheld
280403 - Chemotherapy Carboplatin Withheld Blood Counts Fall Significantly
280404 - Blood Counts Fall Significantly Chemotherapy Carboplatin Withheld
280405 -
280406 - Follow up ref SDS F4 PU6K, ref SDS E8 PU6K.
280407 -
280408 - Blood counts decrease this week, shown by the Lab report today with
280409 - NEUTS 0.99, ref SDS 0 QY6H, compared with NEUTS 1.37 last week on
280410 - 080814, ref SDS F4 QY6H  This is too far below UCSF minimum of 1.5 for
280411 - Millie to safely get chemotherapy treatment.  As a result, the doctor
280412 - ordered Carboplatin chemotherapy withheld today, and approved adding
280413 - treatment with Neupogen tomorrow and Saturday in order to increase
280414 - blood counts enough for safe chemotherapy next week, as reported in
280415 - the record meeting with the medical team in the Breast Care Clinic on
280416 - the 2nd floor. ref SDS F5 4B84
280418 -  ..
280419 - Case study on 060809 shows Millie has often received chemotherapy when
280420 - blood counts are below the standard for safe treatments, and on some
280421 - occassions has received Neupogen to increase blood counts. ref SDS 7
280422 - HV45
280424 -  ..
280425 - Decrease in blood counts today demonstrates rising neutropenia that
280426 - causes a "roller coaster" above and below the specified target from
280427 - week to week while getting Neupogen treatments in recent months.
280429 -  ..
280430 - Research on neutropenia was reported on 070301, ref SDS 17 O59H, when
280431 - Doctor Rugo was concerned about holding blood counts with weekly
280432 - Carboplatin treatments. ref SDS 17 VF6O
280434 -  ..
280435 - Approval for Millie to get Neupogen this week was discussed during the
280436 - meeting with the medical team on the 2nd floor before treatment today.
280437 - ref SDS F5 RV93  The prescription for Neupogen is shown in the
280438 - Chemotherapy Order for cetuximab, per below, ref SDS 0 RU7O, and was
280439 - previously scheduled by Donna at the Kaiser Infusion Clinic on 080809.
280440 - ref SDS F1 WJ4O
280442 -  ..
280443 - Patient history getting cetuximab and Carboplatin is listed above.
280444 - ref SDS 0 5B6J
280445 -
280446 -
280447 -
2805 -

SUBJECTS
Default Null Subject Account for Blank Record

2903 -
290401 -  ..
290402 - Neupogen Case Study Missed Carboplatin Treatments Low Blood Counts
290403 -
290404 - Millie has received 24 Neupogen treatments, and missed 4 chemotherapy
290405 - treatments due to rising neutropenia.  Millie's letter to the medical
290406 - team on 080307 asked about solving low blood counts. ref SDS 83 HS6R
290407 - On 080423 Millie notified the medical team to maintain a full dose of
290408 - Carboplatin because these treatments yielded very favorable response.
290409 - ref SDS 93 TY6Y  On 080501 a mixup in communication reduced the dose
290410 - of Carboplatin with the aim of not missing treatments.  Adding
290411 - Neupogen to avoid missing treatments might have enabled maintaining
290412 - full dose of Carboplatin to increase recovery. ref SDS 97 CZ3N
290413 -
290414 -            [On 080918 case study shows 2 Neupogen treatments on
290415 -            each of all 4-weeks in the chemotherapy cycle avoids
290416 -            missing chemotherapy treatments. ref SDS G5 OK67
290418 -  ..
290419 - Reduced treatment may relate to rising cancer marker today, 080821.
290420 - ref SDS 0 A16M  Millie has received only 14 of 18 total treatments
290421 - prescribed with Carboplatin, since starting the 2nd arm of the
290422 - clinical study on 080306...
290424 -        ..
290425 -                      Neupogen            Carboplatin
290426 -       Date    NEUTS  Cur Totl Cycl Trm  Rcvd   Missed
290427 -
290428 -        080821  0.99   2   24    7   1    14      4... ref SDS 0 QY6H
290429 -        080814  1.37   0   22    6   4    14.......... ref SDS F4 QY6H
290430 -        080807  2.41   2   22    6   3    14.......... ref SDS E8 QY6H
290431 -        080731  1.92   2   20    6   2    13.......... ref SDS E2 QY6H
290432 -        080724  2.32   2   18    6   1    12.......... ref SDS D8 QY6H
290433 -        080717  2.47   1   16    5   4    11.......... ref SDS D1 QY6H
290435 -             ..
290436 -            On 080718 2 Neupogen treatments were cancelled at Kaiser,
290437 -            ref SDS D2 9W9I, because the day before at UCSF on 080717
290438 -            NUETS were high, and there was no Carboplatin chemotherapy
290439 -            treatment given for the 4th week in the cycle on 080717.
290441 -             ..
290442 -            On 080719 the day after CT testing, Millie went to Kaiser
290443 -            and received 1 Neupogen treatment as a precaution ordered
290444 -            by Kaiser after bleeding trauma during failed CT test using
290445 -            the Power Port the day before on 080718. ref SDS D3 SR37
290447 -         ..
290448 -                      Neupogen            Carboplatin
290449 -       Date    NEUTS  Cur Totl Cycl Trm  Rcvd   Missed
290451 -         ..
290452 -        080710  5.12   2   15    5   3    11......... ref SDS C5 QY6H
290453 -        080703  2.90   2   13    5   2    10......... ref SDS C2 QY6H
290454 -        080626  1.80   2   11    5   1    09......... ref SDS B7 QY6H
290455 -        080619  0.74   1    9    4   4    08......... ref SDS B2 QY6H
290456 -        080612  3.77   2    8    4   3    08......... ref SDS A9 QY6H
290458 -             ..
290459 -            On 080609 Kaiser orders 2 Neupogen treatments per week in
290460 -            Infusion Clinic, ref SDS A8 IL6I, for UCSF prescription in
290461 -            Chemo Orders on 080529, ref SDS A8 L16I, which were
290462 -            received on 080605. ref SDS A6 JN38
290464 -         ..
290465 -                      Neupogen            Carboplatin
290466 -       Date    NEUTS  Cur Totl Cycl Trm  Rcvd   Missed
290468 -         ..
290469 -        080605  1.55   2    6    4   2    07......... ref SDS A6 QY6H
290470 -        080529  2.26   1    4    4   1    06......... ref SDS A5 QY6H
290471 -        080522  0.96   0         3   4    05......... ref SDS A2 QY6H
290472 -        080515  1.21   0         3   3    05      3.. ref SDS A1 QY6H
290473 -        080508  5.41   1    3    3   2    05......... ref SDS A0 QY6H
290474 -        080501  1.34   1    2    3   1    04......... ref SDS 98 QY6H
290475 -        080424  1.34   0         2   4    03......... ref SDS 95 QY6H
290476 -         ..
290477 -        080417  0.95   0         2   3    03      2.. ref SDS 92 QY6H
290478 -        080410  6.85   0         2   2    03......... ref SDS 90 QY6H
290479 -        080403  1.34   1    1    2   1    02......... ref SDS 87 QY6H
290480 -        080327  2.30   0         1   4    01......... ref SDS 86 QY6H
290481 -        080320  1.28   0         1   3    01      1.. ref SDS 85 QY6H
290482 -        080313  2.05   0         1   2    01......... ref SDS 84 QY6H
290483 -        080306  1.75   0         1   1    00......... ref SDS 82 QY6H
290484 -
290485 -
2905 -

SUBJECTS
Default Null Subject Account for Blank Record

3003 -
300401 -  ..
300402 - Side Effects Neupogen Treatments Continue Mild Tolerance Acceptable
300403 -
300404 - Follow up ref SDS F4 SB8I.
300405 -
300406 - Side effects of Neupogen may be lessening, reported on...
300407 -
300408 -               080810................, ref SDS F2 9W9I
300409 -               080803................, ref SDS E3 9W9I
300410 -               080726................, ref SDS E0 9W9I
300411 -               080721................, ref SDS D5 9W9I
300412 -               080713................, ref SDS C8 RM94
300413 -               080629................, ref SDS C1 6Q5J
300414 -               080628................, ref SDS B9 6Q5J
300415 -
300416 - ...suggesting increased ability to tolerate 2 Neupogen treatments per
300417 - week.
300418 -
300419 -
300420 -
3005 -

SUBJECTS
Default Null Subject Account for Blank Record

4503 -
450401 -  ..
450402 - Coagulation Control INR 2.4 Normal Stable PT 26.2 High
450403 -
450404 - Follow up ref SDS D8 K66J.
450405 -
450406 - The labs today show INR 2.9 at the high end of the scale, but still
450407 - continuing within the prescribed range. ref SDS 0 PU7Y
450409 -  ..
450410 - On 080804 Millie responded to a letter from Kaiser dated 080730 asking
450411 - about results of the test on 080724. ref SDS E6 WQ6I
450412 -
450413 -            [On 080827 Millie reported INR test results to Gloria at
450414 -            Kaiser Coagulation Control Clinic in Martinez, CA.
450415 -            ref SDS F8 504R
450417 -             ..
450418 -            [On 080827 Millie received a letter notifying that Kaiser
450419 -            received the report on INR results for the blood test
450420 -            today, and advising Millie to continue the same regimen for
450421 -            Coumadin to treat pulmonary embolism. ref SDS G1 VD7O
450422 -
450423 -
450424 -
450425 -
4505 -

SUBJECTS
Default Null Subject Account for Blank Record

4603 -
460401 -  ..
460402 - Cetuximab Chemotherapy Order for 7th Cycle
460403 -
460404 - Follow up ref SDS D8 MM6N. ref SDS B7 MM6N.
460406 -     ..
460407 -    Outpatient Infusion Orders
460409 -     ..
460415 -    Auth#                                     Stor BCC LOC
460416 -    Visit:  14587572             DOS 20080821
460418 -     ..
460419 -    Date:  20080815
460421 -     ..
460422 -    Study Order for CC#05752:  Phase II Trial of Cetuximab alone and
460423 -    in combination with Carboplatin in ER-negative, PR-negative,
460424 -    HER2-negative Nonoverexpressing Metastatic Breast Cancers.
460426 -     ..
460427 -    Arm:  2 - Cetuximab + Carboplatin
460429 -     ..
460430 -    Dates to be given: 20080821 - 20080910
460432 -     ..
460433 -    Allergies:  NKDA
460435 -     ..
460436 -    Height:  62 inches
460438 -     ..
460439 -    Weight:  141 pounds
460441 -  ..
460442 - There is handwriting next to this part of the form that shows...
460443 -
460444 -              [0 with line drawn through] 10% weight change
460446 -  ..
460447 - This may reflect that the dose of cetuximab is only changed with 10%
460448 - change in weight, and this criteria is not met today, so the dose is
460449 - the same as for the prior Chemotherapy Order on 080724, because there
460450 - has not been a 10% change in weight.  UCSF did not submit the
460451 - Chemotherapy Order for treatment starting cycle 7 on 080724; there was
460452 - a Chemotherpay Order for cycle 6 starting on 080626.  At that time
460453 - weight was 140 pounds compared to 141 today, which seems to reconcile
460454 - the handwriting on the form today. ref SDS B7 4E6V
460456 -  ..
460457 - Chemotherapy Order for Cetuximab continues...
460459 -     ..
460460 -    BSA:   1.67
460462 -     ..
460463 -    Diagnosis:  Breast Cancer (IBC)
460465 -     ..
460466 -    ICD-9 codes: 174.9 198.5 198.3
460468 -  ..
460469 - Chemotherapy Order for cetuximab on 080501 shows ICD-9 codes 174.4 and
460470 - 198.2, ref SDS 96 SH6H, the Chemotherapy Order on 080626 shows 174.9
460471 - and 198.2, ref SDS B7 SH6H, rather than the codes in the cetuximab
460472 - order today.
460474 -  ..
460475 - Chemotherapy Order for Cetuximab continues...
460476 -
460477 -    Cycle:  7
460479 -     ..
460480 -    Pre-medications 30 - 60 minutes prior to cetuximab infusion
460482 -     ..
460483 -    x  Diphenhydramine 25 mg IV
460484 -
460485 -       Benadryl............... explained on 070201. ref SDS 11 DC7J
460487 -     ..
460488 -    Medication:  (plan to give weekly)
460489 -
460490 -    x  Cetuximab - Erbitux - (study supply) (maintenance)
460491 -
460492 -       250 mg/m*m = 428 mg
460494 -     ..
460495 -    Maximum infusion rate is 5 ml/minute. (concentration 2 mg/ml)
460497 -     ..
460498 -    Infuse once weekly for 8 weeks.  First dose is to be given on date
460499 -    080821.
460501 -     ..
460502 -    Cetuximab is administered undiluted through a low protein binding
460503 -    0.22 micro in-line filter.  Use NS soution to flush the line at
460504 -    the end of the Infusion.
460506 -     ..
460507 -    Arm 2:  Administer carboplatin if vital signs are unremarkable one
460508 -    hour after cetuximab infusion.
460510 -     ..
460511 -    Vital signs at baseline, upon cetuximab completion and one hour
460512 -    after cetuximab.
460513 -
460514 -    **** please not start and stop times ****
460515 -
460517 -     ..
460518 -    Laboratory work:
460519 -
460520 -    x  See carboplatin orders.
460521 -    x  Notify MD for dose modifications if patient has severe acne
460522 -       form rash
460523 -    x  CBC with differential and plateletes every 4 weeks
460524 -    x  Creatinine and magnesium every 4 weeks
460525 -       BUN, AST, Alk Phos, ALT, total bilrubin, electrolytes every
460526 -       8 weeks
460527 -  ..
460528 - Chemotherapy Order Cetuximab continue...
460529 -
460530 -    If levels are outside of normal laboratory values notify
460531 -
460534 -  ..
460535 - Chemotherapy Order Cetuximab continue...
460537 -     ..
460538 -    x  Physician has discussed risks/benefits of chemotherapy with the
460539 -       patient.  Consent, form obtained.
460540 -
460541 -       x  Yes  O2 [oxygyn] by nasal cannula at 2 liters/min prn for chest pain or SOB
460543 -           ..
460544 -       x  Yes  Diphenhydramine 50 mg IV prn x 1 unticaria pruntis, SOB
460545 -               (this is Benadryl)
460547 -        ..
460548 -       x  Yes  Hydrocrotisone 100 mg IV prn x 1 unticaria pruntis, SOB
460550 -        ..
460551 -       x  Yes  Aubterol inhaler 2 - 4 puffs prn SOB or chest tightness
460553 -        ..
460554 -       x  Yes  Epnephnna nhaler 2 - 4 puffs prn SOB or chest tightness
460556 -  ..
460557 - There is handwriting at this part of the form which says...
460558 -
460559 -          Neupogen 480 mcg SQ on D2, D3 & each does chemo [unrecognizable letters]
460560 -               Receive at Kaiser
460561 -
460562 -                   [...this comment prescribing Neupogen on
460563 -                   Chemotherapy Order for cetuximab that does not
460564 -                   affect blood counts, reflects doctor's consideration
460565 -                   during a meeting with the medical team earlier this
460566 -                   morning on 080821 to increase Neupogen treatment
460567 -                   this week based on significant decline in blood
460568 -                   counts from chemotherapy 2 weeks ago. ref SDS F5
460569 -                   4B62
460571 -                    ..
460572 -                   [...see below Chemotherapy Order for Carboplatin was
460573 -                   received a week later, and shows the same
460574 -                   prescription for Neupogen. ref SDS 0 PWSY
460576 -  ..
460577 - Chemotherapy Order Cetuximab continue...
460579 -        ..
460580 -       breast CC05752  cetuximab 080814
460581 -       Approved 060615
460583 -        ..
460584 -       Physician Signature
460585 -
460588 -                Date:  080815
460590 -        ..
460591 -       Nurse Signature:
460592 -
460595 -                Date:  080313
460597 -  ..
460598 - No nurses signature is shown in the copy received from UCSF; may have
460599 - been entered and filed in UCSF records later.
460600 -
460601 -
460602 -
4607 -

SUBJECTS
Default Null Subject Account for Blank Record

4703 -
470401 -  ..
470402 - Carboplatin Chemotherapy Orders
470403 -
470404 - Follow up ref SDS D8 N54I, ref SDS B7 N54I.
470405 -
470406 - Chemotherapy Order for Carboplatin was not submitted today, because
470407 - Millie's blood counts were too low for safe treatment, per above.
470408 - ref SDS 0 PU6K
470410 -  ..
470411 - Chemotherapy Order was received from UCSF a week later on 080828.
470412 - ref SDS G2 N54I
470413 -
470414 -        [On 080827 Millie notified UCSF to prepare Chemotherapy Order
470415 -        for Carboplatin treatment tomorrow. ref SDS F9 KU5J
470416 -
470417 -        [On 080828 Chemotherapy Order for Carboplatin was submitted to
470418 -        the Infusion Clinic, ref SDS G2 N54I, and the order for labs
470419 -        was ready for Millie's treatment. ref SDS G2 FW5N
470421 -  ..
470422 - No evident difference between chemotherapy orders today and for last
470423 - month starting cycle 6 on 080724. ref SDS D8 N54I
470425 -     ..
470431 -    Auth#                                     Stor BCC LOC
470432 -    Visit:  14587572             DOS 20080828
470434 -     ..
470435 -    Date:  20080821
470437 -     ..
470438 -    Study Order for CC#05752:  Phase II Trial of Cetuximab alone and
470439 -    in combination with Carboplatin in ER-negative, PR-negative,
470440 -    HER2-negative Nonoverexpressing Metastatic Breast Cancers.
470442 -     ..
470443 -    Arm:  2 - Cetuximab + Carboplatin
470445 -     ..
470446 -    Error Dates Treatment Should Not Include Today
470447 -
470448 -    Dates to be given: 20080821  *** error ***
470449 -                       20080828
470450 -                       20080904
470452 -  ..
470453 - Chemotherapy Order for 080821 listed all three dates
470454 - the doctor ordered not Carboplatin
470455 - today, per above. ref SDS 0 PU6K
470457 -  ..
470458 - Looks like a data entry error.
470460 -  ..
470461 - Millie did not get Carboplatin today, and this is shown correctly
470462 - further in the Chemotherapy Order under "Days", ref SDS 0 PVSW
470464 -  ..
470465 - Chemotherapy Order Carboplatin continues...
470466 -
470467 -    Allergies:  NKDA
470469 -     ..
470470 -    Height:  62 inches
470472 -     ..
470473 -    Weight:  140 pounds
470475 -  ..
470476 - Not clear why Chemotherapy Order for cetuximab shows 141 pounds,
470477 - ref SDS 0 4E6V, and this Cheotherapy Order for Carboplatin shows 140
470478 - pounds; may reflect that different people did the orders, and one
470479 - person used diagnostics taken today, and the other used the number
470480 - from the form for the prior Carboplatin cycle last month; however,
470481 - last month on 080724 the weight was 138 pounds. ref SDS D8 PVRW
470483 -  ..
470484 - Chemotherapy Order Carboplatin continues...
470485 -
470486 -    Diagnosis:  Metastatic breast cancer (IBC)
470488 -     ..
470489 -    ICD-9 codes: 174.9, 198.5, 198.3, 196.2
470491 -  ..
470492 - This ICD-9 codes section conflicts with assignments in Chemotherapy
470493 - Order for 080724, ref SDS D8 PVSS and for 080626. ref SDS B7 PVSS
470494 -
470496 -  ..
470497 - Chemotherapy Order Carboplatin continues...
470498 -
470499 -    Cycle:  7
470501 -     ..
470502 -    Days: xxx 8, 15  (arm 2)
470504 -  ..
470505 - Note that day "1" is crossed out because Carboplatin was not approved
470506 - for treatment today due to low blood counts, per above. ref SDS 0 PU6K
470508 -  ..
470509 - This conflicts with "Dates to be given" section shown above.
470510 - ref SDS 0 PVQX
470512 -  ..
470513 - Chemotherapy Order Carboplatin continues...
470515 -     ..
470516 -    Antimetics:
470517 -
470518 -    Follow up ref SDS D8 PVTT, ref SDS B7 PVTT.
470519 -
470520 -    x  Dexamethasone    10 mg   IV     (Decadron)
470521 -    x  Ondansetron  8 mg   IV          (Zofran)
470522 -
470524 -     ..
470525 -    Chemotherapy (plan to treat weekly for 3 out of 4 weeks).
470526 -    Carboplatin Dose Reduced May Aid Blood Counts Maintain Treatments
470527 -
470528 -    Follow up ref SDS D8 PVUQ, ref SDS B7 PVUQ.
470529 -
470530 -    May administer Carboplatin if vital signs are unremarkable one
470531 -    hour after cetuximab infusion..
470532 -
470533 -    ** Please note start and stop times **
470535 -     ..
470536 -    Carboplatin (commercial supply) AUC 1.5 = 175 mg in D5W 250 ml
470538 -  ..
470539 - Chemo orders today seem to show the same dose specified for cycle 4
470540 - started on 080529 and marked "error," ref SDS A5 PVUQ, reviewed on
470541 - 080626. ref SDS B6 2X5L  At that time, the medical chart was
470542 - confusing, because Brigid could not find the Chemotherapy Order for
470543 - 080529 marked "error." ref SDS B6 RF4J  UCSF planned to investigate
470544 - the error in the Chemotherapy Order. ref SDS B6 RF53
470546 -  ..
470547 - Chemotherapy Orders continue...
470548 -
470549 -    IV over 30 minutes weekly x 3 doses followed by 1 week rest.
470551 -  ..
470552 - [hand writting...]
470553 -
470554 -               Carbo dose to remain the same unless CR > 1.3
470556 -  ..
470557 - [...where CR = "Creatinine"]
470558 -
470559 -            Carboplatin dose in mg = (desired AUC)(GFR+25)
470560 -
470561 -        GFR (estimated) =
470562 -
470563 -               (140-age in years)(weight in kg)(for females x 0.85)
470564 -               ----------------------------------------------------
470565 -                         (Cr in mg/dL)(72)
470567 -  ..
470568 - Unlike previous Chemotherapy Orders issued on 080403 which showed
470569 - handwritten values in the dosage formula, ref SDS 87 NV9H, there is
470570 - no similar handwriting on the Chemotherapy Orders received today from
470571 - UCSF.
470573 -  ..
470574 - Chemotherapy Orders continues...
470576 -     ..
470577 -    Laboratory Work:
470578 -
470579 -    Follow up ref SDS D8 PWPW, ref SDS B7 PWPW.
470580 -
470581 -    x  CBC with differential and platelets
470582 -    x  Creatinine, magnesium every 4 weeks
470583 -    x  BUN, AST, Alk phos, Alt, Total bilirubin, eletrolytes every 8 weeks
470585 -  ..
470586 - Before meeting with the medical team this morning, Millie got a blood
470587 - draw in the Infusion Clinic, per above, ref SDS 0 439L, as planned in
470588 - Millie's letter to UCSF this morning on the agenda for meeting with
470589 - the medical team. ref SDS F5 6Y5K
470591 -  ..
470592 - Chemotherapy Orders continues...
470593 -
470594 -    If ANC >= 1.5 x 1000/L, platelets >= 75 x 1000/L give 100% of dose
470596 -     ..
470597 -    If ANC <  1.5 x 1000/L, platelets <  75 x 1000/L....
470598 -
470601 -        ..
470602 -    x  See cetuximab orders.
470604 -  ..
470605 - The section checked to see cetuximab orders refers to the Chemotherapy
470606 - Order for cetuximab, per above. ref SDS 0 MM6N
470608 -  ..
470609 - Chemotherapy Orders continue...
470610 -
470611 -       Study tubes
470613 -  ..
470614 - The "Study tubes" section today is not checked and is blank; however,
470615 - this morning Heather reported that Jill, the new Clinical Study
470616 - Coordinator, delivered the 7 vials to the Infusion Clinic, per above,
470617 - ref SDS 0 LO4G, required for the trial protocol, and requested in
470618 - Millie's letter to the medical team this morning. ref SDS F5 6Y5K
470620 -  ..
470621 - Last month on 080724, the section on "Study tubes" was filled out, but
470622 - showed only three (3) study tubes were delivered. ref SDS D8 QD7H
470624 -  ..
470625 - Chemotherapy Orders continue...
470627 -     ..
470628 -    Neupogen Prescribed in Chemotherapy Orders
470629 -
470630 -    Follow up ref SDS B6 PWSY, ref SDS A4 PWTR.
470631 -
470632 - During the meeting with the medical team on the 2nd floor at 0800 this
470633 - morning, the doctor ordered continuing for the 7th cycle starting
470634 - today the same prescription issued for the 4th cycle shown in the
470635 - record on 080529, ref SDS A5 PWSY  The Chemotherapy Orders for today
470636 - shows in handwriting...
470637 -
470638 -        Neupogen 480 mcg SQ on D2 3 3 carbo
470640 -  ..
470641 - This duplicates the handwritten prescription in the Chemotherapy Order
470642 - for cetuximab received above. ref SDS 0 RU7O
470644 -  ..
470645 - This seems to reflect instructions that Neupogen is only given on the
470646 - 3 days in the cycle when Millie gets Carboplatin, and so is skipped
470647 - for the 4th treatment in the cycle when Millie gets only cetuximab.
470649 -  ..
470650 - On 080609 Zan in the Kaiser Oncology Pharmacy set up an account for
470651 - Millie to get Neupogen treatments in the Kaiser Infusion Clinic based
470652 - on Chemotherapy Orders showing the UCSF prescription.  At that time,
470653 - Zan used the Chemotherapy Orders for 080529 which show a prescritpion
470654 - for 2 Neupogen treatments per week. ref SDS A8 L16I
470656 -  ..
470657 - Chemotherapy Orders continue...
470659 -     ..
470660 -    x  Physician has discussed risks/benefits of chemotherapy with the
470661 -       patient.  Consent, form obtained.
470662 -
470663 -       x  Yes  O2 [oxygyn] by nasal cannula at 2 liters/min prn for chest pain or SOB
470665 -           ..
470666 -       x  Yes  Diphenhydramine 50 mg IV prn x 1 unticaria pruntis, SOB
470667 -               (this is Benadryl)
470669 -        ..
470670 -       x  Yes  Hydrocrotisone 100 mg IV prn x 1 unticaria pruntis, SOB
470672 -        ..
470673 -       x  Yes  Aubterol inhaler 2 - 4 puffs prn SOB or chest tightness
470675 -        ..
470676 -       x  Yes  Epnephnna nhaler 2 - 4 puffs prn SOB or chest tightness
470678 -        ..
470679 -       Physician Signature
470680 -
470683 -                Date:  080815
470685 -        ..
470686 -       Nurse Signature:
470687 -
470690 -                Date:  080724
470692 -  ..
470693 - No nurses signature is shown in the copy received from UCSF; may have
470694 - been entered and filed in UCSF records later.
470695 -
470696 -
470697 -
470698 -
470699 -
470700 -
470701 -
470702 -
4708 -