CONTACTS 

SUBJECTS
Meetings Results 081016 Examination UCSF Doctor Review Response Trea

3003 -
3003 -    ..
3004 - Summary/Objective
3005 -
300501 - Follow up ref SDS 38 0000.
300502 -
300503 -
300504 -
300505 -
300507 -  ..
3006 -
3007 -
3008 - Progress
3009 -
300901 - Submitted letter summarizing results of the meeting today at UCSF,
300902 - and discussion on starting a new treatment regimen...
300903 -
300904 -    1.  Subject: Work Plan Consider Change Treatment Sunitinib Clinical Study
300905 -        Date: Thu, 16 Oct 2008 23:57:24 -0700
300910 -         ..
300911 -    2.  Dear Doctor Rugo,
300913 -         ..
300914 -    3.  Initially, request comment from Gloria at Kaiser's Coagulation
300915 -        Control Clinic in Martinez on the blood test today at UCSF.
300916 -        ref SDS 39 K66J
300918 -  ..
300919 - Responds to Gloria's letter dated 081004 received yesterday on 081015
300920 - asking about blood test results. ref SDS 37 YG5H
300922 -  ..
300923 - Millie's letter to the medical team continues...
300924 -
300925 -    4.  As a precaution, I skipped Coumadin today pending guidance from
300926 -        Gloria on INR 4.2.  Brigid indicated that significantly
300927 -        elevated pulse for several hours above 180 reported on 081012,
300928 -        ref SDS 36 4I8M, does not raise concerns, but, at that time,
300929 -        the INR results were not yet reported.
300930 -
300931 -            [On 081019 Millie notified Gloria that Coumadin treatment
300932 -            was resumed the next day on Friday, 081017. ref SDS 46 TH7T
300934 -             ..
300935 -            [On 081024 Millie received a letter from Kaiser reporting
300936 -            receipt of notice in Millie's letter today that INR 4.2
300937 -            elevated above normal, ref SDS 59 RF5I, and further
300938 -            received a form letter that says to notify Kaiser about
300939 -            changes in health, and activity, which was done in the
300940 -            letter today without any evident awareness by Kaiser.
300941 -            ref SDS 59 B46J
300943 -             ..
300944 -            [On 081024 Millie notified Kaiser that INR 2.3 returned to
300945 -            normal range between 2.0 and 3.0 with another blood test a
300946 -            week later on 081023 at UCSF. ref SDS 60 6V5T
300948 -         ..
300949 -    5.  Today, during treatment, I received from Megan [actually
300950 -        Glenna] a consent to participate in a new study, ref SDS 39
300951 -        KV4O, and dated recently on 080820...
300953 -             ..
300954 -            Study Title:  A phase I/II study of sunitinib (SU11248) in
300955 -            combination with metronomic cyclophosphamide and
300956 -            methotrexate for patients with metastatic breast cancer.
300958 -         ..
300959 -    6.  This implements planning you discussed during the meeting today
300960 -        on the 2nd floor in the Breast Care Clinic.
300962 -  ..
300963 - UCSF proposal to consider sunitinib clinical study aligns with
300964 - Millie's request in the letter to the medical team yesterday to begin
300965 - review of options for future treatments. ref SDS 38 K45V
300967 -  ..
300968 - Treatment with cyclophosphmaide in the sunitinib trial, per above,
300969 - ref SDS 0 J38U, appears conflicting with patient history.
300970 - Cyclophosphamide is the generic name for Cytoxan, which Millie
300971 - received with Andriamycin (i.e., AC) twice previously.  Doctor Johnson
300972 - stopped AC after just 2 cycles in June 2002, because treatment was
300973 - ineffective, reported 020603. ref SDS 2 WO4O  AC was prescribed again
300974 - beginning on 050104 for the purpose of qualifying Millie for a
300975 - clinical trial.  However, after 4 cycles, AC was ended on 050329,
300976 - because the cancer marker went up with each treatment. ref SDS 11 T58M
300978 -  ..
300979 - Today, Doctor Rugo explained that there is discretion to waive some
300980 - criteria, since the main benefit expected for Millie is with the
300981 - "targeted" therapy sunitinib, similar to cetuximab.  The past 2 years,
300982 - Millie experienced high quality of life with cetuximab alone.  After
300983 - adding carboplatin chemotherapy, this treatment was not very
300984 - effective, because after many relapses Millie's cancer has mutated to
300985 - resist chemotherapies.
300987 -             ..
300988 -            [On 081017 entered Sunitinib clinical study consent
300989 -            document into the record for case management. ref SDS 42
300990 -            HF5H
300992 -             ..
300993 -            [On 081018 Doctor Stritter speaking at a Wellness Community
300994 -            event related her research showing promising potential for
300995 -            Millie's treatment with Sunitinib. ref SDS 44 PQ6X
300997 -             ..
300998 -            [On 081021 Millie submitted sunitinib consent document to
300999 -            primary care physician at Kaiser to prepare for meeting on
301000 -            081024 to consider approval for this line of treatment.
301001 -            ref SDS 50 W83I
301003 -             ..
301004 -            [On 081022 Millie hand carried a printed copy of Consent
301005 -            document to primary care physician at Kaiser in Walnut
301006 -            Creek to prepare for meeting to review sunitinib clinical
301007 -            study and consider approval for this treatment. ref SDS 51
301008 -            XK5H
301010 -             ..
301011 -            [On 081024 primary care phsyician prescribes treatment for
301012 -            Millie at UCSF with sunitinib metronomic and multi-agent
301013 -            protocol, ref SDS 63 XZ8W, because Millie's advancing
301014 -            cancer has become resistant to chemotherapy and so requires
301015 -            double agent drugs, and Kaiser only has single agent
301016 -            treatments which will be ineffective to treat Millie's 5th
301017 -            relapse of IBC, and further, becauser Kaiser's experience
301018 -            with sunitinib indicates this can be effective for Millie.
301019 -            ref SDS 63 ER4I
301021 -             ..
301022 -            [On 090514 0830 Doctor Rugo prescribes MPA clinical trial
301023 -            for Millie to recover from the 8th relapse of cancer, and
301024 -            assigns Millie to get MPA only in order to avoid side
301025 -            effects of cyclophosphamide that caused severe side effects
301026 -            for Millie on the sunitinib protocol. ref SDS A6 265I
301028 -             ..
301029 -            [On 090615 1418 Doctor Rugo exercised discretion to waive
301030 -            some criteria in order to expedite Millie starting
301031 -            treatment to recover from medical mistakes getting
301032 -            radiation medical services from UCSF on referral, and which
301033 -            missed treating cancer in the breastbone. ref SDS A7 RY7N
301035 -  ..
301036 - Millie's letter to the medical team continues...
301037 -
301038 -    7.  It would help me review and follow up to get the computer file
301039 -        for this document.  Jackie submitted the computer file for the
301040 -        cetuximab Carboplatin study, received on 070116. ref SDS 16 0Q7I
301042 -         ..
301043 -    8.  I could type it up from the paper, but it saves a lot of work
301044 -        to get the computer file.
301045 -
301046 -            [On 081017 the doctor will discuss with Pfizer giving a
301047 -            copy to the patient of the computer file for the consent
301048 -            document. ref SDS 41 MO3F
301050 -             ..
301051 -            [On 081017 entered Sunitinib clinical study consent
301052 -            document into the record for case management. ref SDS 42
301053 -            HF5H
301055 -             ..
301056 -            [On 081031 Glenna proposed sending via email the signature
301057 -            page of the Consent document in a computer file.
301058 -            ref SDS 75 CC3O
301060 -         ..
301061 -    9.  By copy to Doctor Johnson, I am letting him know about the UCSF
301062 -        proposal [per above, ref SDS 0 J38U], so he can investigate,
301063 -        and advise me during the meeting next Friday at Kaiser.  If
301064 -        there is a problem getting the computer file, I will submit the
301065 -        Sunitinib study papers received today, so Doctor Johnson can
301066 -        make a copy to review.
301068 -  ..
301069 - UCSF proposal to consider sunitinib clinical study, per above,
301070 - ref SDS 0 J38U, aligns with Millie's request in the letter to the
301071 - medical team yesterday to begin review of options for future
301072 - treatments, ref SDS 38 K45V, and implements Doctor Johnson's guidance
301073 - in the meeting 080829 for UCSF to begin planning for transition to a
301074 - new treatment, ref SDS 32 RP9R, required by finding of progression of
301075 - cancer reported by Lynn at UCSF on 080821, ref SDS 30 4C6O, and
301076 - concurred by Doctor Johnson's examination at Kaiser a week later on
301077 - 080829. ref SDS 32 RP8T
301079 -             ..
301080 -            [On 081019 Millie sent a letter to the primary care
301081 -            physician submitting Doctor Stritter's favorable comments
301082 -            on the sunitinib clinical trial for treatting Millie's 5th
301083 -            relapse of IBC. ref SDS 45 D13Q
301085 -             ..
301086 -            [On 081021 Consent document for Sunitinib clinical study
301087 -            sent to primary care physician to prepare for meeting on
301088 -            081024. ref SDS 47 7L5S
301090 -             ..
301091 -            [On 081023 agenda for meeting at Kaiser review questions on
301092 -            sunitinib clinical study. ref SDS 53 L45S
301094 -             ..
301095 -            [On 081022 Millie had FNA procedure at Kaiser in Walnut
301096 -            Creek. ref SDS 52 NZ5N
301098 -             ..
301099 -            [On 081023 Kaiser reports pathology on FNA biopsy was
301100 -            positive for breast cancer. ref SDS 54 4Q9Q
301102 -             ..
301103 -            [On 081023 Doctor Rugo advises that pathology report on FNA
301104 -            biopsy showing positive for breast cancer stops Millie
301105 -            treatment on cetuximab Carboplatin clinical study,
301106 -            ref SDS 55 D65G; doctor meeting with staff to schedule next
301107 -            steps. ref SDS 55 KY7Y
301109 -             ..
301110 -            [On 081023 Millie's letter to Doctor Rugo reviews work plan
301111 -            to begin sunitinib clinical study to maintain continunity
301112 -            of treatment for IBC. ref SDS 56 4T8W
301113 -
301115 -  ..
301116 - Progression of Cancer 6th Relapse and 5th Relapse of IBC
301117 -
301118 -
301119 -   10.  This proposal to change treatment reflects examination today
301120 -        showing rising IBC intensity on my left arm, and small nodules
301121 -        in the breast bone area.  IBC rash in the breast and abdomen
301122 -        areas remains light and scatterd suggestive of responding to
301123 -        treatment;  however, the left arm and new nodules seem very
301124 -        significant.
301126 -  ..
301127 - Rising systems of IBC on left arm, and nodules in breast bone area
301128 - seem conflicting with cancer marker CA 15-3 95 stable for 3 months.
301129 - Stable to reduced IBC rash at other sites aligns with stable cancer
301130 - marker, reported in the record for treatment at UCSF today.
301131 - ref SDS 39 VK6H
301132 -
301133 -            [On 081024 1150 Doctor Johnson's examination at Kaiser
301134 -            found substantial progression of IBC disease, ref SDS 62
301135 -            W19H, and so approved the UCSF work plan for transitioning
301136 -            to treatment with sunitinib protocol at UCSF, ref SDS 62
301137 -            Y85H, as shown in this record below. ref SDS 0 J36R
301139 -  ..
301140 - Millie's letter to the medical team continues...
301141 -
301142 -   11.  You further found the swelled node in the left supraclavicular,
301143 -        reported by Lynn on 080821. ref SDS 30 4C6O [and confirmed by
301144 -        Doctor Johnson a week later on 080829, ref SDS 31 1Z6O, and the
301145 -        medical team was notified later that day. ref SDS 32 RP8T]
301147 -         ..
301148 -        Case Study 6th Relapse Overall and 5th Relapse IBC
301149 -
301150 -        Follow up ref SDS 28 0T8H, ref SDS 15 H54F.
301151 -
301152 -        1.  Lymph node biopsy positive start
301153 -            bevacizumab Taxotere.............. 040318, ref SDS 5 8R6M
301154 -        2.  Cancer marker IBC increase end
301155 -            bevacizumab Taxotere due to
301156 -            pulmonary embolism................ 041210, ref SDS 9 025H
301157 -        3.  Cancer marker IBC recurs 9 months
301158 -            months after mastectomy........... 060711, ref SDS 14 025H
301159 -        4.  Cancer marker IBC worsens end
301160 -            capeticabine Taxotere............. 061201, ref SDS 15 RU6J
301161 -        5.  IBC progression with increased
301162 -            lymph nodes in axilla add
301163 -            Carboplatin to cetuximab.......... 080306, ref SDS 28 NW3N
301164 -        6.  IBC worsesn CT test swelled
301165 -            LN left supraclavicular; treatment
301166 -            cetuximab and Carboplatin end;
301167 -            begin work plan for sunitinib
301168 -            metronomic protocol............... 081016, ref SDS 0 J34U
301169 -
301170 -               [On 090122 2321 Doctor Rugo diagnoses 6th relapse of
301171 -               IBC, ends sunitinib treatment. ref SDS A3 J47F
301173 -  ..
301174 - Millie's letter to the medical team continues...
301175 -
301176 -   12.  Doctor Johnson concurred the following week, noted in the
301177 -        letter to the team on 080829. ref SDS 32 RP8T
301178 -
301179 -            [On 081023 Doctor Daamen reports pathology on swelled lymph
301180 -            node in left supraclavicular positive for breast cancer.
301181 -            ref SDS 54 4Q9Q
301183 -             ..
301184 -            [On 081023 Doctor Rugo ends Millie's treatment with
301185 -            cetuximab and Carboplatin because biopsy on 081022 was
301186 -            positive for cancer. ref SDS 55 D65G
301188 -             ..
301189 -            [On 081113 CT test neck finds swelled lymph node in left
301190 -            supraclavicular. ref SDS 86 5O6N
301192 -         ..
301193 -   13.  I was encouraged today by your remarks that this study aligns
301194 -        with Doctor Johnson's goals on 080829 for "targeted" treatment,
301195 -        ref SDS 32 RP9R, [that the most difficult side effect taking
301196 -        sunitinib is a dry mouth, or mouth sores causing saliva], and
301197 -        that UCSF has another study [scheduled to start in about 4
301198 -        months], which can treat my IBC, as well as non-study options.
301199 -
301200 -            [On 090121 Glenna asked for help from Millie's "well
301201 -            ordered record" of patient history in order to expedite
301202 -            finding treatments in time to be effective, which Doctor
301203 -            Rugo has proposed for treating Millie after sunitinib,
301204 -            ref SDS A2 Y67L; listed the report today that UCSF is
301205 -            starting another study, and that UCSF has other non-study
301206 -            options for Millie. ref SDS A2 QC4I
301208 -             ..
301209 -            [On on 090130 Millie's letter to the medical team reports
301210 -            that on 090129 Doctor Rugo prescribed treating Millie with
301211 -            hyperthermia in the Radiation Oncology Department at UCSF,
301212 -            and in order to establish local control of expanding IBC,
301213 -            following relapse during treatment with sunitinib study.
301214 -            ref SDS A4 AY9Q
301216 -             ..
301217 -            [On 090514 0830 Doctor Rugo prescribes MPA clinical trial
301218 -            of another "targeted" drug for Millie to recover from the
301219 -            8th relapse of cancer, and assigns Millie to get MPA only
301220 -            in order to avoid side effects of cyclophosphamide that
301221 -            caused severe side effects for Millie on the sunitinib
301222 -            protocol. ref SDS A6 265I
301224 -         ..
301225 -   14.  Discussion occurred so fast today that I cannot remember these
301226 -        details.  Recall I was in shock and emotional from the pace of
301227 -        events.  I deeply appreciate your manner today [Millie asked
301228 -        "What's going to happen to me?" -- if there are no more
301229 -        treatments for her difficult patient profile.  Doctor Rugo put
301230 -        her arm around Millie's shoulder and said "Don't worry.  We're
301231 -        not going to let anything happen to you!  We have more drugs
301232 -        lined up after sunitinib" - per Doctor Johnson's instructions,
301233 -        above. ref SDS 0 J35X], along with Brigid and Megan, helping me
301234 -        deal with transition.
301236 -  ..
301237 - UCSF report on having more treatments for Millie after sunitinib, per
301238 - above, ref SDS 0 J38U, aligns with Millie's request in the letter to
301239 - the medical team yesterday to present options for future treatments.
301240 - ref SDS 38 K45V  Millie's letter yesterday asked about meeting again
301241 - with Doctor Benz to get an updated list of additional treatments for
301242 - Millie's patient profile.  Doctor Rugo's remarks today may indicate
301243 - she consulted with Doctor Benz, so that continuity of care is
301244 - maintained without interruption.
301246 -  ..
301247 - During the meeting, Doctor Rugo said that UCSF will coordinate with
301248 - Kaiser to sort out payment issues for this next treatment, so that
301249 - Millie does not face problems of over-billings that occurred last
301250 - year, shown by the record on 070830. ref SDS 17 7X5G
301252 -  ..
301253 - Doctor Rugo commented on health care challenges of rising costs to
301254 - meet rising demand for medical services, while balancing requirements
301255 - for cost containment.  She seemed to indicate her son was hospitalized
301256 - briefly for a minor malady a few years ago while on vacation in Hawii.
301257 - She was shocked to get the bill, and wound up making equitable payment
301258 - for services her son received.  Yet, 2 years later, she still gets
301259 - demands for unjustified overcharges.
301261 -  ..
301262 - As a result, the doctor wants to ensure payment arrangements are
301263 - resolved for Millie on her next treatment, in order to prevent a
301264 - repeat of problems last year.
301265 -
301266 -            [On 081017 Millie thanks doctor again for assistance coping
301267 -            with transition. ref SDS 41 NR9P
301269 -             ..
301270 -            [On 081017 Sunitinib Consent document explains the clinical
301271 -            study offers "targeted" treatment for breast cancer.
301272 -            ref SDS 42 006S
301274 -             ..
301275 -            [On 081018 Doctor Stritter speaking at a Wellness Community
301276 -            event related her research showing promising potential for
301277 -            Millie's treatment with Sunitinib. ref SDS 44 PQ6X
301279 -             ..
301280 -            [On 081021 Consent document for Sunitinib clinical study
301281 -            sent to primary care physician to prepare for meeting on
301282 -            081024. ref SDS 47 7L5S
301284 -             ..
301285 -            [On 081023 agenda for meeting at Kaiser review questions on
301286 -            sunitinib clinical study. ref SDS 53 L45S
301288 -             ..
301289 -            [On 081024 1150 primary care physician related experience
301290 -            treating patients with sunitinib at Kaiser, other than for
301291 -            breast cancer, shows some patients suffer side effects of
301292 -            fatigue and neuropathy; the dose levels may different from
301293 -            what Millie will get at UCSF, and Millie's good physicial
301294 -            condition from vigorous exercise will help minimize these
301295 -            effects in Millie's case. ref SDS 62 O668
301297 -             ..
301298 -            [On 081219 1140 Doctor Johnson disappointed that treatment
301299 -            with sunitinib was delayed for months due to problems
301300 -            performing case management, ref SDS A1 KK3M; Kaiser asks
301301 -            Millie again to remind Doctor Rugo to identify more
301302 -            treatments at UCSF that can be provided in time to be
301303 -            effective recovering from future relapses. ref SDS A1 H85I
301305 -             ..
301306 -            [On 090121 Glenna asked for help from Millie's "well
301307 -            ordered record" of patient history in order to expedite
301308 -            finding treatments in time to be effective, which Doctor
301309 -            Rugo has proposed for treating Millie after sunitinib,
301310 -            ref SDS A2 Y67L; listed the report today that UCSF is
301311 -            starting another study, and that UCSF has other non-study
301312 -            options for Millie. ref SDS A2 QC4I
301314 -             ..
301315 -            [On 090223 0947 dentist billed $17,000 for son's
301316 -            examination in hospital Emergency Department for 3 hours
301317 -            and for which no treatment was required. ref SDS A5 K06O
301318 -
301319 -
301320 -
3014 -

SUBJECTS
Work Plan Treatment 5th Relapse IBC Biopsy FNA Fine Needle Aspiratio
Meetings Results 081016 Examination UCSF Doctor Review Response Trea

6504 -
650501 -  ..
650502 - Work Plan Transition Treatment for Millie 5th Relapse IBC
650503 - Status Change Triple Negative Biopsy Evaluate Expand Treatments
650504 - 5th Relapse IBC Work Plan Biopsy Check Triple Negative Status Change
650505 -
650507 -  ..
650508 - Millie's letter to the medical team continues...
650509 -
650510 -   15.  The work plan seems to be...
650511 -
650512 -               [On 081017 0021 Doctor Rugo thanks Millie for help on
650513 -               coordinating UCSF work plan for Kaiser to get Millie
650514 -               ready in time for treatment to be effective at UCSF.
650515 -               ref SDS 41 ZM3G
650517 -                ..
650518 -               [On 081029 work plan updated, ref SDS 72 LH4O; submitted
650519 -               to Glenna, study coordinator at UCSF. ref SDS 72 H96H
650520 -
650521 -        1.  Kaiser biopsy the node in the left supraclavicular to
650522 -            verify cancer.  I have the form Brigid prepared and signed
650523 -            today that says in part...
650525 -                    ..
650526 -                   FNA L SC node, ER PR HER2 neu status
650528 -             ..
650529 -            Ordering test for status change may indicate the sunitinib
650530 -            study targets triple negative, and if the node is positive
650531 -            for cancer, then status can be assessed.
650533 -  ..
650534 - This makes biopsy to evaluate progression and check for status change
650535 - critical for starting treatment as soon as possible to prevent cancer
650536 - on the 5th relapse of IBC from cascading out of control.  Aligns with
650537 - patient history in case study on 041230 showing primary care physician
650538 - at Kaiser describes timely treatment essential for oncology care.
650539 - ref SDS 10 P19O
650541 -  ..
650542 - On 040303 Millie had FNA biopsy of a node in the left supraclavicular
650543 - performed by Doctor Lau in the Head and Neck Department. ref SDS 3
650544 - Y171  Pathology was positive on 040309, ref SDS 4 0001, leading to
650545 - determination of recurrence, and metastatic cancer on 040318,
650546 - ref SDS 5 8R6M, treated with the Avastin clinical study.  Kaiser did
650547 - not test for status change with the FNA biopsy on 040303.
650549 -  ..
650550 - A month later on 040419 the surgeon performed a punch biopsy of the
650551 - left breast to assess recurrent rash, as an added procedure during
650552 - surgery to implant a port catheter. ref SDS 6 789F  On 040429 the
650553 - surgeon advised the biopsy was positive for cancer, but did not
650554 - disclose what kind of cancer. ref SDS 7 C155  On 040517 the pathology
650555 - report was submitted on the punch biopsy.  Review after the meeting
650556 - showed IBC, and there was no finding on status change. ref SDS 8 6T5G
650558 -  ..
650559 - On 050909 Doctor Shim at Kaiser Oncology in Oakland recommended that
650560 - Kaiser in Walnut Creek test for status change that can have a huge
650561 - impact on expanding treatments for Millie. ref SDS 13 JX9P
650563 -  ..
650564 - On 060711 Kaiser in Walnut Creek reported status change was tested
650565 - with the biopsy on 040419, despite there being no report in pathology
650566 - received on 040517, and remained triple negative, ref SDS 14 SW7O,
650567 - i.e., there was no change from original status on 020321. ref SDS 1
650568 - LA7O
650570 -  ..
650571 - On 071007 Millie attended a cancer support group seminar; the speaker
650572 - indicated criteria for HER2 negative may have dropped from 2 to 1.6;
650573 - asked Doctor Rugo at UCSF about propsects of expanding treatment to
650574 - use Herception available onlyt to HER2 positive patient status.
650575 - ref SDS 18 S68T  On 071009 Doctor Rugo advised that UCSF continues to
650576 - rely on HER2 negative standard at 2, i.e., there has been no change in
650577 - criteria. ref SDS 19 HH4W
650579 -  ..
650580 - On 080207 Doctor Rugo asked Millie to request the pathology report
650581 - from Kaiser on the biopsy for 040419 that was described on 060711 as
650582 - having tested for status change, ref SDS 20 6S6G; and in order to
650583 - assess current options for treating Millie's 4th relapse of IBC.
650584 - ref SDS 20 655G  On 080219 UCSF received report for biopsy on 040419
650585 - and determined there is no change in Millie's triple negative status
650586 - as of that time on 040419, which would increase treatment options.
650587 - ref SDS 26 VX6G
650588 -
650590 -  ..
650591 - Case Study Status Change Order Biopsy Obtain Pathology Findings
650592 -
650593 - Today, the order for biopsy to check status tries again to expand
650594 - Millie's treatment options, ref SDS 0 J36R, first proposed by Doctor
650595 - Shim at Kaiser in Oakland on 050909, ref SDS 13 JX9P, and encouraged
650596 - by the report on 071007 of change in status criteria. ref SDS 18 S68T
650598 -                 ..
650599 -            1.  [On 081017 1410 visited Arlette at Kaiser in the
650600 -                Oncology Department when Millie was getting Neupogen
650601 -                treatment in the Infusion Clinic; she had talked to the
650602 -                doctor, and understood the doctor had received this
650603 -                letter, ref SDS 0 J34R, and was aware of the work plan,
650604 -                ref SDS 0 J36R, and that the needle biopsy of the node
650605 -                in the left supraclavicular to test for cancer and
650606 -                status change was being ordered for Millie at Kaiser to
650607 -                implement the prescription at UCSF today. ref SDS 43
650608 -                UP6I
650610 -                 ..
650611 -            2.  [On 081019 Millie sent a letter to Kaiser confirming
650612 -                understandings that the primary care physician is
650613 -                ordering the biopsy to test for cancer and status
650614 -                change requested by UCSF; hoping to get biopsy done OB
650615 -                081024. ref SDS 45 DZ5T
650617 -                 ..
650618 -            3.  [On 081021 Millie scheduled 081023 1045 at Kaiser in
650619 -                Surgery Department to biopsy "lump." ref SDS 48 0X9T
650620 -                Called and changed to 1445 after Millie returns to
650621 -                Concord from treatment at UCSF in San Francisco.
650622 -                ref SDS 48 4Q4C
650624 -                 ..
650625 -            4.  [On 081021 Surgery Advice Nurse considers requirements
650626 -                for case management to get biopsy results for meeting
650627 -                with doctor 081024 1145 to evaluate changing treatment
650628 -                for cancer;, ref SDS 48 IW66; checks UCSF work plan for
650629 -                FNA left supraclavicular and status change, advises
650630 -                this scope more typically performed in Head and Neck
650631 -                Department, ref SDS 48 PQ7T; Advice Nurse checks with
650632 -                surgeon; Surgery Department cancels order for biopsy,
650633 -                prepares referral to Head and Neck who can perform same
650634 -                day biopsy ref SDS 48 03GE
650636 -                 ..
650637 -            5.  [On 081021 letter to primary care physician requests
650638 -                follow up tomorrow with Head and Neck to clarify
650639 -                referral, and expedite the work. ref SDS 49 3U6S
650641 -                 ..
650642 -            6.  [On 081022 Millie visits Kaiser Head and Neck
650643 -                Department; Kaiser expedites work schedules FNA biopsy
650644 -                on the neck in the afternoon at 1400; Millie submitted
650645 -                UCSF order for the FNA biopsy and request to check for
650646 -                status change. ref SDS 52 HD85
650648 -                 ..
650649 -            7.  [On 081022 Millie notified medical team of adjustments
650650 -                to referral for FNA biopsy and checking for status
650651 -                change, and thanked the doctor for coordinating changes
650652 -                to expedite the work. ref SDS 51 2Y9T
650654 -                 ..
650655 -            8.  [On 081022 FNA biopsy performed at Kaiser; pathology
650656 -                report expected within a few days to a week,
650657 -                ref SDS 52 NZ5N; if pathology negative for cancer,
650658 -                Kaiser proposes retest with core biopsy, a more
650659 -                rigorous procedure. ref SDS 52 HH99
650661 -                 ..
650662 -            9.  [On 081022 FNA procedure checking for status change was
650663 -                not specified in referral from Surgery; the doctor
650664 -                corrected the problem by attaching UCSF order for FNA
650665 -                and checking status change to the transmittal for
650666 -                sending the specimen to the pathology lab. ref SDS 52
650667 -                RS8M
650669 -                 ..
650670 -           10.  [On 081023 FNA biopsy positive for breast cancer; need
650671 -                to do core biopsy because lab says FNA biopsy does not
650672 -                produce enough material to check for status change.
650673 -                ref SDS 54 W15N
650675 -                 ..
650676 -           11.  [On 081023 Kaiser letter advises that testing status
650677 -                change ER PR HER2 neu requires another biospy using a
650678 -                core rather than an FNA procedure, and asks if this
650679 -                test is necessary, suggesting reason to pause for
650680 -                careful consideration using a core biopsy procedure.
650681 -                ref SDS 54 4Q5V
650683 -                 ..
650684 -           12.  [On 081023 Kaiser expedited work scheduled Millie for
650685 -                core biopsy the next day on 081024 1130 to test for
650686 -                status change. ref SDS 54 667F
650688 -                 ..
650689 -           13.  [On 081023 UCSF medical team sent 5 letters saying FNA
650690 -                biopsy adequate for testing status change, ref SDS 55
650691 -                NI7S, aligned with written UCSF order today,
650692 -                ref SDS 0 J36R; the last letter says hopefully Kaiser
650693 -                will use FNA procedure to test for status change.
650694 -                ref SDS 55 KY8R
650696 -                 ..
650697 -           14.  [On 081024 Kaiser Head and Neck Department responds to
650698 -                UCSF Oncology saying the Kaiser Lab requires core
650699 -                biopsy to test for status change. ref SDS 57 008H
650701 -                 ..
650702 -           15.  [On 081024 Millie requested assistance from primary
650703 -                care physician on deciding the type of biopsy to test
650704 -                for status change that expands available treatments for
650705 -                cancer. ref SDS 58 579O
650707 -                 ..
650708 -           16.  [On 081024 Millie met with Kaiser Head and Neck
650709 -                Department; decided to perform core biopsy to test for
650710 -                status change, because Kaiser Lab uses different
650711 -                procedures from the lab UCSF uses to check biopsy
650712 -                tissue for status change; Kaiser further decided to
650713 -                defer performing core biopsy until 081107 after Millie
650714 -                returns from vacation to reduce risks of complications
650715 -                cascading out of control without ready access to Kaiser
650716 -                health care while traveling. ref SDS 61 G15K
650718 -                 ..
650719 -           17.  [On 081027 Kaiser delays core biopsy 3 times to 081117,
650720 -                providing more time to evaluate benefits justify risks
650721 -                to make core biopsy necessary. ref SDS 65 G15K
650723 -                 ..
650724 -           18.  [On 081027 Millie notified UCSF that Kaiser delayed
650725 -                core biopsy again to 081117, ref SDS 66 G15K, and asks
650726 -                if this will delay getting treatment for cancer with
650727 -                the UCSF work plan for starting the sunitinib clinical
650728 -                study. ref SDS 66 R79W
650730 -                 ..
650731 -           19.  [On 081027 Glenna's letter for UCSF later in the day
650732 -                does not mention requirements for biopsy to test status
650733 -                change. ref SDS 67 TU5I
650735 -                 ..
650736 -           20.  [On 081027 Glenna called and planned to ask Doctor Rugo
650737 -                about requirements for biopsy to test status change in
650738 -                order for Millie to start the sunitinib clinical study.
650739 -                ref SDS 68 934O
650741 -                 ..
650742 -           21.  [On 081027 Glenna clinical coordinator for sunitinib
650743 -                clinical study - Millie receives letter on setting up
650744 -                for Millie to start treatment. ref SDS 67 TU5I
650746 -                 ..
650747 -           22.  [On 081029 sunitinib work plan update proposes doing
650748 -                FNA biopsy at UCSF to check for status change.
650749 -                ref SDS 72 SF3P
650751 -                 ..
650752 -           23.  [On 081029 letter to UCSF discusses doing FNA biopsy
650753 -                for status check at UCSF instead of core biopsy at
650754 -                Kaiser. ref SDS 72 C49U
650756 -                 ..
650757 -           24.  [On 081031 letter to UCSF with copy to Kaiser asks
650758 -                about doing FNA biopsy at UCSF. ref SDS 74 NN5S
650760 -                 ..
650761 -           25.  [On 081031 Glenna called and advised that biopsy for
650762 -                status change is not a requirement for the sunitinib
650763 -                clinical trial, and so recommended contacting Doctor
650764 -                Rugo UCSF and Doctor Johnson at Kaiser. ref SDS 75 T27H
650766 -                 ..
650767 -           26.  [On 081031 Millie submits letter to medical team asking
650768 -                about doing the FNA biopsy to test status change at
650769 -                UCSF to reduce risks of core biopsy method. ref SDS 77
650770 -                AJ6U
650772 -                 ..
650773 -           27.  [On 081101 Doctor Rugo says FNA biopsy to check for
650774 -                status change is not part of the sunitinib clinical
650775 -                study; requires Kaiser approval of payment which would
650776 -                be very cost effective since FNA biopsy at UCSF would
650777 -                cost much less than the more invasive and problematic
650778 -                core biopsy Kaiser has scheduled for Millie on 081113.
650779 -                ref SDS 78 5G5H
650781 -                 ..
650782 -           28.  [On 081102 Millie's letter to Doctor Rugo with copy to
650783 -                primary care physician at Kaiser asks how much the FNA
650784 -                biopsy to test for status change will cost at UCSF, and
650785 -                notes this should be less expensive than doing the core
650786 -                biopsy at Kaiser. ref SDS 79 AD3F
650788 -                 ..
650789 -           29.  [On 081103 primary care physician at Kaiser responded
650790 -                to Doctor Rugo's letter on 081101 offering to perform
650791 -                FNA biopsy test for status change and saying this
650792 -                requires separate payment authorization, by advising
650793 -                that Kaiser "will perform the procedure," without
650794 -                clarifying using FNA or core biopsy procedure.
650795 -                ref SDS 80 2M64
650797 -                 ..
650798 -           30.  [On 081103 UCSF responds saying in total "Great."
650799 -                ref SDS 81 BY3H
650801 -                 ..
650802 -           31.  [On 081106 Doctor Daamen called and changed the
650803 -                schedule again, ref SDS 82 5F5H, for the core biopsy
650804 -                back to 081107 1600. ref SDS 82 5F68
650806 -                 ..
650807 -           32.  [On 081106 1213 letter notifies medical team that core
650808 -                biopsy to test for status change advanced from 081117
650809 -                to 081107 1600. ref SDS 83 7P68
650811 -                 ..
650812 -           33.  [On 081106 1631 Kaiser called back and said Millie was
650813 -                not scheduled for the core biopsy tomorrow on 081107
650814 -                1600, because Doctor Kahn would not be in the office,
650815 -                and Doctor Wong's schedule had changed, so nobody could
650816 -                do the biopsy for Millie on 081107. ref SDS 82 IP7L
650818 -                 ..
650819 -           34.  [On 081106 1643 Kaiser called back and advised after
650820 -                investigation that Millie is scheduled to meet with
650821 -                Doctor Kahn on 081107 1600 for the core biopsy as
650822 -                scheduled by Doctor Daamen, and the earlier problem was
650823 -                computer user issue. ref SDS 82 PQ9Y
650825 -                 ..
650826 -           35.  [On 081107 biopsy performed at Kaiser Head and Neck
650827 -                Department on 081107. ref SDS 85 7P5O
650829 -                 ..
650830 -           36.  [On 081113 Millie received partial results of the
650831 -                biopsy performed on 081107. ref SDS 87 QY5I
650833 -                 ..
650834 -           37.  [On 081119 Kaiser submits summary of final pathology
650835 -                report, ref SDS 88 5O8G, for the biopsy on 081107,
650836 -                ref SDS 85 496L, and it shows status unchanged, ER, PR,
650837 -                Her2neu still triple negative. ref SDS 88 UQ5P
650839 -                 ..
650840 -           38.  [On 081119 Millie notifies medical team of results on
650841 -                biopsy test for status change, ref SDS 89 V14I; Millie
650842 -                requests pathology report on biopsy from primary care
650843 -                physician. ref SDS 89 L34X
650845 -                 ..
650846 -           39.  [On 081120 Kaiser notifies Millie that entire pathology
650847 -                report can be submitted. ref SDS 90 VU9N
650849 -                 ..
650850 -           40.  [On 081120 Millie asks Kaiser to submit entire
650851 -                pathology report for the biopsy on 081107 that tested
650852 -                for status change. ref SDS 91 VG3X
650854 -                 ..
650855 -           41.  [On 081120 Kaiser notifies Millie the full report for
650856 -                pathology on the core biopsy performed on 081107 has
650857 -                been submitted with Kaiser's internal email system.
650858 -                ref SDS 92 OL5K
650860 -                 ..
650861 -           42.  [On 081120 Millie receives full pathology report for
650862 -                the biopsy on 081107. ref SDS 93 OL5K
650864 -                 ..
650865 -           43.  [On 081120 review pathology report shows criteria for
650866 -                HER2neu status is presented, ref SDS 93 LF9V, and
650867 -                conclusion of HER2neu negative is also presented,
650868 -                ref SDS 93 LF5V; however, the report does not seem to
650869 -                show specific findings on HER2neu that support a
650870 -                conclusion of negative. ref SDS 93 QQ3K
650872 -                 ..
650873 -           44.  [On 081202 0253 Millie's letter to medical team cites
650874 -                findings of triple negative and notes pathology report
650875 -                omits findings that support conclusion of triple
650876 -                negative status. ref SDS 94 AT4V
650878 -                 ..
650879 -           45.  [On 081202 1038 Millie's letter to Doctor Daamen at
650880 -                Kaiser requests findings for pathology on biopsy on
650881 -                081107 that support conclusion of triple negative
650882 -                status. ref SDS 95 GZ3W
650884 -                 ..
650885 -           46.  [On 081202 1253 Doctor Daamen checking with Kaiser lab
650886 -                to ensure accuracy of triple negative status
650887 -                conclusion. ref SDS 96 4P4K
650889 -                 ..
650890 -           47.  [On 081202 1314 Millie sent a letter to Kaiser
650891 -                clarifying scope of requirements on obtaining
650892 -                additional findings from the lab on status change.
650893 -                ref SDS 97 3E8M
650895 -                 ..
650896 -           48.  [On 081202 1428 Doctor Daamen reports the pathology lab
650897 -                submitted the specimen from the biopsy on 081107 for
650898 -                FISH testing to determine HER2 neu status; but have not
650899 -                received numerical analysis. ref SDS 98 4P5N
650901 -                 ..
650902 -           49.  [On 081202 1456 Kaiser submitted results of pathology
650903 -                for biopsy on 081107 showing HER2 neu FISH test = 1.1,
650904 -                ref SDS 99 FG5G, well below criteria for positive 2.0,
650905 -                and below change in criteria to 1.6 reported under
650906 -                consideration on 071007. ref SDS 18 S68T
650908 -                 ..
650909 -           50.  [On 081202 1502 Millie letter to Kaiser commends Doctor
650910 -                Daamen for outstanding work investigating details of
650911 -                tests that affect options treating cancer to extend and
650912 -                enhance quality of life, ref SDS A0 FG5G; cites risks
650913 -                of cynacism that discourage good management
650915 -  ..
650916 - Millie's letter to the medical team continues...
650917 -
650918 -        2.  I did not see anything in the study documents that mentions
650919 -            triple negative.  Please let me know where this issue is
650920 -            mentioned in the documents.
650922 -  ..
650923 - Actually, since the study documents do not specify triple negative, as
650924 - the cetuximab Carboplatin does, reported on 070116, ref SDS 16 0Q7I,
650925 - then the doctor may be using the occassion to test for cancer to check
650926 - status, and if Millie has experienced status change, and so is no
650927 - longer triple negative, then this would open a lot more treatment
650928 - options.
650930 -                 ..
650931 -                [On 081017 the doctor responds that "it is not a study
650932 -                for triple negative alone." ref SDS 41 6J3T
650934 -                 ..
650935 -                [On 081031 Glenna advised in a call that the sunitinib
650936 -                study does not require biopsy for status change.
650937 -                ref SDS 75 T27H
650939 -  ..
650940 - Opportunity to expand treatment options based on status change,
650941 - because of reports that criteria for status had changed since status
650942 - was originally tested on 020321 was presented to Doctor Rugo last year
650943 - on 071007. ref SDS 18 S68T  At that time, the doctor advised
650944 - understandings that criteria for status had not been lowered.
650945 - ref SDS 19 HH4W
650947 -                 ..
650948 -                [On 081018 Doctor Stritter presented advanced cancer
650949 -                treatments at a seminar; described sunitinib as a
650950 -                promising drug designed for "multi-targeted" treatment
650951 -                that improves performance achieved by cetuximab; if
650952 -                Millie is no longer triple negative, then ER, PR, and
650953 -                HER2neu may present additional targets for sunitinib to
650954 -                relieve current symptoms, and prevent recurrence of
650955 -                Millie's cancer. ref SDS 44 IT8V
650957 -  ..
650958 - About 4 months later, on 080207 the doctor asked about investigating
650959 - status change to assess options for treating Millie's 4th relapse.
650960 - ref SDS 20 6S6G  The next day on 080208 Millie sent a letter to the
650961 - medical team, including Kaiser, asking Kaiser to submit the report for
650962 - the biopsy on 040419 to Doctor Rugo at UCSF. ref SDS 21 OO5W  On 080213
650963 - Millie sent a letter asking if UCSF received the record from Kaiser
650964 - showing status change. ref SDS 22 7G9V  Millie sent another letter to
650965 - UCSF on 080214 asking if UCSF had received the biopsy report on status
650966 - change requested from Kaiser on 080208. ref SDS 23 Y86G  Another letter
650967 - was sent the next day on 080215 reminding UCSF to ask for data from
650968 - Kaiser to evaluate status change. ref SDS 24 ID6Q  On 080219 Millie
650969 - asked UCSF again about receiving the report on status change from
650970 - Kaiser. ref SDS 25 1K4S
650972 -  ..
650973 - On 080226 another patient reported status change occurred in her case.
650974 - ref SDS 27 M36R
650976 -  ..
650977 - On 080219 UCSF received the report for biopsy on 040419 and determined
650978 - there had been no change in Millie's triple negative status, which
650979 - would increase treatment options. ref SDS 26 VX6G
650981 -  ..
650982 - Millie's letter to the medical team continues...
650983 -
650984 -        3.  Hopefully, I can get the biopsy tomorrow afternoon, when I
650985 -            stop by for Neupogen treatment scheduled at 0200p.  I will
650986 -            try calling Arlette in the morning while hiking to see if
650987 -            things have been put in motion for the biopsy.
650988 -
650989 -                [On 081017 called Arlette at 0830; she had not yet read
650990 -                the letter with the work plan; said whe would find the
650991 -                doctor and ask about probress ordering the biopsy.
650992 -                ref SDS 43 UP5G
650994 -                 ..
650995 -                [On 081017 1410 visited Arlette at Kaiser in the
650996 -                Oncology Department when Millie was getting Neupogen
650997 -                treatment in the Infusion Clinic; she had talked to the
650998 -                doctor, and understood the doctor had received this
650999 -                letter, ref SDS 0 J34R, and was aware of the work plan,
651000 -                ref SDS 0 J36R, and that the needle biopsy of the node
651001 -                in the left supraclavicular to test for cancer and
651002 -                status change was being ordered for Millie. ref SDS 43
651003 -                UP6I
651005 -                 ..
651006 -                [On 081022 FNA biopsy performed at Kaiser; pathology
651007 -                report expected within a few days to a week,
651008 -                ref SDS 52 NZ5N; if pathology negative for cancer,
651009 -                Kaiser proposes retest with core biopsy, a more
651010 -                rigorous procedure. ref SDS 52 HH99
651012 -             ..
651013 -        4.  I can bring the form to Kaiser tomorrow, if necessary.  I
651014 -            think Doctor Johnson can order the biopsy, based on his
651015 -            findings on 080829, and patient history ordering a previous
651016 -            biopsy of this location on 040227, which resulted in
651017 -            diagnosing my first relapse, reported on 040309.
651018 -            ref SDS 4 0001
651019 -
651020 -                [On 081017 1410 visited with Arlette at Kaiesr; she
651021 -                reported the primary care physician is working on
651022 -                ordering the biopsy, and did not request documentation
651023 -                from UCSF. ref SDS 43 X47I
651025 -                 ..
651026 -                [On 081019 Millie sent a letter to Kaiser confirming
651027 -                understandings that the primary care physician is
651028 -                ordering the biopsy to test for cancer and status
651029 -                change requested by UCSF; hoping to get biopsy done OB
651030 -                081024. ref SDS 45 DZ5T
651032 -                 ..
651033 -                [On 081021 Millie scheduled 081023 1045 at Kaiser in
651034 -                Surgery Department to biopsy "lump." ref SDS 48 KS8K
651035 -                Called and changed to 1445 after Millie returns to
651036 -                Concord from treatment at UCSF in San Francisco.
651037 -                ref SDS 48 4Q4C
651039 -                 ..
651040 -                [On 081021 Surgery Advice Nurse considers requirements
651041 -                for case management to get biopsy results for meeting
651042 -                with doctor 081034 1145 to evaluate changing treatment
651043 -                for cancer;, ref SDS 48 IW66; checks UCSF work plan for
651044 -                FNA left supraclavicular and status change, advises
651045 -                this scope more typically performed in Head and Neck
651046 -                Department, ref SDS 48 PQ7T; Advice Nurse checks with
651047 -                surgeon; Surgery Department cancels order for biopsy,
651048 -                prepares referral to Head and Neck who can perform same
651049 -                day biopsy ref SDS 48 03GE
651051 -                 ..
651052 -                [On 081021 letter to primary care physician requests
651053 -                follow up tomorrow with Head and Neck to clarify
651054 -                referral, and expedite the work. ref SDS 49 3U6S
651056 -                 ..
651057 -                [On 081022 FNA procedure checking for status change was
651058 -                not specified in referral from Surgery; the doctor
651059 -                corrected the problem by attaching UCSF order for FNA
651060 -                and checking status change to the transmittal for
651061 -                sending the specimen to the pathology lab. ref SDS 52
651062 -                RS8M
651064 -             ..
651065 -        5.  Proceed with current treatment schedule, pending
651066 -            evaluation of biopsy, and other qualifying criteria.
651068 -             ..
651069 -        6.  The study requires a CT test; this can be done when I
651070 -            return from vacation on 081113, as discussed in the letter
651071 -            yesterday to the medical team. ref SDS 38 K34V
651073 -  ..
651074 - CT test is actually required on 081107, 8 weeks after the previous
651075 - test on 080911, ref SDS 33 LK3R, in time for review meeting with
651076 - medical team at UCSF on 081113.
651078 -  ..
651079 - Millie's letter to the medical team on 081015 submitting the agenda
651080 - for meeting on 081016 cited planning by the primary care physician at
651081 - Kaiser to order the CT test on 081107 at Kaiser in Walnut Creek based
651082 - on success using Millie's Power Port at Kaiser in Oakland on 080911.
651083 - ref SDS 34 SG4X  On 081015 letter to medical team on agenda to meet on
651084 - 081016 reminds about scheduling the CT test on 081107 at Kaiser in
651085 - Walnut Creek. ref SDS 38 K354
651087 -  ..
651088 - Objective is to get CT Department at Kaiser in Walnut Creek prepared
651089 - to avoid problems that occurred for the test on 080718. ref SDS 29
651090 - LK3R
651091 -
651092 -               [On 081023 agenda for meeting at Kaiser to order next
651093 -               CT test on 081107 (not 081113), 8 weeks after prior
651094 -               test on 080911. ref SDS 53 TH9K
651096 -                ..
651097 -               [On 081024 primary care physician ordered CT test at
651098 -               Kaiser in Walnut Creek on 081107 1300, and asked
651099 -               Millie to coordinate arrangements for the CT
651100 -               Department to use the Power Port, based on success
651101 -               doing the prior CT at Kaiser in Oakland. ref SDS 64
651102 -               V58K
651104 -                ..
651105 -               [On 081024 coordinated with manager CT test department
651106 -               on solving problems with prior test on 080718.
651107 -               ref SDS 64 PPVW
651109 -                ..
651110 -               [On 081028 Millie's letter to Dennis at Kaiser in Walnut
651111 -               Creek submitted background on the CT test in Oakland on
651112 -               080911, and provides work plan to do the next test at
651113 -               Kaiser in Walnut Creek. ref SDS 69 PE8X
651115 -                ..
651116 -               [On 081029 called and talked to Dennis about doing
651117 -               Millie's CT test at Kaiser in Walnut Creek. ref SDS 70
651118 -               QK7M
651120 -                ..
651121 -               [On 081029 Florida confirms Kaiser CT department
651122 -               approves doing test using Millie's Power Port, access
651123 -               scheduled in Infusion Clinic 081107 1230. ref SDS 71
651124 -               4E3G
651126 -                ..
651127 -               [On 081030 telecon Steve at Bard he has coordinated with
651128 -               Agenal who did CT test using Millie's Power Port
651129 -               successfully on 080911 at Kaiser in Oakland, ref SDS 73
651130 -               XN9C; and has further talked to Dennis at the CT
651131 -               Department at Kaiser in Walnut Creek; feels Dennis's
651132 -               team at Walnut Creek is good to go for doing Millie's CT
651133 -               test with the Bard Power Port on 081107. ref SDS 73 UF5H
651135 -  ..
651136 - Millie's letter to the medical team continues...
651137 -
651138 -        7.  If the biopsy is negative, the CT test will support the
651139 -            current treatment.
651141 -             ..
651142 -        8.  You recommended keeping the current treatment schedule [for
651143 -            laboratory work] in tact, listed on 080918, ref SDS 35
651144 -            QO4K, which can be adjusted as needed depending on results
651145 -            of the biopsy.
651146 -
651147 -                [On 081031 Glenna called and scheduled Millie to visit
651148 -                Doctor Rugo on 081113 0830 to start new treatment in
651149 -                the sunitinib clinical study; 081113 0830 was
651150 -                previously scheduled for the cetuximab Carboplatin
651151 -                study. ref SDS 74 T15L
651153 -                 ..
651154 -                [On 081031 Glenna's letter confirmed Millie get lab
651155 -                work on 081107, as previously scheduled, ref SDS 76
651156 -                SI4X, and then begin treatment the following week on
651157 -                081113 after meeting with the doctor in the monring on
651158 -                081113, as orginally scheduled. ref SDS 76 SJ3W
651160 -                 ..
651161 -                [On 081107 Millie gets lab work at UCSF implementing
651162 -                work plan to start treatment on referral from Kaiser in
651163 -                the clinical study for sunitinib at UCSF. ref SDS 84
651164 -                4G61
651166 -             ..
651167 -        9.  Thumbing through the file today, you got the impression I
651168 -            qualify for the study.  Let me know if you need support to
651169 -            assemble patient history.
651171 -             ..
651172 -       10.  My concerns about this study are primarily side effects;
651173 -            the list seems ominous.  You seemed to say today that one
651174 -            patient in the study so far has responded well for 4
651175 -            months, and with minimal side effects.
651176 -
651177 -                [On 081024 primary care physician cited experience at
651178 -                Kaiser patients treated with sunitinib have severe skin
651179 -                problems, including neuropathy. ref SDS 63 XZ9V
651181 -                 ..
651182 -                [On 090121 side effects sunitinib very severe in
651183 -                Millie's case. ref SDS A2 TW53
651184 -
651185 -
651186 -
651187 -
651188 -
651189 -
6512 -