Thursday, August 26, 2010

More Chemo, Different Chemo

Marco sent me the information about the new chemo he will be taking. It's a combination treatment called Gemzar with Taxotere.

Here are some excerpts from the current studies on this combination chemo treatment. Some terminology to remember too about response rates and palliation:

Complete Response means:
All detectable cancer is now gone after treatment. There can still be cancer left, but too little to detect, so a Complete Response is not the same thing as a cure, although some patients with a Complete Response may be cured.

Partial Response means:
Roughly speaking, a decrease in the amount of cancer of at least 50%, but less than 100%. More precisely, a decrease in the total cross sectional area of all measurable tumors of at least 50% but less than 100%.

Objective Response Rate is:
The proportion of patients with defined tumour shrinkage; generally it is the sum of partial responses and complete responses

Palliative chemotherapy is:
A type of chemotherapy that is given specifically to address symptom management without expecting to significantly reduce the cancer.

Adjuvant chemotherapy is:
Chemotherapy given to destroy left-over (microscopic) cells that may be present after the known tumor is removed by surgery. Adjuvant chemotherapy is given to prevent a possible cancer reoccurrence.

Neoadjuvant chemotherapy is:
Chemotherapy given prior to the surgical procedure. Neoadjuvant chemotherapy may be given to attempt to shrink the cancer so that the surgical procedure may not need to be as extensive.

From current sarcoma articles:

"Treatment options for patients with advanced soft-tissue sarcoma remain limited. There are few agents that achieve high objective response rates and none that result in cure for even a minority of patients. Although doxorubicin with or without ifosfamide remains a mainstay of treatment for many histologic types of advanced soft-tissue sarcoma, the combination of gemcitabine and docetaxel (Marco's current treatment) has become an established treatment option for patients, perhaps particularly those with leiomyosarcoma. The clinical development of the gemcitabine–docetaxel regimen is outlined, and data demonstrating the efficacy of this regimen in soft-tissue sarcoma are reviewed.

...retrospective studies and some case reports have been published that provide additional information regarding the activity of fixed-dose-rate gemcitabine and docetaxel in soft-tissue sarcoma. In one retrospective study, 133 patients with any number of prior treatment regimens were treated with fixed-dose-rate gemcitabine and docetaxel. Thirty-eighty percent of patients had had two or more prior regimens; 57% of patients had leiomyosarcoma. Objective response was observed in 18.4% of 114 patients evaluable for response (three complete responses and 18 partial responses). Sixteen of the responses were among 66 patients with leiomyosarcoma (24.2%), and five were among patients with other soft-tissue sarcoma histologies...

In another retrospective study, 35 patients with any number of prior regimens received fixed-dose-rate gemcitabine. The objective response rate was 43% (five complete and 10 partial responses). Objective responses were seen in seven patients with leiomyosarcoma, one malignant fibrous histiocytoma / undifferentiated high-grade pleomorphic sarcoma, two osteosarcomas, three angiosarcomas, one malignant peripheral nerve sheath tumor, and one Ewing's sarcoma.

There have also been case reports of objective responses to gemcitabine and docetaxel in other unusual sarcomas. A patient with pulmonary angiosarcoma was reported to have achieved a complete radiographic response. In addition, a patient with locally advanced leiomyosarcoma of the bladder had a near-complete pathologic response to gemcitabine–docetaxel delivered as neoadjuvant therapy.

"Apart from the chemosensitive small round cell tumors such as Ewing’s sarcoma family of tumors (ESFT) and rhabdomyosarcomas (RMS), some of which are potentially curable even when metastatic, all other patients with metastatic soft tissue sarcomas (STSs) are destined to die from their disease however aggressive their management. There are some exceptions, including a proportion of patients with limited pulmonary disease who have a long survival after lung metastasectomy as well as a fraction of patients (30%) among those achieving complete response (CR) after chemotherapy (accounting for 1–3% of patients with metastatic disease). For the majority of patients, the goals of treatment include palliation of symptoms and prolongation of survival with improved quality of life. Given this fact, one needs to consider how aggressive the treatment should be in order to balance the hoped for benefit against the inevitable toxicity. One important question that remains open is whether combination chemotherapy is better (in terms of overall survival [OS]) than sequential administration of active single chemotherapy agents...

The key role of chemotherapy in the management of STS is in the palliation of advanced disease. Active agents include doxorubicin, often used as a single agent, and ifosfamide. The combination of these two agents may produce a more rapid response and an increased likelihood of tumor shrinkage, but it is not yet clear whether there is a definite advantage to the use of combination therapy in terms of survival. Adjuvant chemotherapy for STS remains controversial but may be advantageous in certain situations, for example, where optimal RT cannot be given and local control is vital. Individual disease types are now treated differently, for example, synovial sarcoma is particularly sensitive to ifosfamide, angiosarcoma to taxanes and leiomyosarcoma to gemcitabine or the combination of gemcitabine plus docetaxel..."

From: Update on gemcitabine and docetaxel combination therapy for primary and metastatic sarcomas. Hensley ML. Curr Opin Oncol. 2010 Jul;22(4):356-61.

Role of chemotherapy in the management of soft tissue sarcomas. Krikelis D, Judson I. Expert Rev Anticancer Ther. 2010 Feb;10(2):249-60

Day Two After Chemo...

Marco had been feeling fine after the chemo on Tuesday...he is starting to experience the dry mouth syndrome after the first couple of days with the other chemo's he would experience this too. So it was expected...he looks a little tired but doing well.

Marco is getting a different type of chemo this time. Marco's sister will be posting it later if you are interested in reading about it and what it is used for and what it does. So he will be going down to COH and coming home after each chemo. He just had one on Tuesday and will return next Tuesday ( 8 days later) for two chemos and get an immune system boost shot the next day.

Thank you all for your thoughts and positive vibes you all having been sending. We appreciate them all.

Fighting On!

Tuesday, August 24, 2010

Starting Chemo Again

Our lives have been shaken up by the thought that Marco has to again endure all the probing needles, dealing with the IV hook-up's, dealing with the aftermath of nausea, vomiting, possibly loosing his hair yet again, dealing with the chemo brain in such a short amount of time ....this time around.
I wonder how strong these chemo that they are going to give him this time are going to be. It's going to be 2 rounds of this shit to shrink them.

Really putting my positive energy that he is able to tolerate it as well as he has had in the past. I hate this, he is called in and is read what the bag says, like we know what the hell it means. "You will be getting this, this, some of that, along with this, with an explanation of what each does and it should run about this amount of time."

There is something about seeing the shit dripping into the the chamber before entering the tube that will eventually go into his veins.
As soon as you know it went in, the pit of my stomach just tightens and all I can think about is I fuck'n hope it works.

Well, today Marco will start a new regimen of Chemo. Out Patient: He will get first dose this morning, he will return in eight days and get the second dose. Then go back to get a Nulasta shot to boost up his immune system.
After twenty-two days he will again do the same as above mentioned, x-ray's will be done to see if the tumor has shrunk. If so, the plan is to do surgery to remove it.

The tumor is near the chest wall, up on his scapula. Surgery would be performed by Dr. Trisal. This would be a big surgery, reconstruction and cosmetic construction would be need too. He will have a longer recovery and with that lots of pain.

Handsome, I know that this is going to be another physical as well mental challenge for you. Let's see what this chemo does.....I hope it takes out this SOB for good! Time to take out the warrior outfit, I know you have it in you to face this shit again. You know that we all stand behind you on any decision you make.

Positive vibes with lots of love that this chemo does what it has to do. We all love you very much!!!!!! I want to say that I appreciate all that you do...for yourself and for us to get better, and the kids know all the extra effort you put in for them too. As stupid as this may sound but thank you ......for fighting everyday and continue to fight for your life these last 3 years.

Monday, August 23, 2010

WE WANT OUR ROAD TRIP MOMENT BACK!!!!!

What I would have given to hear that the fishing trips that we have taken , had taken a tole on Marco's surgery area. That would of been the best words out of the doctors mouth. Instead the words that we all dread were uttered out of the doctors mouth " Well, the cancer is back"; even thought we had an incline that it may have been the case, you are never prepared. It still hits you like a fuck'n pile of bricks.

Marco had already made a decision to not do anymore chemo treatments or surgery's but has now taken a second look at things and has decided to go ahead and do the chemo. Going in with mixed emotions, he is the one that is going through all this and he is the only one that has to deal with all this shit. I can only go by what he is feeling by looking at him and seeing the look in his face that he feels like shit.

We had just taken that beautiful coastal road trip a couple of weeks ago. In that time I can say that we left cancer behind us and we didn't think of COH we didn't think that maybe something would be growing inside Marco. It was a peaceful road trip we didn't even get on each others nerves. We all enjoyed each others company....it was the best time we have had as a family that we all enjoyed. Who knew that this awesome feeling would come to a straight halt.

Why can't we just stay on the "road trip moments". Why doesn't this SOB just stop growing and coming back. Why did all this happen in the first place? Why is this happening again?

Marco has to deal with chemo again and it's unfair........he says it's the worst thing someone has to go through. Not to mention all the surgery's he has had and all the pain that comes with the aftermath.

Selfish is the word that came to our minds in the last couple of days.....is the person who is going through cancer selfish for not wanting to go through all the shit with chemo and surgery. Are they selfish that they need to think twice before saying yes to harsh treatments , selfish to say I DON'T WANT TO GO THROUGH THIS ANY MORE!!!!! to put themselves first besides their children, wife, family and friends. This is one the hardest things that goes through Marco's mind. I had to take 3 steps back and say you are right.

The same way we are selfish to say you need to do the treatments, chemo, surgery's, radiation, even though we know all the shit that he goes through because he has gone through it before and "He can do it!".....I am not sure anymore....and neither is Marco.

We are selfish to think that all this shit needs to be done for the kids, for the wife, for the family and anyone else. I feel selfish to think that he may be doing all of this because he feels he has to prove a point, not to look like he is giving up, the pressure he feels of letting family down. When will enough be enough..........Marco has had to make one of the most difficult decisions in his life. It all comes down to damned if you do and damned if you don't kind of decisions. At the end Marco is the one to make that decision and we all need to respect his decisions. Whether we like it or not.....we are not the ones going through all this shit.

Today was the one of many devastating days to hear that the cancer is back. You can't imagine the anger that I feel...it is just overwhelming in ever way possible.

Marco will start chemo tomorrow because of the 1% something will help, but 99% of his entire being is saying he should not be doing it.....that outta tell you something.

Tuesday, August 17, 2010

Worried It May Be Back Again.....

Well, its been about 3 weeks since Marco last saw Dr. Chow at COH. He recommended that Marco get a full body PET Scan because there was something "worrisome". Dr. Chow wasn't 100% sure what he was seeing in his CT Scan, that was taken prior to his last visit. Tomorrow he will be having this test done.

As of Sunday he has been slowly feeling some pain more than other days. At first he thought it might be from going fishing, but last night he had a fever and he says that the pain is that of when he first got out of surgery. We are now worried if this SOB is back again.

My friend Karen posted on Facebook a couple of weeks ago that she hoped it was something stupid they would find. To some this may sound harsh words or some may even find it offensive but I know exactly what she is saying.....I am hoping for STUPID right now. STUPID would mean that there would be nothing there but scar tissue and what they saw there 3 weeks ago is no longer there now. I wouldn't even be mad that they made a STUPID mistake, I told her that I never thought STUPID could be something good and right now STUPID would be great news.

But it is "worrisome" when there is extreme pain with fever and not know were it is coming from.

You all know that Marco is not one to complain but he is now. He can't stop massaging his arm and his left side were the surgery area is. His face says it all, there is something going on....I am wishing positive vibes your way Marco that it's something STUPID and that they take this pain away.

This is one of those helpless moments that you can't do a damn thing to take his pain way. Wishing I could do more but I can't so the waiting begins for the results to find some answers to a million questions. We will keep you posted.......

Thank you to all for all your thought and positive vibes...

Tuesday, August 10, 2010

Get Together



Here in this picture is Sal, Monica, Laura, Beto, NoNo, Liz, Marco and myself posing.




All the kids with their dad's .......


All of the guys had fun laughing and reminiscing of good times and all they did. They would all want to get together every time they would see each other. They would make comments that let's get together and BBQ and bring all the family. Till I go tired of hearing them and I made it a point and called everyone and they all came to the park and had a great time. Who knew that this would happened after so many years .....that I would be the one to call them to get together...if someone would have told me that 20 some years ago I would of thought they were crazy...funny how things come about....
The smiles just show you that they all had a great time! Marco especially had a great time hanging out with his old buddies.

Monday, August 9, 2010

Feeling Well Enough .......

July 21st, Marco decided he felt good enough to take a 3/4 boat out to go fishing. NoNo and Nito joined in all the fun. Marco did pretty well out there.




DLP posing while we wait for the bait to be placed in the holding tank on the boat.





Nito holding a Mackerel as he does a catch and release

Nono finishing up his breakfast burrito on the boat.




Here are the boys as we arrive at 3am to the 22nd Landing



I haven't written in quit a while so I will try to update this blog up to were we are now. I will be going back in time after I get some pictures of DLP's 16th birthday when I get the pictures to show you. Marco has been doing well.