update: proposed treatment and status


These are notes from Prof. Baum in Germany. I think it helps explain the current condition and proposed treatment regimen better than I can.

"Anthony has several extremely hypermetabolic (FDG-avid) lesions, which usually is a sign of tumor aggressiveness. Therefore he has – according to the new NANETS/WHO classification of 2010 (see attached) – a so called mixed neuroendocrine carcinoma (see page 609) which was also confirmed by the immunohistochemical studies we have performed on his primary tumor in the pancreas tail and the liver mets."

"I proposed to him yesterday exactly TEMODAR+XELODA for chemo (A more aggressive alternative (if this combination fails) would be Cisplatin+Etoposid.)"

"However, one could try first SUTENT for 4 weeks (approved for pancreatic NET in Europe) or NEXAVAR (Sorafenib) or AFINITOR (Everolimus), then repeat the FDG-PET/CT and measure the metabolic response to the treatment with one of the kinase inhibitors. If it fails, then persue with TEM+XEL, if it works we would do follow up every 3 to 6 months. 5-FU alone is not effective in our experience."

"Actually the Ga-68 DOTATOC SMS receptor PET/CT (done yesterday) showed that there was obviously a very good response of the differentiated metastases as the somatostatin receptor positive lesions have nearly gone (there are only few weakly positive lesions seen in the residual liver and there are no extrahepatic sites)."

"I suggest that he has in addition a EUS (eventually with biopsy) with special focus on the pancreas head/corpus as the FGD-PET/CT shows a very hypermetabolic lesion in this region (attributed as “aortocaval lymph node” in the PET/CT report) which could, however, also be a second primary tumor in the pancreas."

Comments

Post a Comment

Popular posts from this blog

Tickets to Germany: Bad Berka

Image
A blurred landscape photos for no good reason... We have our tickets for Germany. -Flying into Frankfurt arriving the morning of February 6th. On the 7th, we take the train to Bad Berka. Scan on the 8th. If the scan looks ok, we will proceed with surgery in Omaha with Dr. Botha. But before heading back to the US, we'll take the train to Berlin, and fly out from there on the 13th. If the scan is not so great, i.e., too many tumors in the liver to operate of extensive disease, we will see if I can stay for PRRT treatment. I'm not sure if this is an option at this time with respect to scheduling in the hospital, etc.... I still need to work out some logistics... that is, how does my surgeon in Nebraska review the imaging from the scan? When will a report be completed? That's all for now...
Read more

...a long winded story not written all that well.

Image
A cornfield somewhere in Wisconsin: Taken with a Horizon 35mm panormic: Taken just after a spell of severe stomach pains. October.2008 So, here it goes, from the beginning: I've had recurring stomach pains for at least 4 years. For those who know me well, I’m a relatively “high-strung” individual… Ok, maybe I’m borderline OCD? Initially, doctors thought these stomach pains might be related to anxiety? But sometime late in 2007, my pain slowly started to get worse. Well, I thought it must be an ulcer or something? At times, I’d have these attacks that would last for days, stabbing. When the pain started to become more frequent in November of 2008, Andrea forced me to see a doctor. The doctors initially thought it might be an ulcer, or, an issue with my gallbladder. I was sent for an ultrasound in early December 2008… and this is when it all began. During the ultrasound they noted that I might indeed have gallstones, for which an operation would be required. In addition, they n
Read more

On the refrigerator...

Image
Just three years ago I was officially diagnosed with Cancer. Happy Cancerversary!!! But hey, guess what? I'm still alive and well... Fu*k you Cancer! If my next MRI at the end of March shows stable disease, I will have had no progression in 1 year (Currently 10.25 months stable). Every day that I can spend with my wife, my work, friends and family, I'm happy. Now... Here we come Europe! We leave Sunday for Switzerland and Italy (Photobooth business abroad!).
Read more