{"id":1239,"date":"2011-06-10T00:16:43","date_gmt":"2011-06-10T00:16:43","guid":{"rendered":"http:\/\/www.ackc.org\/?p=1239"},"modified":"2012-01-27T18:57:23","modified_gmt":"2012-01-27T18:57:23","slug":"mdx-1106-out-with-melanoma-in-with-hepatitis","status":"publish","type":"post","link":"https:\/\/www.ackc.org\/jayedit\/mdx-1106-out-with-melanoma-in-with-hepatitis\/","title":{"rendered":"Out with Melanoma, In with Hepatitis"},"content":{"rendered":"

Note: This\u00a0article\u00a0<\/a>is cross posted from The Kidney Cancer Chronicles.<\/p>\n

If you\u2019ve been following this blog, you\u2019ll know that Dena and I have been doing a little disease shopping lately. We\u2019ve gotten bored with kidney cancer and are checking out other life-threatening diseases in order to put a little spark back into our marriage.<\/p>\n

We flirted with melanoma, but the dermatology surgeon who performed the biopsy confirmed for us that the lesions were not malignant but were SKs \u2013 lesions that have many of the characteristics of melanoma but are harmless. Our oncology team was delighted by this news, not to mention Dena and me. Not only do we not have to deal with a second primary cancer but we get to stay on the MDX-1106 trial.<\/p>\n

Or so we thought. But, today, I decided to dabble in hepatitis.<\/p>\n

I know, right?<\/p>\n

I was just doing my own thing, minding my own business, getting needled up this morning at Johns Hopkins when Fabulous Alice, my trial nurse, showed up at the infusion center with bad news. Evidently my \u201caspartate amino tran,\u201d which sounds like some kind of Latinate curse, is sky high. The normal range for people is between 0 and 37, and for the previous months mine has ranged around 20ish. Today it was 254. This is a \u201cGrade 3\u201d something or other, according to the trial\u2019s protocol. I guess it\u2019s like DefCon 3 without the shock and awe. Maybe just a little shock. It could result in hospitalization.<\/p>\n

And there\u2019s the old \u201calanine amino trans.\u201d (Seriously, who comes up with these terms? Clearly a drunk, which, I guess, is appropriate for liver disease.) Normal range here is between 0 and 40, and mine is 91. This is only a Grade 1 kerfuffle. (I enjoy the word kerfuffle. You should try it sometime. Why can\u2019t I have a Grade 3 Kerfuffle? That would be awesome.)<\/p>\n

So when Alice showed up talking about aspartates and alanines, I did what any reasonable person would do: I slapped her around a couple of times and told her to go sober up. But she wouldn\u2019t leave. So I asked her to translate.<\/p>\n

\u201cBasically, your liver is inflamed. You have hepatitis.\u201d<\/p>\n

\u201cHepawhat?\u201d<\/p>\n

\u201cTitus.\u201d<\/p>\n

Blank look.<\/p>\n

\u201cHave you been drinking?\u201d she asked.<\/p>\n

\u201cYou\u2019re the one blathering on about ala-thingies.\u201d<\/p>\n

\u201cSeriously. These kinds of numbers usually indicate heavy drinking. The kind that abuses the liver.\u201d<\/p>\n

\u201cNo, no, no \u2013 you\u2019re thinking of my wife.\u201d<\/p>\n

\u201cNo drinking then?\u201d<\/p>\n

\u201cNo.\u201d<\/p>\n

I think she actually wanted me to say yes. That would just mean that I\u2019d just need to dry out and the numbers would go back down. However, as most of my friends now complain, I hardly drink at all anymore. An occasional bourbon on a weekend evening, a beer after a round of golf or something. Nothing to cause this. Which means we don\u2019t know what is causing this surge in liver enzymes. A potential culprit, which could be disturbing, is the drug \u2013 MDX-1106.<\/p>\n

You may remember that when I started this trial, one of the more dangerous (though rare) side effects listed was autoimmune disease. MDX-1106 is a drug that, in a nutshell, kicks the immune system into high gear to fight the cancer. Sometimes this goes awry, and the immune system goes a little berserk and attacks your body\u2019s healthy organs. This could be what\u2019s happening here. Which could be serious, as it could shut down my liver, which is in itself a potentially fatal development.<\/p>\n

However, there are treatments to deal with the hepatitis. If my enzyme counts don\u2019t go down, they will hospitalize me and begin these treatments as soon as next week. Unfortunately, should it come to that, I will not be able to continue the trial, as the hepatitis treatments are steroidal in nature. Any steroids would interfere with the immune system, and therefore interfere with the MDX-1106.<\/p>\n

Our concern over the past few weeks about the melanoma was, in some ways, less about the melanoma and more about the potential to be forced off the trial. Caught early, the melanoma could have been cut out and, likely, that would have been it. Similarly, although hepatitis can be dangerous if not addressed, I feel confident that we can take care of it. The concern is at what cost.<\/p>\n

At this time we don\u2019t really know if this will play out negatively. The enzyme counts spiked overnight; maybe they will go back to normal overnight in a similar fashion. The oncology team canceled today\u2019s MDX infusion, and scheduled a new round of bloodwork for Monday. At that time, the counts need to drop by at least half. If they do, we\u2019ll likely move forward with the treatment on Thursday. If they don\u2019t, then we\u2019ll have to consider our options.<\/p>\n

So we\u2019re trying not to stress too much about it at the moment. Until we know what Monday\u2019s blood draw shows, there\u2019s no point. Besides, I have bigger problems. Congressman Anthony Weiner keeps leaving angry messages on my answering machine and Twitter account due to Dena\u2019s last blog post.<\/p>\n

And for the record, I did not have tweets with that woman.<\/p>\n","protected":false},"excerpt":{"rendered":"

If you\u2019ve been following this blog, you\u2019ll know that Dena and I have been doing a little disease shopping lately. We\u2019ve gotten bored with kidney cancer and are checking out other life-threatening diseases in order to put a little spark back into our marriage. First we flirted with melanoma; now we’re dabbling with Hepatitis.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[9,46,47,12],"class_list":["post-1239","post","type-post","status-publish","format-standard","hentry","category-blog","tag-kidney-cancer","tag-mdx-1106","tag-mdx1106","tag-rcc"],"_links":{"self":[{"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/posts\/1239","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/comments?post=1239"}],"version-history":[{"count":11,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/posts\/1239\/revisions"}],"predecessor-version":[{"id":1763,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/posts\/1239\/revisions\/1763"}],"wp:attachment":[{"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/media?parent=1239"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/categories?post=1239"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/tags?post=1239"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}