Day 22 - Yesterday's meeting with the doc

Kent, Sherri & Natalee met with Dr. Olsen, Natalee's oncologist, yesterday (I hung out in the room too, so I could understand the treatment plan and be able to share it on the blog). Dr. Olsen consulted with several different doctors and cancer centers to help determine what the best course of action would be. She spoke with Dr. Brendan Curti at Providence Cancer Center, with the doctor at MD Anderson Cancer Center in Houston who is running the clinical trial as discussed earlier, as well as oncologists at the Mayo Clinic and UCSF (where they are currently running a clinical trial on the drug that Natalee will be using).

After analysis and testing on the tumor, they were able to determine that there were a great deal of VEGF proteins in the tumor, which gives them information on what the cancer's characteristics are and how to fight or supress.

Dr. Olsen decided to place Natalee on sunitinib (phonetically, it is sue-NIT-tin-ib, the brand name is Sutent). She will take 37.5 mg once a day (in capsule form), every day for 28 days. Then she will take a drug holiday for 14 days. Those two events are considered one cycle. She will undergo 9 cycles of treatment. At the end of each cycle there are tests and scans to measure and assess how effectively the drug is working.

The side effects that the doctor is most concerned about are:

• hand-foot syndrome
• diarrhea
• high blood pressure

Some other side effects could include:

• nausea
• skin discoloration
• it could make her hair lighter in color
• altered taste

As a result of the side effects, Natalee will have to limit her involvement in basketball and volleyball. :-( She needs to keep her body protected from any activity that is jarring on her bones.

Natalee has three separate groups of enlarged nodes, two on her left lung and one on the right lung. At the beginning of the second cycle of treatment, they will take another full set of bone scans and then again at the beginning of every even-numbered cycle (fourth, sixth, eighth) to see if the spots in her lungs are shrinking. Most likely, after the insurance authorizes the medication (it costs approximately $7,000 per month for this drug), they will start the treatment next week, maybe Tuesday or Wednesday.

Today marks the 14th day after her surgery, and she was able to go to the appointment yesterday with absolutely no pain pills. Not even Tylenol! She looks great and demanded a milkshake and fries on the way home from the appointment, as she needs to put on some weight.

Just one more note, Natalee needs to avoid grapefruit juice and St. John's Wort while she's on the sunitinib. So if you were planning on making her cookies laced with St. J's Wort, you'll have to scrap those plans. I'm pretty sure she'll prefer chocolate chip anyway. ;-)