A change in treatment

Doc H2 had been in contact with Doc P and gone over Alan's previous treatments. He is proposing treatment with two new drugs that we have not used before, Docetaxel and Gemcitabine. These aren't considered first line therapies for sarcomas since the other drugs we have been using have a longer clinical history. These drugs have approximately 30% response rate for all sarcomas, but we are looking at salvage therapy now.

The drugs will be given in a 21 day cycle - the Gemcitabine will be given on Day 1 over a 1-1 1/2 hour infusion. Then, both the Gemcitabine and Docetaxel will be given on Day 8 (1 1/2 hours for the Gemcitabine and an hour for the Docetaxel). So, in some ways this chemotherapy will be easier for Alan- only two days in the office over a week instead of five days in a row. Hopefully he will be able to tolerate these drugs well. After two cycles, Doc H2 wants us back at MD Anderson for scans.

In the mean time, Doc H2 will present Alan's case next week to the Joint Pedi Conference. Because of the holidays, he has not had a chance to consult Doc HJ about the resectability of the tumor. This will also be a chance to consult the radiologists on Alan's case. Proton Therapy would be preferable since it would tightly focus the radiation with less risk exposure to the nearby organs. Whether they decide on Proton Therapy or conventional radiation therapy, he will be six weeks in treatment.

At first, Doc H2 was considering waiting until the conference made some decisions on Alan's treatment before going ahead with the new chemotherapy plan, but we were nervous about not hitting back at this tumor as soon as possible. With the tumor resting against Alan's nerves, we didn't want to risk any further involvement in his spine. And though the previous treatments were obviously not enough to keep the tumor from growing back, they were protecting Alan from metastasis (the undifferentiated sarcoma has a much higher chance of metastasis than infantile fibrosarcoma we thought he had at the beginning). Shrinking the tumor will also make any surgery or radiation therapy go easier and ease any pain that the tumor has been causing Alan. So he will be in touch with Doc P to confirm the new plan.

We'll be back in the third week of February.