Positive First Step

We got the news back on the first scan for Elle since she started her new treatment. And the news was positive.

The metronomic chemo dosing, combined with the anti-angiogenic drugs, has greatly reduced the tumor's growth after the first round. In this kind of treatment, that is actually what you want to see. When you start, it still takes time for the newest part of the tumor, and it capillaries, to be shut down. But the treatment seems to be working. They had to measure the scans several times to identify where any growth had taken place at all. So now we start round two and hopefully we see even less growth or possibly a complete halt.

What this has done for now, though, is reopen a possibility to reducing the tumor's size. There is a procedure known as embolization, which is basically identifying a blood vessel that feeds only the tumor and injecting it with a gel that completely blocks the flow of blood. Which, in turn, kills that section of the tumor. If we could use this procedure to reduce the size of the tumor, then even more possibilities could open up. But for now, the focus is on seeing if we can possibly do this.

After months of bad news, to hear some good news was...I don't think "amazing" is too strong of a word to use here. And Elle's appearance and energy have been remarkable. She seems more like old Elle than she has in a long time.

So keep your fingers crossed for more good news. But today is a good day indeed.

Update on Elle

I apologize for the lengthy absence of updates on the site. It has been a busy couple of months.

We are pretty much still where we were after our visit to Dana-Farber in April...hoping that these options we have will work. Elle had a double dose of Cisplatin/Doxorubicin and Etoposide/Ifosfamide in May and early June that all but brought the tumor to a halt. But now she has a little trouble absorbing the fluids used to hydrate her for these chemo rounds. Due to the location of the tumor near her heart, it has to work harder to re-absorb all that fluid. So it makes it much harder.

So now Elle is doing something called metronomic dosing, which is taking smaller doses of chemo every day as opposed to large does over a short period. There is some encouraging literature on this idea. And we are combining that with an increase in anti-angiogenesis treatment. Elle was taking Celebrex to begin with and that is continuing. But we have added two more drugs to the mix that do the same thing (kill blood flow to the tumor/stop its growth).

The first is fenofibrate, which some people may know as Tricor. It's an anti-cholesterol drug that also seems to have a good response in fighting tumor growth. The other is an older drug that raises eyebrows: Thalidomide. Since Elle isn't in any danger of getting pregnant, it is relatively safe for her.

The hope is that these three drugs, in combination with oral daily low-dose chemo (Etoposide and Cyclophosphamide) will halt the tumor's growth and (fingers crossed) begin to even bring it down a little. And there was a good discussion with the radiology department. If we can definitely halt the tumor's growth, we may be able to start targeting parts of the tumor with radiation therapy. And if that happens, who knows...

But with all this, Elle has still been full of energy and life and joy. Here is a picture of her and her brother on vacation in Vermont last week.

And here they are as Ben and Jerry

Hard News

We met with the doctors at Dana-Farber yesterday. Unfortunately, her tumor's size, combined with its location, makes radiation therapy a non-starter. The resultant damage to surrounding tissue would be too great.

We've also exhausted the conventional treatments for PPB. Which means we are now into the more "fingers crossed" types of treatments.

We're starting on Monday with a re-visit to the Etoposide/Ifosfamide treatment she had after the surgery date was canceled in December. That combo actually halted the growth of the tumor. So hopefully we will get a similar result.

There is another treatment called Anti-angiogenesis, which targets the blood supply to the tumor. This would be a combo of low-dose etoposide on a regular basis combined with Celebrex. Yes, it's originally an arthritis drug that got some bad press because of related drugs like it that were causing heart attacks in elderly people. But Celebrex survived, in part because it has shown some promise in cancer treatment in combination with chemotherapy.

And then there are the "Phase I" trials, where a patient is given a new treatment to find out how safe it is and to find the best dose for future studies.

Beth and I decided to pursue the chemo options while also making Elle available for the Phase I trials. Basically, we are leaving no stone unturned.

It was hard to get that news yesterday. You are in a weird place when you are disappointed that the doctors don't want to irradiate your daughter's chest. But I still believe that Elle is going to beat this thing. I can't see another outcome. She is just too damned stubborn.

Back To The Drawing Board

Elle's latest round of chemo just finished and, unfortunately, the tumor hasn't stopped growing. On the upside, the rate of growth was slowed. And, most importantly, it is still just the single tumor. Even more importantly, Elle is still full of energy and positive attitude.

So there are a few things that could happen now. We could try more chemo. We could go ahead with radiation therapy. There are some Phase 1 trials at Dana Farber that could be investigated. And there is discussion of a possibly biopsy. Apparently, in extremely rare cases, the type of cancer can change. So there are still a lot of options and choices on the table.

It's another disappointment, but actually better than the last couple of times. But in the end we will beat this thing. Elle simply won't allow any other outcome.

Here she is, showing off a very blue tongue after eating a very blue Fruit Rollup.

Walking for Elle

My sister-in-law's sister-in-law, Michelle Harlfinger, is doing a charity walk in Massachusetts, the 11th Annual Champions Fighting Cancer Walk. She is graciously and wonderfully walking for Elle. So if you can give little, please visit her page. Because everyone should be able to get the care Elle is getting.

Thanks, Michelle!

Keepin' On Keepin' On

Well, the unfortunate news is that the last round of chemo did not reduce the tumor. It actually grew some more. That was very disappointing to say the least. What made it bearable at some level is that Elle continues to have a ton of energy and vigor. She is chasing the cats, demanding that books be read to her and eating hamburgers like it was going out of style.

That said, we have another chemo combination to try. We are introducing a new drug here called Vinorelbine. It is related to the Vincristine that Elle has received so many times. You may be asking "What makes it different?" I really don't know, to be honest. But we are combining it with our old friend Cyclophosphamide, but in a pill form and in a lower dose.

So why use a drug that didn't work the last time we used it? Apparently there is an emerging body of literature that suggests that combining it with the Vinorelbine can be effective against cancer types like Elle's. It's like drinking gin. You mix it with chocolate milk and it tastes like crap. But mix it with OJ and you have an Orange Blossom. The gin isn't any different, it just works better with something else. Obviously, we're hoping that this is the Orange Blossom of chemo treatments.

The other good thing for Elle is that this treatment takes relatively little time each day. The Vinorelbine is a push through her line and the Cyclo is in the aforementioned pill form. It will take all of 10-15 minutes each day for her to get the treatment at the clinic. This pleases Elle immensely.

There may be some form of chemo next week as well...that has yet to be determined. But we now have another plan and we are forging forward.

Just a Pic

Elle enjoys frosting!!