TR: Oncologists

[Plakespear]

Well, yesterday was spent talking to doctorsw about coming up with a strategy to kick the shit of of cancer yet again. The poor bastard doesn't get it. Every time he tries something, I just give him a big wallop. Well, this time, I think I'm just going to have to beat the poor sucker so bad that he doesn't come back. Ever. The problem is, I'll probably have to take a bit of a bigger beating this time as well, kind of like Ali did when he beat George Foreman.

So after much deliberation, I am planning on doing the interleukin 2 treatment, most likely at Columbia Presbyterian in NYC. It's pretty close to the Back Page, so you NYC maggots can stop by and see me before you go out for beer and wings. While this isn't set in stone yet, this is probably the best plan of attack for me for this round (which I hope is the final round).

Unfortuantely, this doesn't bode well for a South America trip this summer. My immune system probably won't be up for flying thousands of miles to a less than first world country. So I guess I'll have to rage extra hard at the COLORADO summit next winter, where I'll take some of the money you guys are trying to raise for me and buy some beer and liquor for you all. And if I have anyhting left over, I'll give Max and AKPM a few singles and steer them to the nearest titty bar.

[slippy]

Good luck!

[marshalolson]

Well, yesterday was spent talking to doctorsw about coming up with a strategy to kick the shit of of cancer yet again. The poor bastard doesn't get it. Every time he tries something, I just give him a big wallop. Well, this time, I think I'm just going to have to beat the poor sucker so bad that he doesn't come back. Ever. The problem is, I'll probably have to take a bit of a bigger beating this time as well, kind of like Ali did when he beat George Foreman.

HELLYEAH! thats the attitude!

[Joey Joe Joe Junior Shabadoo]

Best of luck. I know IL 2 can be a pretty awful while you are getting it but I am sure you will make that cancer your bitch. Keep your chin-up and know we are pulling for you.

[tarkman1]

We'll hold you to your claim to be at the next summit. I'm thinking you will not have buy a single beer.

[XtrPickels]

get after it plake!

[hutash]

Get some cancer ass, remember attitude is all important, keep up that kick ass 'tude, and you will kick it.

[Sutter]

Nils, keep us all in the loop about how we can help. And kick some ass!

[GoldMember]

When you get it down with your foot on its windpipe, don't let it up. Hang in there and good luck. Looking forward to the SA TR next summer!

[CUBUCK]

Let me know when and where and I'll be sure to stop by. Give it hell!

[Buzzworthy]

I am planning on doing the interleukin 2 treatment, most likely at Columbia Presbyterian in NYC.

Nils, can you expand on what this treatment entails and why you chose it?

Holy cow, I looked up this treatment on Google.

Are you looking at in patient High Dose or Outpatient.


What I found quickly

What Is Interleukin-2?
Interleukin-2 is the only drug approved in the US for the treatment of metastatic RCC. It is also approved in many other countries. But IL-2 isn't just a drug. IL-2 is a natural part of your immune system, a messenger protein called a cytokine which activates parts of your immune system. IL-2 does not kill tumor cells directly like classical chemotherapy. Instead, IL-2 activates and stimulates the growth of immune cells, most importantly T-Cells, but also Natural Killer Cells (NK Cells), both of which are capable of destroying cancer cells directly.

There are several types of T-Cells but, without going into detail, certain T-Cells are capable of killing tumor cells if they recognize a specific antigen on the surface of the tumor cell. Antigens are normally proteins. Each T-Cell is specific for only one antigen but you have many different T-Cells. NK Cells have the ability to kill tumor cells without needing to recognize a specific antigen (I'm not sure how!). While this sounds good, NK cells are weaker cancer killers than T-Cells. The so called LAK cells which were used in some of the early immunotherapy experiments are actually NK cells.

Why IL-2?
Back in 1989 my goal was a cure or at least a long remission and it is probably your goal now. In my view, the proven chance of getting such a result is the reason to try IL-2. At this time the only other therapy I know of that has this kind of long term result is surgery in some cases. I explore the documentation for and odds of getting that kind of result from IL-2 in detail in my pages on specific IL-2 therapies.

Why Not IL-2?
Although the therapy rarely causes serious permanent damage, it's more or less miserable while you're getting it, and often more rather than less. Most importantly, only a small minority of patients get the kind of long term relief that is the reason to try it. In the end whether it's worth it to endure the side-effects of IL-2 for a small (but the best known unless surgery is also an option) chance at a great result is strictly a personal decision. In my case, I was 33 years old and quality of life wasn't an issue since the disease had already taken that from me. I had nothing to lose. You might feel differently.

IL-2 Eligibility
IL-2 eligibility always a matter of clinical judgment - it's not like eligibility for a clinical trial which is mainly determined by rigidly specified criteria and it's not a legal thing either. Requirements to take IL-2 vary somewhat according to which IL-2 therapy it is and I do discuss additional requirements for specific IL-2 therapies in articles on each therapy, particularly high dose IL-2, which is more rigorous than other IL-2 therapies.

Some Typical Requirements
Some patients are too sick to tolerate IL-2 treatment. If you cannot get out of bed for more than short periods, or require oxygen, then IL-2 is probably not an option. At the same time, you can still be quite ill and take IL-2 treatment, even high dose IL-2. At the time I started my treatment, I had lost a great deal of weight, was not quite recovered from surgery, was slightly anemic, and in rather severe pain from my bone metastases. Despite this, all of my major organs were functioning normally, and as it turned out, I not only tolerated a high dose IL-2 protocol but was able to take more of the treatment than most. Don't count yourself out!


If you have brain active metastasis, IL-2 is contraindicated. If you had brain metastasis but it was surgically removed or effectively treated with radiosurgery and now have metastases in other areas, such as the lungs, then IL-2 based treatment is a possibility. I once met a patient who had very widespread metastasis, including a brain lesion. He had surgery for this brain lesion, and then had high dose IL-2 and all of his remaining tumors vanished! When I saw him, this formerly "hopeless case" looked and felt well and he has good prospects of staying well. If you have active brain metastasis then you need to get that taken care of first. See my article on brain metastasis for more.


If you need to take steroids such as cortisone, decadron, or predinsone, then IL-2 treatment is unlikely to be effective because these drugs suppress the immune response. Many patients with brain metastasis require steroids after surgery for some time to control brain swelling. Steroids are prescribed for many other unrelated conditions as well, and you may wish to consult with your doctor to see if other methods of treatment would be possible if this is the case. If you've lost adrenal function because both adrenal glands were removed surgically, then you will need steroids to replace the amount your adrenals would have made. I don't think this use of steroids merely to give you a normal level would prohibit IL-2 treatment.


If you have another serious medical condition, you may not be able to take IL-2. This would include diseases which seriously affect the function of your heart, lungs, kidney(s) or liver, as well as serious auto-immune diseases such as lupus. Again, many people with another medical problem can still take IL-2 treatment. In some cases they would be limited to outpatient versions. Again don't automatically count yourself out. I recommend getting an opinion from an expert in IL-2 treatment if there is any doubt at all. For instance, if you've lost both kidneys and are on dialysis IL-2 may still be possible.
IL-2 Therapies
There is a bewildering variety of different IL-2 regimens. Many different dose levels, methods of administration, and as well as schedules and combinations with other drugs have been tried and more than a few are in current use. While I don't cover them all in CancerGuide, I do cover the most commonly used and of course anything I find that looks especially promising.

For detailed coverage of specific regimens, see:
Classic High Dose IL-2 Therapy, the oldest and best proven version of IL-2 therapy, this is an intensive inpatient treatment usually given in ICU.
Selected Outpatient IL-2 Therapies, including some of the outpatient combination therapies.
New and Experimental Therapies, which includes any new and promising IL-2 therapies.
Notes on IL-2 Administration and Dosing
It's very helpful to understand IL-2 dosing when comparing the details of different IL-2 protocols. You may not be interested in these minutiae now, but as you get further into the details you may want to come back and give this section a closer look.

It will be helpful to read my general article on Understanding Cancer Drug Dosing first.

Administration
Because IL-2 is a protein it can't be given by mouth because you'd simply digest it, so it's normally given by injection (it has also been given by inhalation on an experimental basis). Outpatient IL-2 is given by injection under the skin (subcutaneous), much like the way diabetics inject insulin. Most patients learn to self inject. Inpatient IL-2 is normally given by injection into the vein (Intravenous Infusion). IV dosing can either be a continuous infusion (CIV) or more usually, a dose is given over a short period every few hours. This is called bolus dosing. The Classic High Dose IL-2 Protocol uses bolus dosing.

How IL-2 is Made
This isn't essential reading but it is pretty interesting!

Proteins like IL-2 are huge molecules made of dozens of amino acids linked together. A single amino acid is a relatively small molecule. A protein is very unlike typical small molecule drugs like aspirin, most chemotherapy drugs, and in fact most drugs you've ever heard of. Small molecules can be synthesized in a chemical plant but it isn't practical to make proteins by ordinary chemical synthesis.

But every cell of every living thing knows how to make proteins which, among other things, catalyze most of the chemical reactions necessary for life. The instructions for making a particular protein are encoded in the gene for that protein. To make IL-2, scientists transferred the gene for human IL-2 into bacteria (nice trick!). The bacteria then make the IL-2 protein in large quantities, which can then be purified as a drug (another nice trick!).

[verbier61]

kick it right in the ass, bro! I am an hematologist-oncologist, just PM me for any info you might be interested in. If folks at columbia are proposing you the low dosage IL-2 schedule, then your south america trip might not be spoiled

[teleee]

Holy SHIT Plakespear, I have been gone from the board for a while and just saw this. Damn dude, best wishes, my prayers are with you. Good luck!! And I second the I doubt you'll be buying beers at any summits for quite some time.

[BushwackerinPA]

dude you have cancer but yet are more worried about using your money and buying us beer, and showing Max and AKPM to the nearest tittie bar.

You ll beat you deserve to.

[gravitylover]

Damn.

678

[steve]

It's pretty close to the Back Page, so you NYC maggots can stop by and see me before you go out for beer and wings.

We'll have to sneak some beer in for you..
We'll kick its ass with chemo + alchohol!