2 Surgeries==> then IL-2 ==> now Votrient/Pazopanib

Phoenix Rising said:

Stay happy and positive!
Moraboy, I am usually nutso just before a scan, and up to the day of my appointment to get the results. This time, I was wholly positive and had been so for weeks before the scan. I think a positive outlook does the body good! Let us know how it goes!

Texas_wedge said:

Scan results
I guess that with your particular platter of mets, Steve, it was improbable that it would be all good news. That said, it's got to be a major triumph that that huge kidney tumour has shrunk so much (is the percentage in linear measure? If so, then in volumetric terms it's now only a fifth of the size it was!) It's great that the plan is working and you'll be able to have a nephrectomy rather sooner. That large reduction in total tumour burden will improve the capacity of your immune system to fight the mets and at 50ish you have (comparatively) youth on your side.

I appreciate that there are questions of insurance/costs and also toxicity but a thought occurs to me. We know that a judicious use of a combo of drugs often produces a response much greater than the sum of the parts. The doc is thinking of switching you to everolimus and dropping the Votrient that has done a great job on your primary tumour. Might there not be a case for considering continuing the Votrient (perhaps at a reduced dose) and adding the Afinitor? The Votrient side-effects are relatively gentle, anyway. I have no idea about possible interactions between Votrient and Afinitor but one is a VEGF drug and the other an mTOR inhibitor and we know that RCC seems vulnerable to the old one-two punch combo.

Unless you think this is a stupid suggestion, maybe you could put it to your doc (and let us know the answer she gives)? It's good that your liver isn't so bad. How about the lymph nodes?

Are you continuing to teach? Anyway, it's great to hear that your mood and spirits continue to stand you in good stead. I hope it's onward and upward from here.

Texas_wedge said:

TW
Ange, it's actually best, with a primary tumour, to cut it out completely, if that's possible. If it isn't (Steve's was huge at 15cm x 15cm and awkwardly placed) then neo-adjuvant therapy to shrink it, with a view to making it operable, is desirable. At worst, shrinkage will lessen pain.

My BP is well up and I've just been given a presciption for a mild anti-hypertensive which will enable me to go on with intensive exercise without anxiety. I reckon the Votrient is working because my pain level has gone down a little.

Texas_wedge said:

Shrinkage
That's right, Ange - my oncologisr confirmed yesterday that there's been a gap from last scan to start of drug treatment such that we don't know exactly where we started from, considering the tumour was growing very rapidly. My next scan will be after 2 cycles on Votrient, so not until early January. I agree that if the pain keeps lessening it would seem like a promising sign.

I do hope you can get Mom to see Dr. Motzer soon and getting a second opinion is invariably a good idea, even if it leads to more head scratching. Please give her my best wishes.

Texas_wedge said:

TW
Ange, it's actually best, with a primary tumour, to cut it out completely, if that's possible. If it isn't (Steve's was huge at 15cm x 15cm and awkwardly placed) then neo-adjuvant therapy to shrink it, with a view to making it operable, is desirable. At worst, shrinkage will lessen pain.

My BP is well up and I've just been given a presciption for a mild anti-hypertensive which will enable me to go on with intensive exercise without anxiety. I reckon the Votrient is working because my pain level has gone down a little.

Texas_wedge said:

Shrinkage
That's right, Ange - my oncologisr confirmed yesterday that there's been a gap from last scan to start of drug treatment such that we don't know exactly where we started from, considering the tumour was growing very rapidly. My next scan will be after 2 cycles on Votrient, so not until early January. I agree that if the pain keeps lessening it would seem like a promising sign.

I do hope you can get Mom to see Dr. Motzer soon and getting a second opinion is invariably a good idea, even if it leads to more head scratching. Please give her my best wishes.

angec said:

Hi John, just seeing this

Hi John, just seeing this post now.. sorry this reply is so late.  Hope you and Alice are doing well.  How are the leg cramps? I have heard it can also be from some of the bp meds like Metroporal.  One thing I wanted to mention. The GP just told mom that gatorade is hard on the kidney function and should only be used if dehydrated.  Mom was severaly dehydrated and her creatinine is 2.42 so we used gatorade beause we thoguht she said to do so. On the visit on Friday she said no gatorade as it has alot of salt and sugar and not good for kidneys. Incidently, if they give intervenous in the hospital it usally also contains alot of salt and sugar.  So it leaves us to wonder which is the lesser evil.  Just thought i would pass it on since i had recommended the gatorade on another gps advice. Love to Alice and big hugs!

Hi Angec,

Please take the time, when you can, to review this video lecture given by Dr. Robert Lustig called, "Sugar - The Bitter Truth":

http://www.youtube.com/watch?NR=1&feature=endscreen&v=dBnniua6-oM

In it you will discover that Gatorade not only contains lots of sugar - but the kind of sugar it contains is High Fructose Corn Syrup (HFCS).  Fructose, unlike glucose, can only be metabolized by the liver.  In Dr. Lustig's (and so many others) view excess sugar should be considered a "chronic" (not acute) poison.  That is, unlike an acute poison such as arsenic, this one acts slowly over time.  Gary Taubes, wrote extensively about this in an article titled, "Is Sugar Toxic?" in the New York Times Magazine back in April 2011:

http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html?pagewanted=all&_r=0

Many sweetened drinks contain high levels of sodium (salt).  Then sugar (usually fructose) is added to it to mask the salty taste.  The result? You drink more of the beverage and yet still remain thirsty.  It is insidious.

The original Gatorade, developed by the University of Florida, used to taste just awful.  When Pepsi bought the rights to market and manufacture it they changed the formula to include tons of fructose to mask that awful taste...

Gatorade should only be consumed by atheletes.  The ONLY beverage that can safely relieve hydration is called water.

angec said:

Thank you Nano Second, i will

Thank you Nano Second, i will indeed watch the video.  I am in the same line of thought. Water is the safetest method to relieve dehydration.  The doctor yesterday said it can be used as an emergency for a very short time.  I don't like the stuff either. I will only drink water, green teas and coffee myself.  Thank you for the information. I am sure others will find it useful as well. With so many different opinions from doctors, sometimes it feels as you are darned if you don't and darned if you do!  Be well!

Hi Angec,

Very pleased you are going to check out the video.

Do read Gary Taubes piece as well.  It will take less time (the video is 90 minutes long), but, more importantly, at the end he spells out the connection to cancer.  Here is a portion of it (and show it to those doctors in the hospital):

"Now most researchers will agree that the link between Western diet or lifestyle and cancer manifests itself through this association with obesity, diabetes and metabolic syndrome — i.e., insulin resistance. This was the conclusion, for instance, of a 2007 report published by the World Cancer Research Fund and the American Institute for Cancer Research — “Food, Nutrition, Physical Activity and the Prevention of Cancer.”

So how does it work? Cancer researchers now consider that the problem with insulin resistance is that it leads us to secrete more insulin, and insulin (as well as a related hormone known as insulin-like growth factor) actually promotes tumor growth.

As it was explained to me by Craig Thompson, who has done much of this research and is now president of Memorial Sloan-Kettering Cancer Center in New York, the cells of many human cancers come to depend on insulin to provide the fuel (blood sugar) and materials they need to grow and multiply. Insulin and insulin-like growth factor (and related growth factors) also provide the signal, in effect, to do it. The more insulin, the better they do. Some cancers develop mutations that serve the purpose of increasing the influence of insulin on the cell; others take advantage of the elevated insulin levels that are common to metabolic syndrome, obesity and type 2 diabetes. Some do both. Thompson believes that many pre-cancerous cells would never acquire the mutations that turn them into malignant tumors if they weren’t being driven by insulin to take up more and more blood sugar and metabolize it.

What these researchers call elevated insulin (or insulin-like growth factor) signaling appears to be a necessary step in many human cancers, particularly cancers like breast and colon cancer. Lewis Cantley, director of the Cancer Center at Beth Israel Deaconess Medical Center at Harvard Medical School, says that up to 80 percent of all human cancers are driven by either mutations or environmental factors that work to enhance or mimic the effect of insulin on the incipient tumor cells. Cantley is now the leader of one of five scientific “dream teams,” financed by a national coalition called Stand Up to Cancer, to study, in the case of Cantley’s team, precisely this link between a specific insulin-signaling gene (known technically as PI3K) and tumor development in breast and other cancers common to women...

“I have eliminated refined sugar from my diet and eat as little as I possibly can,” Thompson told me, “because I believe ultimately it’s something I can do to decrease my risk of cancer.” Cantley put it this way: “Sugar scares me.”