Caregiver Chronicles: Let The Treatment Begin

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After a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband, Tom, was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective. Read more posts in this series

Tom and I walked into Room 40 of the Intensive Care Unit (ICU) in December 2004, accompanied by Joy, our nurse. Her question, "Which one of you is the patient?" drew a smile from both of us.

Joking aside, we knew Tom was facing his greatest challenge.

Doc1.jpgThe next morning, he would receive his first dose of Interleukin-2 (IL-2), a protein produced by activated T cells in the body, to treat his renal carcinoma.

Two weeks earlier, Tom had visited with his multidisciplinary team to see if his body could tolerate the treatment. First he saw Jean-Bernard Durand, M.D

IL-2 is an excellent drug, Durand said, but there would likely be fluid retention, which might put undo pressure on the heart.

A week later, we arrived at the Melanoma Center for the administration of IL-2. GI medical oncologist Michael Overman, M.D., explained that melanoma and renal carcinoma patients are treated with this biotherapy. In my journal I wrote, "Neurologic problems crop up with IL-2."

The doctor also said Tom would gain a lot of weight, because of the fluid retention, and would feel bloated and short of breath. The remaining kidney could experience detrimental effects as well.

A cheerful Nicholas Papadopoulos, M.D., professor in the Department of Melanoma Medical Oncology, entered the room, and was surprised Tom looked so good. After a quick examination, he announced, "He's solid."

Dr. Papa, as he is affectionately known, told us that Durand had given Tom a good report. He then explained the complicated IL-2 process, and said that Tom should expect 15-25 pounds of fluid retention.

The goal, he said, would be to administer 14 doses. And because there was a chance Tom could suffer a heart attack, he'd be in the ICU for the duration of the treatments.

The prognosis? Just 5% of patients treated with IL-2 experience complete remission.

His next attempt at survival
Back to ICU Room 40. Tom had received a CAT scan a few days earlier, and had also had a catheter placed in his chest for the intravenous treatments.

The first IL-2 drip began the morning of Dec. 14 and lasted 15 minutes. I got to his room before noon. He said, "It apparently worked." Tom looked good, even though he'd only gotten four hours of sleep the night before.

Tom had a second treatment that evening and managed to tolerate seven doses of IL-2 within the next two days. He was extremely bloated, red and short of breath.

Doctors considered giving him one more dose, but because his heart rate was very high, they decided against it. The next day, Tom was moved to Room 926 in the Green Zone.

Next installment: In the wake of the powerful IL-2 treatments, neurological problems do crop up.

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