internal bleeding?

[Derek12]

buddy is at sloan overnite,hemoglobin counts low...they suspect internal bleeding.what could this be caused by?is it most likely chemo related?

[dadmo]

It's quite possible. You whole intestinal tract becomes very sensitive from the intake to the output. Anything that could cut (nut, seed) or burn (mexican food) could cause a problem.

[Derek12]

i was thinking urinary tract possibly?

[danebert]

There is a good chance it is the chemo. The chemo could have caused a tumor to hemmorage, or a tumor could have hemoraged on its own. Any results with the new chemo drug?

[Derek12]

ok...the bleeding is being caused by the massive abdominal tumors growth,which is perforating a hole in his stomach causing ulcer-like symptoms.he is being rushed to Yale for radiation to attempt to shrink the tumor.he cannot partake in the clinical trial,until the bleeding has stopped.since non-seminatomous tumors arent effected by radiation,i assume he will never be able to try the bms-247550.but why then,are they trying it?

[danebert]

From what I recall, there might be a slight response to radiation. It is used to treat CNS ( central nervous system) germ cell tumors. I don't know what the exact elgibility is for the clinical trial he is on. I did a search on clinicaltrials.gov and couldn't find the trial. ON the MSKCC website there is limited info. Has he received a dose or not? The most important thing now is to treat the direct cause of the bleeding with radation / surgery but I would assume hes not healthy enough to go through surgery. He might also be treated with the drug off trial, but that would be rare in his case.

[danebert]

OK I found the trial, the drug is also known as ixabepilone. One reason he might be taken off trial is his Karnofsky score which is based on his symptoms. They require a score of at least 70%


100 % Normal no complaints; no evidence of disease.
90 % Able to carry on normal activity; minor signs or symptoms of disease.
80 % Normal activity with effort; some signs or symptoms of disease.
70% Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed.


Some info from Medscape

"BMS-247550 is a semisynthetic analogue of the natural product epothilone B and has a mode of action analogous to that of paclitaxel (i.e., microtubule stabilization). In vitro, it is twice as potent as paclitaxel in inducing tubulin polymerization. Like paclitaxel, BMS-247550 is a highly potent cytotoxic agent capable of killing cancer cells at low nanomolar concentrations. Importantly, BMS-247550 retains its antineoplastic activity against human cancers that are naturally insensitive to paclitaxel or that have developed resistance to paclitaxel, both in vitro and in vivo"


Study Type: Interventional
Study Design: Treatment

Official Title: Phase II Study of Ixabepilone in Patients With Metastatic Cisplatin-Refractory Germ Cell Tumors

Further study details as provided by National Cancer Institute (NCI):

OBJECTIVES:

Determine the efficacy of ixabepilone in patients with metastatic cisplatin-refractory germ cell tumors.
Determine the safety of this drug in these patients.
OUTLINE: Patients receive ixabepilone IV over 3 hours on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

PROJECTED ACCRUAL: A total of 10-29 patients will be accrued for this study within 1.3-4 years.

Eligibility

Ages Eligible for Study: 16 Years and above, Genders Eligible for Study: Both
Criteria
DISEASE CHARACTERISTICS:

Histologically confirmed germ cell tumor (GCT) (seminoma or non-seminoma) meeting the following criteria:
Measurable metastatic disease by one of the following methods:
Radiography
If eligibility is defined by measurable disease only, there must be at least 1 site that has not been previously irradiated
Alpha-fetoprotein greater than 15 ng/mL and/or ß-human chorionic gonadotropin greater than 2.2 mIU/L
Previously treated progressive disease meeting 1 of the following criteria:
Not a candidate for potentially curative therapy OR has already received high-dose chemotherapy regimens (prior paclitaxel allowed)
Deemed to be cisplatin-refractory after prior cisplatin-based regimen AND does not want to have potentially curative high-dose therapy (mediastinal or primary refractory GCT)
Prior treatment with 1 cisplatin-based regimen (primary mediastinal nonseminomatous GCT)
PATIENT CHARACTERISTICS:

Age

16 and over
Performance status

Karnofsky 70-100%
Life expectancy

Not specified
Hematopoietic

Absolute neutrophil count at least 1,500/mm^3
Platelet count greater than 100,000/mm^3
Hemoglobin at least 10 g/dL
Hepatic

Bilirubin no greater than 1.5 times normal
SGOT no greater than 2 times upper limit of normal
Renal

Creatinine no greater than 2.2 mg/dL
Other

Not pregnant or nursing
Negative pregnancy test
No active infection
PRIOR CONCURRENT THERAPY:

Biologic therapy

No concurrent immunotherapy
Chemotherapy

See Disease Characteristics
No other concurrent cytotoxic chemotherapy
Endocrine therapy

Not specified
Radiotherapy

See Disease Characteristics
No concurrent radiotherapy
Surgery

Not specified
Other

No other concurrent experimental or commercial anticancer medications or therapies

[Hopeful]

Hi.

This might be a stretch to try but it might be an option. If he has solid tumors in his stomach, have him check into the Cyberknife procedure. It uses direct radiation aimed at the tumor only, and not the surrounding healthy cells, to kill the tumor.

My husband had this done on a 5 inch tumor in his right lung (100% choriocarcinoma) and it killed the tumor; with no growth according to the Pet scan. He also had it done on marble size tumors in his brain. The technology can track moving organs in the body while it is moving.

Maybe this could work for your friend, just to kill the tumors with direct beam of radiation. If it kills the cells, then he can get back on the treatment program.

if you have questions, please let me know.

Patti

[Derek12]

thanks again everyone,its much appreciated.as of right now,he has not recieved a dose of BMS.He is on a morphine pump,and had to be intubated earlier due to a low blood pressure from the bleeding.The reason he didnt get the BMS is that he had to be off oral etoposide for at least one week before going for BMS.The oral etoposide really,just made him very very sick.He was vomiting constantly for the short time he was on it.He has also since had the nasophrangeal tubes removed,and his pressure is normal.They think the bleeding has stopped for now.Still radiation tomorrow.thanks
oh yes surgery is not an option yet....

[Karen]

Derek,
So sorry to hear all your buddy is going through. You're a good friend to him. I agree with Patti on looking into the Cyberknife. Stay strong, and my thoughts and prayers are with your buddy and you.

[Derek12]

went for radiation again today,felt better immediately.gamma knife radiation,being done at Yale closer to home.by the way Yale is building a 454 million dollar cancer center over the next 4 years,around 20 storys tall with the intentions of rivaling Sloan and Dana Farber.Anyways,pain subsided some,but he is ona morphine pump for the pain.liquid diet,and hes taking antibiotics for an upper respiratory tract infection.although he seems relatively strong still,he signed the DNR papers today and gave his father power of attourney.sucks.time is short,and everyone can feel it.i cant even begin to describe how horrible i feel for him,he has it the worst,but his mom and dad and family.its even worse cause when he was first diagnosed,the doctors almost reassured them by telling them close to 80%.if only he wasnt refractory.he was diagnosed late,but really what it breaks down to is that he wasnt a responder.really this kid is a warrior.he has literally exhausted every option possible,and may even still get BMS if the bleeding ever stops.his last x-rays were looking very bad however.tumor markers rising.all in all it seems as if its downhill from here.

[Scott]

I'm so sorry.

[dadmo]

Derek:
I'm sorry to hear this. Stay strong your friend and his family will need your continued support.

[Karen]

Derek,
So sad to hear this. Stay strong for your buddy and his family and we'll be here for you as best we can. My prayers are with you for strength and your friend for comfort.

[Fish]

Derek:

I'm very sorry to hear this. You're an amazing friend and I'm sure your kindness and comfort are appreciated more than you know. Hang in there.

Jim