Biochemotherapy for Treating Metastatic Melanoma
Kari Worth's Story
The day after her daughter’s first birthday, Kari Worth was diagnosed with stage IV metastatic melanoma. Kari had a lot to live for, she had a young son, a little girl and a full life, and obviously she did not want cancer to get in her way. She decided after consulting with her physicians to put all of her faith and energy into what was possibly the only option that could save her life: a cancer treatment called biochemotherapy.
Kari and her husband live in Napa where currently she is a full-time mom after working for many years developing specialty food shops. "This was a life or death situation," states Kari, knowing that her chances for long-term survival with stage IV metastatic melanoma were not good, as stage IV indicates that the tumor has spread to other organs or lymph nodes far away from the original tumor site, such as the brain, kidney or liver.
Kari began biochemotherapy treatment in May of 2003 with David Minor, M.D. at California Pacific Medical Center and recently completed her final treatment of this two and a half year protocol. Biochemotherapy is an intensive drug treatment regime that combines three chemotherapy drugs with two active biological agents, interleukin 2 (IL-2) and interferon.
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During biochemotherapy sessions, patients are admitted to the hospital and over four days receive intensive treatment with five different drugs. This cycle is repeated six times at three-week intervals, after which patients are admitted for two-day treatments once a month for the next one to two years. Kari, who has been hospitalized more than twenty times over the last two years, has taken the creative approach to making her hospitalizations a more pleasant experience. She decorates her hospital room with a variety of art pieces that she brings from home, and hangs them around her bed. "I want to wake up to something that makes me happy," Kari continues "the art I bring in ranges from macaroni glued on construction paper to detailed watercolors." The treatments can be unpleasant and physically incapacitating, side effects range from extreme nausea and vomiting to kidney failure and systemic inflammatory response, inflaming the patient’s entire body including joints and vital organs. "I always knew it didn’t matter when I was in the hospital, Dr. Minor would visit me everyday, even holidays and weekends. He is a very compassionate and caring person," Kari stated.
A close friend or family member always stayed with Kari during her hospitalizations, not just to keep her company, but also to help with her needs due to the severe side effects. Fortunately, today patients at California Pacific are admitted to a new unit called the TICU-3 staffed by nurses who are highly trained to help care for oncology patients receiving IL-2 treatment. Patients in the T-3 also receive care from Christine Kim, R.N., N.P. Christine is an advance practice nurse working exclusively with IL-2 patients. She manages the care of each patient from the moment they are admitted throughout their hospitalization and their discharge. On average, Christine may see anywhere from two to four patients daily. "You really get to know these patients and it’s so rewarding to see a regression in tumor growth because you know the treatment is working," states Christine. Working closely with Dr. Minor, Christine keeps him informed on each patient’s day-to-day condition, and makes sure all medical needs are met.
Christine and Dr. Minor are currently working on a "patient-to-patient" peer-support system for patients undergoing IL2 treatment. The system will pair a patient with someone who has gone through the treatment and understands the day-to-day issues from a personal level.
Biochemotherapy is used on select patients with metastatic cancer. According to Dr. Minor, "the short-term improvement rate for patients with metastatic melanoma receiving chemotherapy alone is only about 15%, and long-term survival is almost zero. When patients are treated with biochemotherapy close to 50% for patients show short-term improvement and 15% are long-term survivors." Dr. Minor recently published a paper titled "Retrospective Study of Biochemotherapy for Metastatic Melanoma: The Importance of Dose Intensity," and clinical research trials are still being conducted on IL-2 therapy at research centers including the California Pacific Medical Center Research Institute.
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According to the American Cancer Society (ACS), melanoma accounts for about 4% of all cancer cases in the United States. ACS estimates that in 2005 there will be 59,580 new cases of melanoma in the United States and approximately 7,770 of these people will die. Nearly one in five Americans will get skin cancer in the course of their lifetime and 25% of these people are under forty years of age. Talk to your doctor about any suspicious moles or skin growths and follow these simple skin protection rules.
- Don’t sunbathe.
- Avoid sun exposure between 10 a.m. and 4 p.m., the peak hours of harmful ultraviolet (UV) radiation.
- Use SPF 15 or higher sunscreens everyday.
- Wear protective clothing, long sleeved shirts, long pants, brimmed hats, and sunglasses when outside.
- Avoid tanning booths.
- Examine your skin every three months.
- Learn the changes in a mole or skin growths that are warning signs of melanoma.
Asked if she would go through biochemotherapy again, Kari stated, "It was brutal, as rough as it gets, would I do it again? Yes."
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