Aa
dosage reduction vs. rescue drugs vs. waiting
I've read so much about all of this by going back through the archives as well as getting help from some of you. First of all, I'm in a trial so there are parameters for courses of action in different situations so it's not based on a doctor's philosophy of treatment. My WBC and ANC dropped on my week 4 labs - WBC is 1.46 and ANC is .67 (670) and trial level for dosage reduction is .75 (750) so I am directed to reduce peg from 180 to 135mcg. A drop to .5 and neupogen is indicated. Then I read a lot of posts from people that would try anything including rescue drugs rather than reduce their dosage. Others say the neupogen has its own set of sx and they would rather reduce. Others would rather wait until ANC drops to .3 before anything (would have been my first choice). Besides these numbers can bounce around, right? Does someone have any hard evidence that any of these courses of action is better or more detrimental than others in reaching SVR or is the whole thing a crap shoot? I may have "accidentally" cheated a little last night on my shot and left slightly more than 135mcg in the syringe as a 20% reduction psychologically seemed better than 25%
I think in these phase II trials they are working out these kind of kinks and want to keep you healthy. I have been und and miscalculated 2 shots missed one dose and now they have reduced the riba, still und, week 18.
I think this study is designed to help you as much as possible and still get the information they need the way they need it. Your coordinators are coordinating w/ Gilead and there is a lot at stake to keep you healthy and get you cleared.
When did you get und? I forgot,
I think this study is designed to help you as much as possible and still get the information they need the way they need it. Your coordinators are coordinating w/ Gilead and there is a lot at stake to keep you healthy and get you cleared.
When did you get und? I forgot,
You'd be better off starting your own thread cuz questions inside another's thread tend to get lost in the shuffle. Anyway Neutrophils are components of WBC. One link gives a very brief blurb about what Neut's are, and explains the formula. The second is an online calculator for ANC.
http://medicalcenter.osu.edu/patiented/materials/pdfdocs/dis-cond/cancer/absolute-neutrophil-count.pdf
and / or
http://easycalculation.com/medical/anc.php
http://medicalcenter.osu.edu/patiented/materials/pdfdocs/dis-cond/cancer/absolute-neutrophil-count.pdf
and / or
http://easycalculation.com/medical/anc.php
Thanks, all. Yes, the guidelines are there for the trial (under 750, reduce, under 500, rescue) and I reduced last night (although maybe not quite as much as they said) This stuff happened quickly at the end of the week and with the holiday, it makes it extra hard to have a real discussion with a doctor. I was bounced back and forth several times on Friday to get blood drawn for retest and see the dermatologist. I would have preferred not to do anything until they got the results from the 2nd draw but I was told to reduce. I will follow the trial guidelines but I want to play as much of an active role in my care as I can. I have gotten several good questions to ask from the posts above.
ANC is Absolute Neutrophil Count and someone else can explain the formula. Mine, at .67 or 670 is considered mild neutropenia, under 500 it becomes more worrisome. On a good note, the two script creams that I got are calming the curse of the dual itching rashes.
Debra
ANC is Absolute Neutrophil Count and someone else can explain the formula. Mine, at .67 or 670 is considered mild neutropenia, under 500 it becomes more worrisome. On a good note, the two script creams that I got are calming the curse of the dual itching rashes.
Debra
Help the beginner out, folks. What is ANC? (I don't see it on the list, but that doesn't mean it's not there.
I always went for the helper meds when I had a choice. Good luck with your trial.
I always went for the helper meds when I had a choice. Good luck with your trial.
Does your trial make decisions based on HGB numbers or WBC numbers?
With regards to your ANC, regardless of what studies you'd be able to pull on adherence to treatment and all that, the trial will have it's guidelines that must be followed. There is a certain amount of leeway given to the treating doctor. Does your trial give your doctor leeway to determine what comes first, the neupogen or the dosage reduction? If yes, you can ask your doctor to go with the neupogen first, stating you don't want a dosage reduction. Adherence to dosages in the first 12 weeks are particularly important. If the trial does not allow your doctor that leeway and it strictly requires dosage reduction at 750 ANC and neupogen at 500 ANC, you'll have to follow trial mandates. Trials are almost always more conservative so the point at which they'll require intervention of either dosage reduction or rescue drug is almost always higher than if on standard of care treatment.
As for ANC levels in general - waiting until ANC drops to .300 is not a great idea and it's entirely situational, in my unlearned opinion. If I were treating, I'd be ready to kick in with the neupogen at .500 and I'd agree to dosage reduction at .300 if the neupogen wasn't working to get those numbers up there. They've found that infections are rare at .500 but letting it drop to .300 ... how close to the fire do you want to get? For some who are running out of options you push the limits a little harder but only if you have to.
In your case, because your trial mandates dosage reduction at .750 ANC, then I'd be asking my doctor to give me neupogen not based on infection risk but to keep your dosages at full adherence as long as possible in that first 12 weeks - IF he has that leeway. The trial may not allow him that. I'd ask for clarification, simply so you know what your real options are within this trial - unless you already know this.
Neupogen does come with side effects compared to procrit - I only had one dose before having to stop treatment so I can't personally speak to that part of it and I'll leave it to someone else. Someone mentioned patient assistance programs and I do believe the drug companies for neupogen and procrit offer assistance. Something to investigate.
If any consolation overall if you have to stick with the dosage reduction, when my trial was unblinded, I found I had been at 90mcg of Interferon for the first 12 weeks of the trial and 135mcg from Week 25 to 34 due to dosage reduction. Trial and treatment ended suddenly at 34 weeks. I ended up with SVR anyway. Deal with the realities but maintain hope.
Trish
With regards to your ANC, regardless of what studies you'd be able to pull on adherence to treatment and all that, the trial will have it's guidelines that must be followed. There is a certain amount of leeway given to the treating doctor. Does your trial give your doctor leeway to determine what comes first, the neupogen or the dosage reduction? If yes, you can ask your doctor to go with the neupogen first, stating you don't want a dosage reduction. Adherence to dosages in the first 12 weeks are particularly important. If the trial does not allow your doctor that leeway and it strictly requires dosage reduction at 750 ANC and neupogen at 500 ANC, you'll have to follow trial mandates. Trials are almost always more conservative so the point at which they'll require intervention of either dosage reduction or rescue drug is almost always higher than if on standard of care treatment.
As for ANC levels in general - waiting until ANC drops to .300 is not a great idea and it's entirely situational, in my unlearned opinion. If I were treating, I'd be ready to kick in with the neupogen at .500 and I'd agree to dosage reduction at .300 if the neupogen wasn't working to get those numbers up there. They've found that infections are rare at .500 but letting it drop to .300 ... how close to the fire do you want to get? For some who are running out of options you push the limits a little harder but only if you have to.
In your case, because your trial mandates dosage reduction at .750 ANC, then I'd be asking my doctor to give me neupogen not based on infection risk but to keep your dosages at full adherence as long as possible in that first 12 weeks - IF he has that leeway. The trial may not allow him that. I'd ask for clarification, simply so you know what your real options are within this trial - unless you already know this.
Neupogen does come with side effects compared to procrit - I only had one dose before having to stop treatment so I can't personally speak to that part of it and I'll leave it to someone else. Someone mentioned patient assistance programs and I do believe the drug companies for neupogen and procrit offer assistance. Something to investigate.
If any consolation overall if you have to stick with the dosage reduction, when my trial was unblinded, I found I had been at 90mcg of Interferon for the first 12 weeks of the trial and 135mcg from Week 25 to 34 due to dosage reduction. Trial and treatment ended suddenly at 34 weeks. I ended up with SVR anyway. Deal with the realities but maintain hope.
Trish
No hard evidence just the opinion I'd rather take the rescue drug. Anything to stay at full dose on the main tx drugs. If you have bad sx to Neupogen, consult your doc and quit taking it. Reaction to Neupogen, like Interferon and Riba, varies. Never had sides with Neup.
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