Still Processing

I wanted to type up my blog last night but in all complete honesty I had to deal with my emotions first.  I feel bad talking to my sisters about it because they have a lot going on in their lives too right now.  I don't want to add it on.  Although I can already hear, don't be ridiculous.  I am upset because I sat down to realize this statement.  "Don't worry, we have a lot of drugs we can use."  In their attempt to comfort me when we were first diagnosed I would get this statement.   Yes, it made me feel better.  No, I didn't expect to cry when we had to switch drugs.  I realize all the stuff they are injecting him with now could potentially be causing different side effects.  I don't mean to fret but its my job.  So this is what we are starting next week.  They said we don't have to overnight it but we do have to be admitted because it takes over 8 hours.

Rituximab

Rituximab

(ri TUK si mab)  

Trade name: Rituxan^®

Chemocare.com uses generic names in all descriptions of drugs. Rituxan is the trade name for rituximab. In some cases, health care professionals may use the trade name rituxan when referring to the generic drug name rituximab.

Drug type: Rituximab is a monoclonal antibody. (For more detail, see "How this drug works" section below).

What this drug is used for: 

• Treatment of certain types of non-Hodgkin's lymphoma.
• Treatment of chronic lymphocytic leukemia (CLL).

Note:  If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful.

How this drug is given:

• As an infusion into a vein (intravenous, IV), over about 6 hours.  The time of the infusion may be shortened, depending on whether or not you have received this drug in the past, or how well you tolerate this drug.
• Medications may be given just before the infusion to reduce the occurrence of infusion-related symptoms.
• There is no pill form of rituximab.
• The amount of this medication you will receive depends on many other factors, including your height and weight, your general health or other health problems, and the type of cancer you have. Your doctor will determine your dosage and schedule.

Side effects:
Important things to remember about the side effects of rituximab:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking rituximab:  

• Fever and chills (see flu like symptoms)

The following are less common side effects (occurring in 10-29%) for patients receiving rituximab:

• Weakness 
• Nausea
• Headache
• Cough 
• Runny nose, shortness of breath, sinusitis (see cold symptoms)
• Throat irritation (see cold symptoms - pharyngitis)

A serious but rare side effect of rituximab is potential for a severe infusion reaction, typically with the first infusion (during infusion or within 30-120 minutes of infusion).  You will be given medication prior to the infusion to decrease this reaction and monitored carefully during the infusion.  If signs of reaction occur, the infusion is stopped.  In most cases, the infusion can be restarted at a slower rate once symptoms subside.

Other rare but serious side effects:

• Patients who have had heart pain or irregular heartbeats in the past may experience this again.  If these occur tell your doctor or nurse, so that they can be treated. 
• Rapid destruction of cancer cells can cause disturbances in metabolism leading to kidney problems.  
• If you have questions about this information ask your doctor.   

Not all side effects are listed above.  Some that are uncommon, occurring in less than 10% of patients, are not listed here.  You should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor:
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.5º F (38º C) or chills (possible signs of infection)
• Shortness of breath, chest pain or discomfort; swelling of your lips or throat
• Confusion

The following symptoms require medical attention, but are not emergency situations.  Contact your health care provider within 24 hours of noticing any of the following:

• Develop a rash or sore joints
• Nausea (interferes with ability to eat and unrelieved with prescribed medications)
• Vomiting (vomiting more than 4-5 times in a 24-hour period)
• Other signs of infection, sore throat, cough, redness or inflammation, or pain on urination

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting rituxamab treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). 
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking rituxamab.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment.  Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). 
• For both men and women: Do not conceive a child (get pregnant) while taking rituxamab. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking this medication.

Self Care Tips:

• Rituximab may cause temporary low blood pressure.  If you are taking medication to reduce your blood pressure, check with your doctor or nurse as to whether you should take it as usual or not before the infusion.
• You may experience shortness of breath, feel flushed or dizzy during the infusion. You will most likely receive medication before the infusion, and you will be closely monitored during the infusion. 
• For flu-like symptoms, keep warm with blankets and drink plenty of liquids.  There are medications that can help reduce the discomfort caused by chills.
• Drink 2 to 3 quarts of fluid for the first 48 hours after each infusion, unless you were told to restrict your fluid intake. 
• This medication infrequently causes nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Sucking on lozenges and chewing gum may also help.
• You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
• In general, drinking alcoholic beverages should be avoided.  You should discuss this with your doctor.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and testing:
You will be checked regularly by your health care provider while you are taking rituximab, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) may also be ordered by your doctor.   

How this drug works:Rituximab is classified as a monoclonal antibody.  Monoclonal antibodies are a relatively new type of "targeted" cancer therapy.

Antibodies are an integral part of the body's immune system.  Normally, the body creates antibodies in response to an antigen (such as a protein in a germ) that has entered the body.  The antibodies attach to the antigen in order to mark it for destruction by the immune system.

To make anti-cancer monoclonal antibodies in the laboratory, scientists analyze specific antigens on the surface of cancer cells (the targets).  Then, using animal and human proteins, they create a specific antibody that will attach to the target antigen on the cancer cells. When given to the patient, these monoclonal antibodies will attach to matching antigens like a key fits a lock.

Since monoclonal antibodies target only specific cells, they may cause less toxicity to healthy cells.   Monoclonal antibody therapy is usually given only for cancers in which antigens (and the respective antibodies) have been identified already.

Rituximab works by targeting the CD20 antigen on normal and malignant B-cells.  Then the body's natural immune defenses are recruited to attack and kill the marked B-cells.  Stem cells (young cells in the bone marrow that will develop into the various types of cells) do not have the CD20 antigen.  This allows healthy B-cells to regenerate after treatment.

Since Gary just came off Cytoxan, we need to give his bone marrow a chance to recover.