Change In Chemo

Ciara had another kidney test on Monday, the same type of test as she had last week called a Gromerular Filtration Rate (GFR). This determines how well the kidney is working and is required before she takes any chemo drugs that are nephrotoxic, that is being dangerous to the kidneys. One of the drugs Ciara was meant to have last week, Cisplatin, is nephrotoxic, hence the test. Her GFR last week was 43, this is pretty low, a normal rate is over 80, and as a result she was unable to have the chemo. It was decided to test and try again this week, but her GFR on Monday was 44, still too low.

After discussions with the head of the clinical trial in the UK, it's been decided that Ciara can no longer take any nephrotoxic drugs. This means that she is no longer part of the chemo trial as she will be veering away from the protocol. She will be continuing with a different chemo regimen called TVD, which are the initials of the drugs involved, Topetecan; Vincristine; Doxorubicin. Her old protocol was involved a session every 10 days, TVD will be every 21 days.

Ciara has now missed out on one chemo session of Cisplatin, and won't be getting Cisplatin or Carboplatin again. Before she starts on the TVD she's due one more of the old protocol sessions, Cyclophosphamide and Etoposide (and the ubiquitous Vincristine). These drugs have a high risk of causing marrow damage and so there needs to be about 20 days between sessions to allow the body to recover. As it's only been 15 days since she last had this her body has not recovered yet; her platelets are still too low to be able to take the drugs. She had plain old Vincristine today plus a platelet transfusion and was sent home again. She'll have a full blood count on Tuesday and hopefully will continue with chemo on Wednesday.

Ciara has had a problem with kidneys from day one and it's a shame and a worry that a group of effective drugs now have to be taken off the list completely. The kidney problem could be a result of the chemo, or the cancer itself, not enough is know about Neuroblastoma to be sure. Some kids get problems with their intestines, others with their heart or ears, Ciara's problem was with her kidneys. It would appear that neither of the kidneys are functioning correctly, possibly as a result of an auto-immune action in one damaging the other. Hopefully it's not long term, but if she had carried on with Cisplatin or Carboplatin, we could be sure that it would be.