Managing Bone Metastasis: Insights on Treatment and White Blood Cell Support

Q: Managing Bone Metastasis: Insights on Treatment and White Blood Cell Support

Dear Miss Len：<br>1. <br>Besides relying on white blood cell growth factors and beef, what other methods can enhance white blood cell counts? --> You might consider consulting a Traditional Chinese Medicine (TCM) physician at a major hospital, as TCM can provide effective relief

Bone metastasis

Dear Dr.
Wu,
I apologize for continually bothering you.
My white blood cell count has not improved; I have had to change from receiving white blood cell stimulants every second week to every week.
This second week's treatment was also delayed, but I am no longer experiencing fever.
Last time, I intended to self-pay for Avastin, but since Herceptin was covered by insurance, I ended up not taking Avastin.
However, a few days after that, I experienced shortness of breath, tremors, nausea, and muscle aches.
After the medication was adjusted, I saw some improvement.
Today, I had a PET scan, and the lymph nodes on both sides of my neck are still present, with one having increased in size.
There is also a concern regarding the sternum (possible bone metastasis?).
Additionally, since I just received the white blood cell stimulant yesterday, it is possible that smaller spots on the bones may not show up on the scan.
I have a few questions:
1.
Besides relying on white blood cell stimulants and beef, what other methods can help increase white blood cell counts?
2.
Is the dose of Herceptin (440 mg) significantly impactful on the body? I often feel that my heart or lungs cannot handle it; could this be due to the medication? I suggested to my doctor to reduce the dosage and increase the frequency, but he said it should be fine and that my side effects are not likely due to the dosage being too high.
Would splitting the dose reduce its effectiveness? (I used to have weekly treatments and still experienced recurrence.)
3.
Originally, I was on (1 week of Eribulin + Capecitabine, followed by Capecitabine every other week).
Last week, I added Herceptin.
Would it be okay to add Avastin as well?
4.
If I must take Avastin, when would be the best time to start? I have been hesitant to begin it, fearing it may not be effective if I experience a recurrence later.
I didn't expect that after just three and a half cycles of chemotherapy, the sternum would show growth (I had a PET scan in March, which is disheartening).
Given that there has been a recurrence, is it advisable to start treatment now?
5.
I was previously supposed to participate in a clinical trial for Avastin, but I was unable to due to my mastectomy, which made it difficult to evaluate the drug's efficacy.
If there are cancer cells in the lymph nodes on both sides of my neck and in the sternum, is that sufficient to evaluate the drug's efficacy for trial participation?
6.
Some say that PET scans during chemotherapy are not accurate.
How long after completing the entire treatment should I wait before having a scan?
7.
Another patient suggested adding Zometa; what are your thoughts on that?
Thank you, Dr.
Wu.
You and my attending physician are like my rebirth parents.
I am truly grateful.
Best regards.

len, 40~49 year old female. Ask Date: 2008/06/11

Dr. Wu Jingtang reply Breast and Thyroid

Dear Miss Len:
1.
Besides relying on white blood cell growth factors and beef, what other methods can enhance white blood cell counts? --> You might consider consulting a Traditional Chinese Medicine (TCM) physician at a major hospital, as TCM can provide effective relief for discomfort during chemotherapy and radiotherapy for some patients.
2.
Is the high dose of Herceptin (440 mg) significantly impacting the body? I often feel that my heart or lungs cannot handle it; could this be due to the medication? I suggested to my doctor to reduce the dose and increase the frequency, but he said it’s fine, and my side effects should not be due to the high dose.
Would splitting the doses reduce effectiveness? (I used to receive weekly doses and still experienced a relapse.) --> The dosage of Herceptin is calculated based on body weight.
Some patients receive it weekly, while others may receive it every three weeks, but the total amount remains the same, so both methods should be effective! Your symptoms are likely less related to it, but you could consider getting an echocardiogram to assess whether your heart function has been affected by the chemotherapy drugs.
3.
Initially, I was on (weekly Taxol + Carboplatin, alternating with Carboplatin), and last week I added Herceptin.
Is it okay to add Avastin as well? --> This is something to consider! BUT...
see point 4.
4.
If I must receive Avastin, when would be the best time to start? (I’ve been hesitant to start it, fearing it might not be effective if I relapse later.) I didn’t expect that after just three and a half cycles of chemotherapy, the sternum would show growth (I had a PET scan in March, and I’m speechless).
Since there has been a relapse, is it advisable to start treatment now? --> After completing six cycles of (weekly Taxol + Carboplatin, alternating with Carboplatin), it would be more practical to have another PET scan for evaluation before considering starting Avastin.
5.
I was previously set to participate in an Avastin clinical trial, but I was unable to due to breast surgery, which prevented me from assessing the drug's efficacy.
If there are cancer cells in two lymph nodes in the neck and the sternum, would this be sufficient to assess the drug's efficacy for trial participation? --> You should consult with a physician involved in the trial, as each study has specific inclusion criteria that must be met to comply with medical research standards.
6.
Another patient suggested adding Zometa; what do you think? --> This medication has shown good effects in patients with bone metastases and can be used (administered once a month).
Wishing you success in your cancer treatment, and keep up the good work!
Sincerely,
Dr.
Wu Ching-Tang, Attending Surgeon, Taoyuan Hospital, Department of Health

Reply Date: 2008/06/11

More Info

Managing bone metastasis and supporting white blood cell (WBC) levels in patients undergoing cancer treatment is a complex and multifaceted issue. Your concerns about the management of your health, particularly regarding the use of growth factors, chemotherapy agents, and the overall treatment plan, are valid and important to address.

1. Increasing White Blood Cell Count: Besides using WBC growth factors like G-CSF (granulocyte colony-stimulating factor) and dietary sources such as beef, there are several other strategies to consider. Regular exercise, adequate hydration, and a balanced diet rich in vitamins and minerals can support overall health and potentially enhance immune function. Some studies suggest that certain supplements, like vitamin C, vitamin D, and zinc, may also play a role in supporting the immune system. However, it is crucial to discuss any supplements with your healthcare provider to ensure they do not interfere with your treatment.

2. Herceptin and Its Effects: Herceptin (trastuzumab) is a targeted therapy used primarily for HER2-positive breast cancer. The dosage you mentioned (440 mg) is indeed significant, and while it is calculated based on body weight, side effects can vary among individuals. Symptoms like shortness of breath, chest discomfort, or fatigue may be concerning, and it is wise to have a cardiac evaluation, such as an echocardiogram, to assess heart function, especially since Herceptin can affect cardiac health. If your doctor suggests that your symptoms are not related to the dosage, it may be worth seeking a second opinion or discussing alternative dosing strategies, such as splitting the dose into smaller, more frequent administrations.

3. Combining Treatments: The combination of Herceptin with other agents like Avastin (bevacizumab) can be beneficial, but it requires careful consideration of your overall treatment plan and the timing of administration. Avastin is an anti-angiogenic therapy that can help inhibit tumor growth by preventing the formation of new blood vessels. Your oncologist will need to evaluate your current health status, the extent of disease progression, and how well you are tolerating existing treatments before making a recommendation.

4. Timing for Avastin: If Avastin is deemed necessary, the timing of its administration is critical. Typically, it is introduced after assessing the response to chemotherapy and imaging studies. If there is evidence of disease progression, starting Avastin sooner rather than later may be warranted. Your oncologist will guide you on the best timing based on your treatment response and overall health.

5. Clinical Trials: Participation in clinical trials can be an option for patients with limited treatment options. The eligibility criteria for trials vary, and having cancer cells in lymph nodes or bones may qualify you for certain studies. It is best to consult with your oncologist or a clinical trial coordinator to explore available options.

6. Imaging During Treatment: Concerns about the accuracy of imaging studies, such as PET scans, during chemotherapy are valid. Chemotherapy can cause inflammation and changes in metabolic activity, which may affect scan results. It is generally recommended to wait several weeks after completing a chemotherapy cycle before undergoing imaging to get a clearer picture of treatment response.

7. Zometa (Zoledronic Acid): Zometa is a bisphosphonate that can help manage bone health in patients with bone metastases. It reduces the risk of skeletal-related events and can help with bone pain. If your healthcare provider recommends it, it may be a beneficial addition to your treatment regimen.

In conclusion, managing bone metastasis and supporting WBC levels requires a comprehensive approach involving careful monitoring, timely interventions, and open communication with your healthcare team. It is essential to address any side effects promptly and to consider all available treatment options, including supportive therapies and clinical trials. Always consult with your oncologist before making any changes to your treatment plan. Your proactive approach to your health is commendable, and I wish you the best in your treatment journey.

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