Archive for October, 2012

Round one with Zaltrap

October 30, 2012

ast Thursday, I started my treatment with the new drug, Zaltrap. I was given the same routine of a six-hour infusion at the hospital, then 48-hour infusion at home. The only difference was the sequencing of the four chemo drug I was given; Zaltrap has to be administered first.

I am recovering from the treatment. The side-effects are pretty much the same, like those pesky hiccups, persistent nausea, and lack of energy. I got meds for nausea (thanks to Noreen) but the hiccups? I have tried everything but the one thing that seems to work for me is yoga breathing techniques. That said, it is always a struggle to recover. The lethargic feeling has a paralyzing effect that makes simple decisions hard. At times, I just don’t want to move and that is when I get depressed.

I think of the long road ahead, the uncertainty of this journey, and the big hope I am placing on this new drug. My options are limited and it did not help when three doctors from New York opined that Zalrap is not worth it (see my previous post ‘In Cancer Care, Cost Matters‘). In fairness, I received a response to my email dated October 18:

Dear Mr. Alvarez,

I am so sorry to hear about your situation and my heart goes out to you and your family. Thank you so much for writing. I will share your email with my two colleagues, and its important insights.

Warmest regards, Peter (Bach)

It still bother me when I am written off even before I get to the starting line. With the Zaltrap regiment started there is nothing left but to complete the 12 sessions; or the finish line. The major milestone will be after I complete four sessions, we re-stage or do a scan to see if I am responding. That should be an interesting moment. It will either be a happy Christmas or a sober one.


P.S. Happy halloween!

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In Cancer Care, Cost Matters

In Cancer Care, Cost Matters

October 18, 2012

Basel, Switzerland

came across this article from the NY Times and it struck a nerve on my part.  I have never responded to articles before but this one is different.  It suck the life out of me because I have high expectations for my first Zaltrap treatment next week.

Dear Drs.Bach, Saltz, and Wittes of Memorial Sloan-Kettering Cancer Center.

I read your NY Times Op-Ed: In Cancer Care, Cost Matters published October 14 with great apprehension and anxiety.  I felt marginalized and sentenced by it.

It is not so much about the cost of Zaltrap that disturbed me but you said about the new drug:

“The drug Zaltrap, has proved to be no better than a similar medicine we already have for advance colorectal cancer…”

You see, I am about to undergo chemotherapy using Zaltrap after my metastatic lung cancer is no longer responding to Avastin.  I have been fighting cancer since March 2008 after it was first detected in my colon. Every year since then it has been a struggle to keep ahead of it as it moved to my liver in 2010, and lately to my lungs in 2012.

Chemotherapy regiments are no stranger to me.  I have endured them all in the last four years.  I even went to Mayo Clinic for second opinion and they said the same thing.  I have limited options but I have limitless hope in finding a cure.  I know how many nodules are in my lungs, I know my Kras mutations, and I see my medical bills piling; but, I do not need to be marginalized to a statistics or a cost-benefit case.

Your explicit clinical opinion cuts to the heart of my predicament, that at best Zaltrap, would have prolonged a patient lives (including myself) by a median of 1.4 months.  That is a bold statement, I struggle to accept.  It makes a good case for “rationalizing” not “rationing” as you stated.

The argument for saving lives always boil done to money.  It funds research or it can extend my life 1.4 months more.  I wish I can explain that to my family.  I do not have a hospital to run or research papers to write, but I think you are missing the point as you sit atop your titles.  I have been hit with so many bad news and realization in my struggles that I tend to ignore them.  I took exception to your article to point out the struggles that I and others go through in hoping for a cure.  Whether a new treatment will extend my life one day or 1.4 months, it is still a gift.

I like to think I am worth it, if I not, I will be the one to tell you so you can write about it.

Bo Alvarez

Email: bo_alvarez@yahoo.com


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Chemo pills: Done.

October 14, 2012

Basel, Switzerland.

nother milestone done, this time in the cancer world. I completed the chemo pills regiment, my oncologist prescribed to me while here in Basel, with few side-effects. I started taking it a day after doing Berlin (no rest for the weary). It was one of the conditions of my extended travel. Oh well.

I can never get very far from cancer reality but I am still very thankful for the blessings I have. I have learned that it does not matter where you are; in Manila, Basel, NY, or Chicago, it is about the people you meet along the way. Each day and each place provides an opportunity to learn, interact, and deepen relationships with people. Here in Switzerland, my wife and I had that chance of renewing friendships with JimmyB from Geneva and establishing new ones with JanetG from Zurich.

Relationships brings new meaning to a favorite dish or a new place. The sculptures and tourist spots of Geneva are meaningless when compared to the home-made lunch prepared by Jimmy. Rhine Falls may just be a waterfall outside of Zurich but when shared with Janet its significance is memorable.

People tell me they are inspired by my journey but the irony is I get my motivation from you. I get energize when I am out and intoxicated with life.  It is true what Forrest Gump said ‘life is a box of chocolates you will never know what you get until you open it.’ It makes me look forward to the next time I melt into the warm kindness friends and people, and I respond with great blessing.

Another week here in Basel and I go home. What awaits be back home is my family….and my oncologist. I go back on full chemo treatment on October 23 with a different regiment, stronger one: Oxaliplatin with a new drug called Zaltrap. The former is a platinum based chemo drug that I had an allergic reaction to and it makes me sensitive to cold things: I had to wear gloves when getting things from the refrigerator or not go there at all. The plan is to load me up with steriods and antihistamine before introducing Oxaliplatin with a slower rate of infusion at the hospital. After the hospital, I bring home my portable infusion pump for more chemo that usually last for 2-days or until I empty the bag. I get a week to recover and do it again to complete 12 cycles of this regiment.  I am not exactly excited about going back to full chemo treatment. I hate it and its crippling side-effects, but I need to do this to see you again…or for the chance to run the NYC marathon next year.

This is when I say ‘life is like a marathon, you will never know how you will finish until you stand at the starting line.’


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Berlin Marathon: Done.

October 5, 2012

Basel, Switzerland.

erlin is done. I still have the afterglow from running Berlin marathon last September 30. It was a memorable weekend in a historic city. It was my second time to visit the city but never this close to see its people and the city first hand. I felt like a celebrity as they came out to cheer you. All along the way you would hear…

Bravo. Aller (‘go’ in French). Laufen (‘run’ in German), Roberto!  Bravo.

There are the beautiful little kids who would even come up to you and extend their hand. High five, dude. As you pass-by they would do ‘the wave’ in chorus with others. Cow bells, horns, and bands every couple of kilometer. As the morning turns into afternoon, the beer gardens lining the route becomes crowded and noisy. They love their beer in Germany. There are no open bottle restriction.

The aide station are well stocked with water, Powerade, hot tea (yes, hot tea!), banana, and apples. Of course, if you are not happy with the selection you can always stop at the next beer garden. Ha!

The historic significance of Berlin is not lost on me. I love history. The marathon start at the Tiergarten, Berlin’s equivalent of NYC’s Central Park or Chicago’s Grant Park. The park was previously the hunting grounds reserved for royalty and the literal translation meant animal garden. The marathon also ends at the park passing through the famous Brandenburg Gate.

Berlin marathon is the fastest marathon course in the world and it is designed for fast runners. I am not a fast runner in my current state and did not break any personal records. I was just so thankful I was able to run it. I was full of anxiety coming to Berlin not knowing whether my cancer-stricken lungs will be able to carry me to the finish line.

Each cough I make would elicit a look in my wife’s eyes to see if I was ok. But as I got pulled by the energy of other runners and started knocking down the miles at a steady pace, my confidence started to build. At the 21 km marker, we were still on pace on my target to finish under 6 hours. My cancer nodules were cooperating. However, by kilometer 32 (mile marker 20) fatigue, stiffness, and cramps started to set in. My lung capacity was limiting me to remove the build up of lactic acid in my muscles.

The sweeper bus have caught us but I was determined to get this done.  It was such a grind so we ended up walking most of the way.

As we near the finish at kilometer 40, other finishers were cheering us on. Bravo! The roads were already open and we are running on the side. Then you turn and get a glimpse of the Gate. As you approach the Gate, you go through a column of other runners merrily drinking their beer. They stop and clap as you pass thru. All were urging you to finish. Laufen, Roberto!  The back-of-the-neck hair raising moment was when you pass under the Gate and whole thing opens up to the finish line (Ziel) with people watching you.

I felt like a deer when flashed with headlights. The Gate was partially obscuring the people behind, then all of the sudden it is there. We get to the finish line with the official timer off but still very thankful we finished and have the medal to prove it.

I did it. I have metastatic lung cancer and I finished the Berlin marathon in 6 hours and 38 minutes.

Before the start of the marathon

Berlin finishers

Berlin medals and bib. Bravo!


P.S. Have been taking my chemo pills for the past 5 days with limited side-effects.  Thanks God.  Also, good luck to all runners running the weekends Chicago marathon.

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