Tuesday, December 31, 2013

THE CYTOKINE QUAGMIRE!

Times and times again we land in this soft land of unknown, with the future of our patient potentially irreversibly compromised, despite a great response to therapy. And we know or suspect the Cytokines without knowledge of clearly which, and what to do about it.  And wonder if we should have seen it coming by more sophisticated measurements (if the insurance covered it!).  This has happened with Bleomycin use, and now with modern therapies, it is happening again!
You find this great target therapy, you give to a patient, the tumor responds, everybody is happy, there it comes by way of proteinuria, abnormal liver functions and worse this dry cough and ultimately shortness of Breath (SOB !-please take this professionally, not as you please) that impairs our patients despite response to therapy!  Interstitial Bronchitis they call it.  And you know it is the Cytokines. At least the response to steroids strongly suggests it...Then the curve ball is thrown at you.  Did you just affect the response by bringing in the steroids? are they going to mitigate response to therapy, do they compromise future therapy, can you resume the treatment with the now known effective drug.  Warning boxes stop you though!  And how we ended up here without scrutiny? how we are cornered to be sleeping at the wheel?  head in the sand again?  In this environment of limited therapeutic options, it is a true Quagmire we found ourselves in.

CRBCM working on better Bio-markers for predicting side effects!
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