Hooray for neutrophils

• Bloodwork and treatment (Irinotecan #8) at Siteman West County

Buzz

From the end of July to the beginning of September, I had six weeks between chemo treatments and my hair started to grow back in a little bit. I had a buzz cut look going on and I even went out of the house without it covered up a few times... but thanks to my latest chemo treatment, my tiny little buzz cut hairs are falling out. I'm on my way back to being a beautiful bald, but I might get more wear out of my wig once the weather cools off a little bit more. That thing is hot.

Buzzed at the US Open

Is there a Zarxio video?

• Neupogen Zarxio injection at the Cancer Care Clinic in Big Barnes

Last week I posted a video about Neupogen. I've had hundreds of Neupogen injections over the last 3+ years but trying to explain how it works isn't easy (without a medical degree.) I do have the Neupogen routine down though. The injections have to be stored in a refrigerator, so the routine is that my nurse will ask me to the hold the injection in my hand (it comes in a pre-filled syringe) to warm it up once she removes it from the fridge. Studies have shown that it is less painful if it is warmed up before it is given. Out of habit, I always look at it, I look at the dosage (there are 2 different pre-filled amounts available) and I have grown accustomed to the look of the packaging (most of the plastic is clear but there is one piece that is tinted orange.)

Long story to say that yesterday when I was handed the syringe, I noticed that there was no orange piece and upon closer look, the brand listed was not Neupogen but Zarxio. Zarxio? What the heck is Zarxio?

It turns out that Zarxio is a substitute for Neupogen. It is not a generic brand but rather a biosimilar product. Huh? It was just approved for use in 2015. It made me wonder, have I ever had it before? Did I have it the other times when I had injections on the weekends at the Cancer Care Clinic? I can't be sure. I've had a lot of bone pain in my hips and back since yesterday's injection and I've never experienced this level of pain from Neupogen injections. One of the first questions I'm going to ask at my appointment on Tuesday is, "have I had Zarxio before?" I'm not sure I want it again.

Zarxio is the first biosimilar product to ever be approved for use in the US. I have spent a lot of time reading about it in the last twenty-four hours. This article is interesting: https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm436648.htm. Here's a little snippet from it that implies that Dr. T would had to have been notified about the substitution:

"Zarxio has been approved as biosimilar, not as an interchangeable product. Under the BPCI Act, a biological product that has been approved as an “interchangeable” may be substituted for the reference product without the intervention of the health care provider who prescribed the reference product."

Hello to Russia, where my blog is suddenly getting lots of love

Приветствую нового читателя в России. Добро пожаловать!

video

• Neupogen injection at Siteman West County

This link is to the manufacturer's website and the page does have a lot of medical mumbo-jumbo, but there is an interesting video that tries to explain how Neupogen works.

http://www.neupogen.com/about/#how-does-neupogen-work

Not today

• Bloodwork, appointment with Dr. T NP A and treatment at Siteman South County

I talked to Dr. T on Friday about my CT scan and he described it as stable. He told me that some of the tumors in my lungs had grown a few millimeters and some in my liver had gotten a little smaller or remained unchanged. Dr. T said that there was nothing in the scan that changes our current plan of treatment. Hector and I took it as good news, especially considering that I have only had a few rounds of chemo since my previous CT scan in June. It's been hard to stay on schedule with my body taking it's sweet time to recover after each treatment. I might have mentioned that once or twice.

So rinse and repeat. My ANC this morning was 0.5 (even after a week of Neupogen injections). We'll give my body another week to recover. We'll have another week of Neupogen injections. And we'll try again for chemo next Tuesday. We did meet with NP A today and we went over the details of the CT scan, there are a couple other spots that increased in size... in addition to the lung tumors. If I had read the scan report before I talked to Dr. T, I'm not sure that I would have described it as stable. And unfortunately the mass near my left kidney that led to me getting a stent... is unchanged in size. That's a bummer. 

Ho hum

• CT scan of my chest, abdomen and pelvis at Barnes West County Hospital and Neupogen injection at Siteman West County

1.09

• Bloodwork, appointment with Dr. T and treatment (Irinotecan #7) at Siteman South County

Finally... enough neutrophils for treatment. Barely.