Precious, Malaria Drugs, and an Update

Photo Opportunity

There’s nothing like a worldwide pandemic to suck the joy out of living with cancer.  It’s cut me off from socializing with friends on my good days, and taken away the auto racing I was looking forward to for entertainment while laying about on the couch on my bad days.  Indoor track season has ended, so I’m left to my own devices for photo opportunities.

I repeatedly make jokes that cancer treatment is slowly turning me into Gollum.  Recently, a meme went around the internet showing Gollum calling a roll of toilet paper “precious!”.  Let’s put the authenticity of my joke to the test, shall we?

Hmm, I still have a bit too much hair in front, but from the rear I assure you I look very much like Gollum.  It’s continuing to fall out, so by the time they do another Lord of the Rings movie I truly believe I could play Gollum without any makeup or special effects.

Cancer, Coronavirus, and Treatment Hype

There’s so much I could say about Covid-19 and how it parallels the experience of having cancer, but today I’ll just stick to the hype over potential treatments.

There’s been a lot of hype in the news about the potential for malaria drugs to treat Covid-19.  The FDA recently approved the use of such drugs, despite a general lack of rigorous evidence that they do anything.  Could malaria drugs stop the virus and get us back to being a normally functioning society?  I’m not holding my breath.  Let me tell you a story.

Chemotherapy kills cancer cells, but it also kills healthy cells.  Generally, the dose of chemotherapy is limited by the bone marrow.  Too much chemo kills all the bone marrow and you can’t make blood cells anymore, and you die.  Back in the 80s or so, somebody had the great idea that if you harvested bone marrow from a cancer patient before chemo, you could use a much higher dose that would be lethal to the bone marrow and kill more cancer in the process.  That was okay because after chemo you would transplant the harvested marrow back into the patient and it would resume making blood.

Patients clammored for this.  They wanted painful surgery to transplant bone marrow, and they wanted their insurance companies to pay for it.  They sued their insurance companies for not covering the procedure even though no studies had been done to show it was effective.  Patients generally won these lawsuits and the insurance companies were forced to cover them.  Guess what?  When studies were eventually done in the 90s, they failed to show any benefit.  Just lots of extra expense and suffering for the patient for no tangible benefit.


So what does this have to do with malaria drugs such as Hydroxychloroquine?  With any drug, there are two important doses: The effective dose at which it is effective against the disease or condition it is intended to treat, and the lethal dose at which serious side effects or death become common.  For a “safe” drug the effective dose is much lower than the lethal dose.  Take Ibuprofen as an example: everybody gets 400 mg.  That’s enough to be effective for a 250 lb person and not enough to be dangerous to a 100 lb person.  Simple!  Chemotherapy drugs aren’t as safe, and the dose is based on body weight and height.  If a toxic reaction occurs, the dose is usually reduced or a switch to another drug made.

Pop quiz, can anybody tell me the effective dose for Hydroxychloroquine when used to treat Covid-19?  It’s a trick question: Nobody knows because those types of studies haven’t been done yet.  We do know based on experience with other diseases that side effects such as macular degeneration (which can lead to blindness) can become an issue at doses of 400 mg/day.  Meanwhile, a small French study using 600 mg/day (a not entirely safe dose, but probably okay for a few days) in combination with an antibiotic found “no evidence of rapid antiviral clearance or clinical benefit”.

That’s just one small study, but one that mentioned the dose used.  Results of other studies have been mixed.  It’s fair to say that the combined results of the studies that have been done haven’t lived up to the hype.  Malaria drugs might still turn out to be helpful, but aren’t a magic bullet.  If they do have a benefit, it may be in high doses when used on the critically ill who are perfectly okay with some chance of having impaired vision.

That is a bit speculative on my part, but I wanted to illustrate the difference between anecdotal evidence where it appears to work really well in one or a small group of patients, versus developing a formal treatment protocol where you can confidently tell doctors what dose to use, when to use it, and what side effects to expect.

They may eventually be shown to have some benefit, but perhaps at dosages that border on unsafe.  A risk of going blind may not be an issue if you’re about to die, but it is an issue if you have only mild to moderate symptoms and are expected to recover.  I don’t see doctors prescribing Hydroxychloroquine at the first sign of a cough and telling you to go back to work.

It’s disappointing to hear that the miracle drug promised on the television isn’t what it was advertised to be.  This is what cancer patients deal with all the time.  When I was first diagnosed with prostate cancer, I had high hopes for a drug called Prostvac.  It was an immunotherapy drug that would allow a patients immune system to attack cancer, and had very good results in early, small studies.  At the time of my diagnosis, a phase 3 trail was underway that would eventually lead to approval of this life saving drug, and it would eventually be available to me in the likely event that my current treatment eventually stopped working.

Unfortunately, the trial was terminated early because “At the third interim analysis, criteria for futility were met and the trial was stopped early.”  In fact, it appears the control group was doing ever so slightly better than the experimental group.  Suffice to say, this outcome wasn’t very good for the company’s stock price.

I feel your pain and frustration of being over-promised and under-delivered.  More importantly, now you don’t just know, but have felt a bit what cancer patients and others with chronic or life threatening diseases go through regularly.

My Quick Update

The third cycle of chemotherapy is kicking the tar out of me.  It was a rough first week, and the second week started with injections of Lupron and Xgeva for my original prostate cancer, which re-invigorated the side effects.  My bones hurt when pressure is applied to them, which is to say that whatever part of my body I’m laying on is painful.  It’s not awful pain, but I do need to take pills to be comfortable enough to sleep.

As I said at the beginning, the pandemic is taking the fun out of cancer.  Indoor track is over, no road trips to meet friends, no watching auto racing on TV.

But I’m slowly adapting.  Eventually I will get to video chatting with people, but am a bit hesitant after a recent phone call had to be cut short due to what I’ll politely call digestive side effects.  Also, by brain doesn’t always thing correctly.  You can’t tell right now because I have a backspace key.  Or maybe you can, I left the typos in an earlier sentence in this paragraph.  Spell checker said it was all okay.

I still get out for walks regularly, and occasionally throw in a short bit of running.  Why, just earlier this week I ran almost a quarter mile, and my heart rate only went up to 192 for that short, slow, downhill effort.

I’ve also rediscovered Gran Turismo 5 on PS3.  Playing it is a bit like an odd form of meditation.  If I don’t stay in the present moment of driving a car at high speed on a virtual race track, I quickly end up crashing into the wall.  This game can absorb hours very easily, when I’m feeling well enough to sit up for that long.

And of course I write blog posts occasionally as well, and think about what shockingly oddball pictures I can put in them to keep my readers amused and shocked.  Yes I know today’s image cannot be unseen.