I've been getting alot of messages and questions on how Royce's is and what he has?I am touched that we have so many friends whom are sincerely concern on how what exactly is going on and how Royce is doing. I will be updating this site personally so that everyone will know what we are going through and how Royce is fighting everyday.
The 1st question in everyone's mind. What happened to Royce?
During June of this
year my husband and I grew increasingly concerned (despite reassurances from
our paediatrician at KPJ,Kuching) that Royce, normally a very lively and outgoing child, was
losing weight, growing listless, refusing to eat and appearing to be in
increasing discomfort. By the end of
June he appeared to be in pain and unable to walk. A scan revealed that he had an abdominal
tumour 11 cm in diameter extending from his right kidney and involving his
liver. On July 3 we transferred him to
the National University Hospital (NUH) in Singapore, where tests including a
biopsy confirmed that the tumour was a cancerous neuroblastoma. As the cancer had not spread to his bone
marrow or other tissues, he was classified as Stage 3 (Medium Risk) and
chemotherapy was started on that basis.
However, subsequent MYCN
(genetic) testing revealed that Royce had amplified genetic material. He was therefore reclassified as High Risk
and his subsequent chemotherapies (performed at KKH Womens and Children Hospital, Singapore) are
being administered on that basis.
Because of the nature of
Royce’s tumour, we were advised by physicians at NUH that we should apply to
transfer Royce to the Hospital for Sick Children in Toronto, Canada. This hospital is participating in a clinical
trial of an immunotherapy treatment specifically aimed at Royce’s type of
cancer. This treatment, which we
understand could significantly increase Royce’s chances of recovery, is not
available in Southeast Asia.
Royce has now been
provisionally accepted for treatment by the Hospital for Sick Children. After
discussions between the medical teams involved, it was decided that Royce
should continue to receive treatment in Singapore (including chemotherapy to
shrink the tumour to operable size, surgery to remove as much of the tumour as
possible, additional chemotherapy, High-dose chemotherapy/radiation therapy and stem cell transplant and radiation,) until
it became necessary to transfer him to Toronto for the Immunotherapy stage,
which is not available in Singapore. At
present we are expecting that this will be in February/March 2015. The treatment in
Toronto is expected to last 4-5 months.
While in Singapore he is under the care of Dr. Soh Shui Yen of KK
Women's and Children Hospital,Singapore who has worked at the Hospital for Sick Children and is familiar with
its staff and protocols.
So far Royce has already completed his 1st , 2nd and 3rd Cycle of Chemo at KK Women's and Children Hospital. Today he had just started his 4th Cycle of Chemo under the N7 Protocol.
WHAT IS N7 Protocol ?
BACKGROUND:
The N7 protocol for poor-risk neuroblastoma uses dose-intensive chemotherapy (as in N6 protocol [Kushner et al.: J Clin Oncol 12:2607-2613, 1994] but with lower dosing of vincristine) for induction, surgical resection and 2100 cGy hyperfractionated radiotherapy for local control, and for consolidation, targeted radioimmunotherapy with 131I-labeled anti-GD2 3F8 monoclonal antibody and immunotherapy with unlabeled/unmodified 3F8 (400 mg/m2).
PROCEDURE:
The chemotherapy consists of: cyclophosphamide 70 mg/kg/d x 2 and a 72-hr infusion of doxorubicin 75 mg/m2 plus vincristine 2 mg/m2, for courses 1, 2, 4, and 6; and cisplatin 50 mg/m2/d x 4 and etoposide 200 mg/m2/d x 3, for courses 3, 5, and 7. 131I-3F8 is dosed at 20 mCi/kg, which is myeloablative and therefore necessitates stem-cell support.
RESULTS:
Of the first 24 consecutive previously untreated patients more than 1 year old at diagnosis, 22 were stage 4 and two were unresectable stage 3 with MYCN amplification. Chemotherapy achieved CR/VGPR in 21 of 24 patients. Twenty patients to date have completed treatment with 131I-3F8, and 15 patients have completed all treatment. With a median follow-up of 19 months, 18 of 24 patients remain progression-free.
CONCLUSIONS:
Major toxicities were grade 4 myelosuppression and mucositis during chemotherapy, and self-limited pain and urticaria during antibody treatment. Late effects include hearing deficits and hypothyroidism.
The N7 protocol for poor-risk neuroblastoma uses dose-intensive chemotherapy (as in N6 protocol [Kushner et al.: J Clin Oncol 12:2607-2613, 1994] but with lower dosing of vincristine) for induction, surgical resection and 2100 cGy hyperfractionated radiotherapy for local control, and for consolidation, targeted radioimmunotherapy with 131I-labeled anti-GD2 3F8 monoclonal antibody and immunotherapy with unlabeled/unmodified 3F8 (400 mg/m2).
PROCEDURE:
The chemotherapy consists of: cyclophosphamide 70 mg/kg/d x 2 and a 72-hr infusion of doxorubicin 75 mg/m2 plus vincristine 2 mg/m2, for courses 1, 2, 4, and 6; and cisplatin 50 mg/m2/d x 4 and etoposide 200 mg/m2/d x 3, for courses 3, 5, and 7. 131I-3F8 is dosed at 20 mCi/kg, which is myeloablative and therefore necessitates stem-cell support.
RESULTS:
Of the first 24 consecutive previously untreated patients more than 1 year old at diagnosis, 22 were stage 4 and two were unresectable stage 3 with MYCN amplification. Chemotherapy achieved CR/VGPR in 21 of 24 patients. Twenty patients to date have completed treatment with 131I-3F8, and 15 patients have completed all treatment. With a median follow-up of 19 months, 18 of 24 patients remain progression-free.
CONCLUSIONS:
Major toxicities were grade 4 myelosuppression and mucositis during chemotherapy, and self-limited pain and urticaria during antibody treatment. Late effects include hearing deficits and hypothyroidism.
source : http://www.ncbi.nlm.nih.gov/pubmed/11464891
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