MM in Chemo Phase

While taking his morning walk in August of this year, Powell White noticed that he was short of breath. He also felt some pain in his back, just below his right shoulder blade. About eight weeks earlier, he had developed a dry cough that had become progressively worse. Although he is only 56 years old, the combination of these three symptoms made Powell suspect something was wrong.

On August 19, 1998, Powell visited his primary doctor for a routine physical exam. He received a clean bill of health. Powell became concerned, however, when his shortness of breath and back pain grew worse. On August 31, Powell returned to the doctor. After a review of the symptoms and another physical exam, the doctor gave Powell a prescription for antibiotics.

By September 3rd, Powell's condition had not improved and he began to have trouble sleeping. He returned to his family doctor, who prescribed sleeping medication. Five days later, Powell's back and chest pains became more intense. His doctor prescribed a different antibiotic. On September 11th, Powell again called the doctor to report that his condition was not improving. The doctor sent Powell to the hospital for a chest film.

Upon viewing the x-ray, the doctors ordered Powell to go to the emergency room right away. The chest film had revealed a large right-sided pleural effusion needing immediate attention. A thoracentesis was performed, and approximately three liters of fluid were drained from Powell's chest.

Powell was then referred to a pulmonary specialist. The pulmonologist performed another thoracentesis and ordered a CT scan. The CT scan revealed an extensive mass in the pleural space of Powell's right lung. The size, location and diffuseness of the mass raised the spector of malignant mesothelioma. To be certain, a pleural biopsy was performed, which later confirmed the diagnosis of diffuse malignant mesothelioma of the sarcomatous variant, with a possible epithelial component.

On September 25, 1998, Powell had a chest MRI to ascertain the extent of the tumor, and determine Powell's suitability for an extra pleural pneumonectomy (EPP). The MRI showed the tumor involved two areas: (1) the right lung base especially over the diaphragm, and (2) the anterior aspect of the right upper lobe. In addition, several mediastinal lymph nodes appeared enlarged.

Before making a decision about how to proceed, Powell wanted a second opinion. He scheduled an appointment with Dr. Douglas Wood, a surgical oncologist with the University of Washington Medical Center in Seattle, Washington. Dr. Wood confirmed the mesothelioma diagnosis. Dr. Wood determined that Powell was a candidate for EPP, and suggested that Powell speak with his colleague Dr. Eric Vallières, also with the University of Washington.

Dr. Vallières is the thoracic surgeon in charge of the mesothelioma program at the University of Washington Medical Center. Eighteen months ago, Dr. Vallières initiated (click here) a Phase III trial which addressed the tri-modal approach to treating diffuse malignant mesothelioma of the pleura. Using this approach, induction chemotherapy is followed by radical surgery, then adjuvant fast neutron radiation therapy.

On October 15, Powell had another pleural effusion drained. According to Powell, the thoracentesis relieves his chest and back pain somewhat. However, Dr. Vallières had informed him that the procedure was risky and should be used sparingly. According to Dr. Vallières, sarcomatous mesothelioma is very aggressive and will follow the thoracentesis needle channel and spread outside the thoracic cavity. In addition, thoracentesis creates scar tissue which may prevent optimum distribution of the chemotherapy agents.

Having agreed to the tri-modal therapy at the University of Washington, Powell received his first chemotherapy treatment on October 26th. Powell states that he is feeling okay, and is not experiencing any side-effects.

Powell will receive chemotherapy every Monday for the next four weeks. At the end of four weeks, he will have completed his first cycle of chemotherapy. At the end of the second chemotherapy cycle, a CT scan will be performed. If the tumor is responding to the chemotherapy, Powell will receive another cycle before undergoing surgery and radiation. If the tumor is not responding to the chemotherapy, Powell will have the extra pleural pneumonectomy followed by neutron radiation therapy.

Powell, his wife Mary Ann, their two daughters and five grandchildren all hope the tri-modal therapy will get rid of the tumor. The Powell family realizes that they have just begun a long journey with an uncertain destination.

** POSTED DECEMBER 2, 1998 **

Mr. Powell White passed away on June 20, 2000