Consultation with Dr. Picozzi

On January 4 we went to Seattle to meet Dr. Picozzi. Mom did very well on the trip. We stayed at the Inn at Virginia Mason which is attached directly to the hospital. The restaurant at the Inn was very good but the prices reflect that. Anne had scheduled us for bloodwork, a CT scan, a chest X-ray and finally a consultation with Dr. Picozzi. Virginia Mason seemed small in comparison with Hopkins but the atmosphere in the Buck building was very pleasant. The cafeteria was reasonable but on that day the food looked better than it actually tasted. At the Hopkins cafeteria I thought the food tasted better than it looked.

We finally had our chance to talk to Dr. Picozzi. He started off by asking us about our backgrounds (schools, jobs, etc.). He seemed really interested in this and I'm not sure if it was because he wanted to make us feel comfortable (people like talking about themselves) or because he liked to get to know his patients. My father, sister and Dr. Picozzi had all gone to Yale and he seemed very pleased with that.

Dr. Picozzi mentioned several things of interest:

• Without adjuvant treatment, the cancer recurs locally 30-60% of the time and recurs systemically 80% of the time.
• It's better to treat systemically sooner rather than later (VMP does both at early stage).
• The standard chemotherapy vs. standard chemoradiotherapy give about the same survival rates.
• He's wary about Xeloda as opposed to using 5FU since there have been no tests to confirm that it is as effective.
• VMP gives long term survival of 40-50%.
• Results at Virginia Mason may be slightly better than those in the initial publication.
• He's made the VMP less toxic recently and believes that the side effects are no worse than standard treatment if you do the VMP at Virginia Mason with their supportive care.
• Only one person dropped out and there have been no deaths.
• Average age of patients treated under VMP is 64.

This is the serene and comfortable waiting room at Virginia Mason.

Doctor Picozzi also mentioned something interesting about my Mom's condition we hadn't heard before. He said that her CA 19-9 pre-surgery was very high - 801.7 and that some institutions would not even operate with such a high number. This might indicate that the chances of some "occult cancer" being around is higher. However, he said that her current CA 19-9 level of 15.7 was a good sign that maybe all the cancer was removed. He also mentioned he had floated the idea of starting a trial with Laheru where they would layer the GVAX vaccine on top of the VMP protocol. I think that would be a fantastic idea.

We were pretty happy with the visit. Dr. Picozzi seemed very knowledgable and very kind. We seem to like the Doctor best that we have seen most recently for some reason :->. If it's true that doing the VMP now is not much more difficult than standard chemoradiation, then it seems like a great approach. My mother definitely needed to hear from Picozzi that the protocol was not too toxic for her and that it was not much more difficult than the standard treatment. We spent the rest of the day looking for a place to stay should we decide to come to Virginia Mason for treatment.