Fred Ho's Cancer Diary

Fighting Fred Ho Tribute December 16 before the Onslaught Begins December 17, 2007

“Bruce Lee defied tradition and earned the anger of narrow traditionalists who opposed his teaching of Chinese martial arts to
non-Chinese, especially to Blacks. Fred Ho continues Lee’s iconoclasm as the singular supporter of Blacks and Latinos in Asian
martial arts today.” --William Kevin “Doc” Savage, 2003

On Sunday, December 16, 2007 at 2 pm, the American Museum of the Moving Image (located at 35th Avenue at 36th Street in Astoria Queens; R or V train to Steinway Street or Q101 bus to 35th Avenue) pays tribute to Fred Ho for his leading role in supporting and promoting Blacks and Latinos in the Asian martial arts in the U.S. The event is the world premiere of a new documentary film by Kamau Hunter and Jose Figueroa, URBAN DRAGONS (2007, 90 minutes), examining the role and presence of Blacks and Latinos in the martial arts in the U.S. Following the screening will be a panel discussion with the filmmakers and the audience and the honoring of Fred Ho. In attendance will be some of the greatest living martial artists of today. The event is part of the Sword and Fist series curated by Warrington Hudlin. Please join us. For information, call 718.784.4520.

After a multitude of tests and doctors’ meetings, a treatment plan has been developed. Because of the finding of the new, second tumor, and due to massive scar tissue from the surgery of the first colon cancer tumor in August of 2006, surgery has been postponed. Chemotherapy and radiation (drugs and information follows) will be administered in the hopes of reducing the tumors and containing cancer cell spread. Tests seem very hopeful and positive that cancer does not appear to have spread to my vital organs of kidneys, liver, lungs, heart, and brain.

The schedule for my combined chemotherapy and radiation treatment is:

On Tuesday, December 11, I will receive my first chemo “load-in” of cetuximab (aka erbitux), and additional x-rays to precisely confirm where radiation will be targeted.

On Monday, December 17, I will go to Beth Israel Hospital for 9 am chemotherapy infusions while ingesting via tablets the chemo drug Xeloda daily Monday thru Friday. Monday thru Friday I will also have radiation.

I will have no treatments on weekends.

Close monitoring will be done of my side effects which include nausea, diarrhea, hand-foot syndrome (extreme flaking, burning, chafing of the skin on my hands and my feet), possible loss of fertility, loss of hair, low blood counts, watery eyes and salivation, a possible metabolic, cholera-type of diarrhea called SN38, and possible mouth sores.

It is anticipated that after 6 weeks of this combined treatment that I will have/need 6 weeks off to recover. During this time I will be tested and evaluated and further treatment (surgery and/or more combined chemo/radiation) will be determined.

Besides two weeks of the flu, I have been feeling very good. I continue to exercise and swim regularly, go for daily walks of at least one mile, and I try to stay relaxed and rested. All of my professional activities have all been postponed to Fall 2008 or Spring 2009, tho I do want to complete a commission from Thomas Buckner for baritone voice and baritone saxophone, text to be written by Jayne Cortez, during my treatments.

I was very moved by the wonderful turn-out of people who came to my last concert on October 25, celebrating the 25th anniversary of my band, the Afro Asian Music Ensemble. Robert Browning of the World Music Institute has been a wonderful friend and supporter. Thank you to the WMI and to everyone who came out and to the performers in both my band, the Afro Asian Music Ensemble, and the opening band, 3Z+. It was a joyful and terrific evening.

I continue to receive many letters, calls and emails sending well wishes and love, as well as generous donations. Thank you to Idell Conaway, Cheryl Higashida, Nick and Laura Unger, Dolly Veale, Sylvie Degiez/Wayne Lopes, Rebecca Lazier and Miyoshi Smith for their cash gifts in this recent period. Tom Buckner and Kamala Cesar gave a very generous donation of $1,000.

For those of you who could find it useful, what follow is my medical analysis and treatment plan.

FRED HO

HO, Fred DOB: 08/10/57

November 14, 2007 INITIAL BETH ISRAEL MEDICAL ONCOLOGY CONSULTATION NOTE

DISEASE: Pelvic recurrence of adenocarcinoma of the sigmoid colon.

HISTORY OF THE PRESENT ILLNESS: The patient is a 50-year-old gentleman found to have a sporadic case of adenocarcinoma of the colon, rectosigmoid, and underwent surgery 8/29/06. Presenting symptomatology was lower GI bleeding and diarrhea. He underwent an R0 resection of a pathologic T4 B N1 (1/22 lymph nodes replaced by metastatic carcinoma with extension into surrounding mesenteric Adipost tissue. The proximal and distal margins are negative for tumor, but no specific comment on circumferential margin status. He completed twelve cycles of adjuvant modified FOLFOX March 2007 under the care of Dr. Dilip Patel (718) 470-4454. Treatment was complicated by grade 2-3 neuropathy from January until June 2007. He also had what sounds like an allergic reaction possibly to the oxaliplatinum, which was successfully managed by swelling oxaliplatinum infusion rate. He has persistent grade-1 neuropathy, but this does not interfere with his musicianship, he is a professional saxophonist.

Unfortunately by July 2007 he developed recurrent diarrhea and bright red blood per rectum. Colonoscopy 9/24/07 showed a friable lesion 15 cm from the anal verge. Correlative biopsy, however, showed nonspecific colitis, no evidence of cancer. He was evaluated by Dr. Antonio Picon (Surgical Oncologist Beth Israel Medical Center) 10/17/07. MRI referral to Dr. David Robbins for EUS, endoscopy and repeat biopsy recommended. The patient’s situation was presented to the GI Tumor Board Beth Israel Medical Center 11/12/07. Attendance included Dr. Warren Enker Colorectal Surgery, Dr. Antonio Picon Surgical Oncology, Dr. Joseph Martz Colorectal Surgery, Dr. Kenneth Hu Radiation Oncology. Consensus was that because the MRI showed the sigmoid neoplasm within the pelvis as well as a presacral mass suspicious for regional nodal metastasis versus mesenteric implant. Consensus was to proceed with neoadjuvant chemoradiation therapy prior to definitive resection.

SOCIAL HISTORY: He is a professional saxophonist. He is a lifelong nonsmoker, nondrinker, nondrug user.

REVIEW OF SYSTEMS: Positive symptoms limited to frequent bowel movement and bright red blood per rectum. He has no symptomatology to suggest anemia and no weight loss. Additional eight systems reviewed and are unremarkable.

PHYSICAL EXAMINATION: Well appearing gentleman and no acute distress. Height: Not documented, weight: 218 lbs, BP: 120/80, pulse: 78, pain: 0, temp: 97. HEENT- PERRL, EOMI, OP: Normal, Lungs: Bilaterally CTA/P, Heart: Regular rhythm, no gallops, or rubs. Abdomen: Soft, nontender, nondistended, no masses, organomegaly, or ascites. Extremities: No clubbing, cyanosis, or edema. Lymphatic survey: There is no cervical, supraclavicular, axillary, epitrochlear, or inguinal adenopathy. Neurological exam: Normal mental acuity. Cranial nerves II-XII, motor and cerebellar function intact.

PATHOLOGY DATA:
Surgical pathology report North Shore University Hospital at Forest Hills rectosigmoid colon – adenocarcinoma of the colon, moderately differentiated pT4 N1 (1/22 lymph nodes positive for metastatic carcinoma, which extends into the surrounding mesenteric Adipost tissue. Proximal and distal margins negative for tumor circumferential margin status not mentioned, lymphovascular invasion not mentioned.

IMAGING DATA:
10/05/07 CT/PET scan skull through thighs.

10/05/07 North Shore Long Island Jewish Health Care System: Findings highly suspicious for recurrent colon cancer at the sigmoid anastomotic site. Small focus of mild hypermetabolism in the rectum maximum SUV of 6.4 without corresponding abnormality on CT scan.

Beth Israel Medical Center 11/11/07 pelvic MRI with contrast:
Findings most consistent with sigmoid neoplasm with mild multifocal extension due to the pericolonic fat.

Focal left presacral mass very suspicious for spread of disease. Mass immediately abuts the piriformis muscle.

Plaque-like soft tissue thickening of the sigmoid mesentery either desmoplastic reaction or spread of disease.

Mildly enlarged heterogenous prostate. Notably presacral mass measures 3.5 x 2.2 x 1.7 cm. This probably involves the mesorectal fashion near its junction within the peritoneal reflexion as well as the presacral space.

Outside colonoscopy report to cecum: Recurrent friable lesion at 15 cm. Remainder of colon is reportedly unremarkable. Colonoscopist, Richard Emanuel, M.D., Forest Hills Medical, 96-10 Metropolitan Avenue, Forest Hills, NY 11375.

LABORATORY DATA:
10/31/07 CBC/CMP: CMP-unremarkable, normal liver function profile, albumen 4.4, WBC 5.0, hemoglobin 15.6, MCV 92.8, platelets 284, CEA 0.8, PT/PTT – unremarkable.

IMPRESSION/PLAN: Sixty-minute consultation with the patient. The next day a thirty-minute conversation with the patient’s sister, Florence Houn, M.D. who is a Preventive Oncologist in Bethesda, Maryland. The patient and his sister understand and agree with the following:

Pelvic recurrence of colon cancer with possible presacral nodal metastasis. They understand that confirmatory biopsy is required before any neoadjuvant intent chemoradiation can begin. Assuming pelvic recurrence of colon adenocarcinoma is confirmed, the 11/12/07 GI Tumor Board consensus was to proceed with neoadjuvant chemoradiation therapy prior to resection. Given the fact that his colon cancer recurred during FOLFOX, he should be thought of as having colon cancer primarily refractory to this regimen. Therefore, non-cross resistant chemotherapy needs to be partnered with radiation therapy in order to optimize not just local control, but also address possible distant micrometastases. Standard treatment for patients with colorectal cancer that is resistant to FOLFOX is irinotecan with cetuximab. In order to optimize radiation sensitivity, I would add Xeloda to this combination. Evidence supporting the feasibility of preoperative chemoradiation therapy with irinotecan, capecitabine, and cetuximab comes from Hong et al Journal of Clinical Oncology 2007 ASCO annual meeting Proceedings Part One Volume 25 #18S, Abstract #4045. The regimen consisted of cetuximab 400 mg/M2 on day -6 one week prior to radiation therapy followed by weekly cetuximab 250 mg/M2, irinotecan 40 mg/M2 and capecitabine 1650 mg/M2 bid weekdays only during radiation. The potential side effects of this regimen including, but not limited to nausea, vomiting, acne like rash over face, back and chest, which can be severe, dry skin, perionychial cracking along the fingernail edges, cutaneous toxicity along the perineum, low blood counts including the potential need for growth factor transfusion support, fevers, allergic reactions, hand-foot syndrome, mouth sores and diarrhea reviewed. He is familiar with these drugs and was given literature on each of them.

Predisposition to iron deficiency anemia – he is encouraged to start taking one iron tablet with one vitamin C tablet daily. He understands to stop this medication the first sign of significant constipation.

Confirmatory biopsy with Dr. David Robbins.

ASAP consult with Kenneth Hu Radiation Oncology.

Followup in this office in two weeks so that plans for chemoradiation therapy can be finalized. In the meantime we will obtain preauthorization for all of the above-mentioned systemic therapies.

Peter Kozuch, M.D.