Steve has been taking a daily 300mg "loading dose" of vandetamib as part of the VanSel1 drug trial he started on Monday. The loading dose is reduced to a lower "continuous dose" of 200mg after four days. This change triggers the first set of research bloods which are tested to see the effect the drug on his body.
Blood samples are taken over a 24 hour period. The first blood sample was taken before the final "loading" dose of vandetamib to check that he was OK to carry on with the drug. Further samples were then taken for research purposes. This happened at 30 minutes after swallowing the tablets, then at two, four, six and twenty four hours after the dose. This allows the research team to look at what happens to the drug in the body through different times of the day - how the body absorbs the drug; how the drug gets to different parts of the body and how the body breaks down and gets rid of the drug.
Less than 2ml of blood is taken at each sample, so not a lot in total. However, because five samples are taken in one session, a cannula (a bit like a tap which can be turned on and off) is used rather than use a fresh needle every time. The cannula is inserted ready for the first sample and stays in until the last sample of the day has been taken.
Cannulas are larger and therefore a little more difficult to insert in to a vein than a fine needle. And that's where the fun began yesterday - trying to find a suitable vein! The nurses started looking in Steve's right arm, then tried in the left, then back to the right. After five or six attempts, they finally managed to find a suitable vein that didn't wriggle away (although we found out later that it only worked when Steve was lying down on the bed, rather than sitting up with his arm at a different angle).
The first blood sample check showed that everything was OK. However, Steve wasn't allowed to take the tablets until he had been seen by a doctor. Although there are two trial doctors, one was in clinic that morning and the other had to look after someone who had come in as an emergency. Consequently, Steve wasn't seen until later than anticipated and didn't take the tablets until almost one o'clock in the afternoon rather than 11 am, pushing back the timing of the research blood samples by about two hours.
We had left home before 8.30 am to get to the hospital by 9 o'clock that morning and arrived back home around 7.45 pm, so rather a long day. However, we passed the time reading newspapers; doing crosswords; writing a long "to do" list and setting priorities; doing a first draft design for the garden which will need to be reorganised if/when the old shed is replace (always assuming it stops raining for long enough to do the job!); looking through kitchen catalogues in the hope of feeling inspired to do a much needed makeover...
....and watching a film on the laptop Salmon fishing in the Yemen, which is described as "an upstream journey of faith to make the impossible possible". Very appropriate for someone with mesothelioma taking part in a phase 1 drug trial.....
Today's hospital visit (the third and final visit this week) was shorter and sweeter - the last research blood sample in the 24 hour batch. Just enough time to flick through a photography magazine.....
Steve is now taking the reduced "continuous" dose of vandetamib (two tablets a day instead of three). We have a hospital-free week to look forward to next week, before returning the week after to start the next part of the study when both drugs (vandetanib and selumetanib) will be taken together for the rest of the cycle.
In the meantime, Steve has felt no noticeable side effects after taking vandetanib for five days - very different to his last chemo regime which saw him in hospital overnight at the end of the first week. If anything, he says that food tastes better and so far, he has been more dynamic than usual...ticking off things on the "to do" list at a surprising rate. And long may it last!