Sunday, April 18, 2010

Back to the lab

Posted by Akin at Sunday, April 18, 2010

When I was on my hematology/oncology rotation in August, I noticed that many of the patients had refractory disease. The nationally recognized NCCN guidelines has a treatment algorithm that often recommends "clinical trials" for these patients (depending on the disease and other factors) after first and second line therapies fail. I noticed that instead of enrollment in clinical trials, some of these patients were being put on chemotherapy regimens that I had never learned in therapeutics and didn't find in the literature (i.e. instead of RVD or VDT-PACE for multiple myeloma, a patient was getting RVD-ACE + vorinostat).

On my pediatrics rotation, when checking for proper dosing, I noticed that many of the medications had no dosage recommendations in pediatric drug handbooks due to lack of data. A specific example than comes to mind is when I realized that a child I was working up was knowingly receiving doses of a blood pressure medication that was 5 times the maximum adult dose. Despite lack of long term data of this dose in children, it was still being used mainly because there was really no other option.

My point is that that there were many drug questions that came up while rounding, but often no studies out there that answered them. The responsibilities of working up patients and preparing for topic discussions prevented me from looking more into these issues.

My March, nontraditional research rotation with Dr. Vicki Ellingrod involving pharmacogenomics allowed me to delve into issues like these. The specific project that I worked on involved the possible association between a genotype and weight gain/insulin resistance in patients who are taking certain antipyschotics. I started off doing lots of reading on background information, reviewing molecular genetics, and attending seminars around campus that were related to the research. But this rotation also allowed me to be as curious as I wanted to be. By the end of the month, I was developing my own initiative: looking up information that I happened to think was relevant or even information that just seemed interesting. Finally, I was able to learn a few lab techniques and get a glimpse of some of the neat research being done around the university.

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