Cancer, Chemo, and Drugs (crack)!

Question

About 5yrs ago my last anal PAP showed squamous cell carcinoma, but had "no lesions which could be biopsied" at that time. I wasn't on any AIDS meds at that time. About 2yrs ago my CD4 count was 47, viral load 600,000, KS lesions started, and I had hairy cell leukoplakia on tongue. I had not gone to the doctor for the 3yrs before (crack addict). The KS went into lungs and started first round of chemo (doxil) about 1yr ago. About 4 months after completing chemo, KS became active again. Now doing 2nd round of chemo (doxil). I haven't had the anal ca checked in 5yrs, my doctor doesn't know who to send me to and seems to have no sense of urgency to do so. I have continued to use crack; although use is minimal now as it has been for the last year or so. As this chemo round will put me at the limit for doxil, what are the other options if my KS isn't controlled this time? Besides the info available on chemo effects and crack effects is there any info on the effects of both being used together? Is there urgency to the anal ca issue and could you recommend anyone in the NY area who knows about it and treats it "successfully"? Thank You very much for any help you can provide.

Answer

That's quite a saga you tell. The most important step in your picture, in my opinion, is to get the help you need to get off crack completely. Without being in control of your crack, it's hard to deal effectively with your HIV, your KS, and you anal cancer.

A few things in your query don't make total sense, but I'll do my best to answer them.

First, in terms of Doxil chemotherapy, you state that "you are at the limit for Doxil". I'm not aware of any limit for Doxil. I'm not sure what you are referring to. If the Doxil stops working, then the next drug would be Taxol which works extremely well even if Doxil no longer is effective.

You ask about the urgency of anal cancer, there is indeed an urgency. Anal cancer must be treated to prevent further spread. I'm beginning to wonder if your PAP showed pre-cancer as opposed to cancer.

Although I don't particularly like to recommend specific doctors, I'll make an exception this time. In New York, Susan Krown (Memorial Sloan Kettering) and Joseph Sparano (Montefiore) treat alot of KS patients. There are many other fine physicians so don't hold it against anyone if I didn't mention them. In terms of anal cancer in HIV-infected folks, the two physicians who treat this are Beth Steir (Memorial Sloan Kettering) and Stephen Goldstone. Stephen wrote the book "The Ins and Outs of Gay Sex"; I highly recommend it for those interested in the subject. It is so chock-full of info presented in a non-judgmental manner.