Reno toddler gets OK for brain cancer treatment | Cancer Kick

RENO, Nev. (AP) ? The family of a Reno toddler suffering with a rare form of cancer is hoping for a miracle now that Nevada?s Medicaid program has approved chemotherapy drugs to treat him.

Sixteen-month-old Brandon Mojica-Lamas began taking medication Monday after continued efforts by his doctor, legal aid lawyers and others, the Reno Gazette-Journal (http://on.rgj.com/z6JlnX) reported.

Brandon was diagnosed last year with a rare, aggressive form of brain cancer.

He went to Lucille Packard Children?s Hospital in Palo Alto, Calif., for chemotherapy and radiation treatments.

In the midst of his treatment program, Amerigroup Corp., the HMO that administers Nevada?s Medicaid program, denied payment for two chemotherapy drugs because they were considered experimental in treating the boy?s rare form of cancer, the newspaper reported.

?We have hope now,? said Jose Rafael Mojica-Guevara, Brandon?s father, who praised the boy?s doctor, Dr. Paul Fisher.

?He fought for my family. He?s my hero and he?s Brandon?s hero.?

Fisher, chief of the division of child neurology at Packard Children?s Hospital, Stanford University, said he is relieved administrators decided to pay for the chemo drugs. He said the months-long battle to secure coverage for the drugs and radiation treatments was more complicated than the treatments themselves.

?This is the messiness of health care in 2012,? Fisher said. ?The patients who have no voice are the ones who suffer most.?

According to documents on file with the Nevada Department of Health and Human Services, Amerigroup denied coverage on the grounds the drugs weren?t federally approved for use in fighting Brandon?s rare tumor.

The family appealed that decision to a state hearing officer but lost the appeal in December, records show. Both federal and state laws prohibit Medicaid coverage for drugs that are considered experimental. Because there is no FDA-approved treatment for Brandon?s type of cancer, all attempts to treat it can then be considered experimental, state officials said.

In September, the doctors at Stanford had completed about half of Brandon?s therapy. The cancer subsided, but this year another tumor appeared on the boy?s spinal cord.

Fisher wanted to treat Brandon with the two drugs that have been effective in beating other forms of cancer. Again, Amerigroup initially declined to approve the treatment, Fisher said.

?Sure, the truth is that there are no drugs FDA approved for this rare cancer, and there is no drug known to be particularly efficacious,? Fisher said. ?But to stand by, do nothing, offer no treatment, and simply watch this child die from cancer is against the standard of care for children with cancer in the United States.?

Fisher wrote to Nevada?s congressional delegation, state social services officials and the Reno Gazette-Journal, calling the decision not to approve treatment an example of a ?death panel.?

Amerigroup?s medical director subsequently approved Brandon?s course of treatment.

Eric Lloyd, the chief operating officer for Amerigroup Nevada, said the company understands the urgency of the boy?s case. He said payment approval for the first round of chemotherapy was denied because it was part of a clinical study and as such was ?experimental.?

In the current situation, he said, Fisher was able to show that the drugs had been used on patients with tumors like Brandon?s and the latest treatment would not be part of a clinical trial. Therefore, the therapy was approved for payment, he said.

?We?re doing everything we can to care for Brandon in every way we can,? Lloyd said.

Chuck Duarte, administrator for the Nevada Division of Health Care Financing and Policy, said Brandon?s case underscores a need to change Medicaid law.

?There needs to be a provision that when no approved therapy exists, doctors may show good cause to use what they think may help,? he said.

On Monday, Mojica-Guevara and his wife, Ana Rosa, tickled Brandon after giving the boy the liquid drugs through a tube in his nose. In a week or so, mother and son will be back at Stanford for radiation treatments.

?We?re praying for a miracle,? Mojica-Guevara said. ?At least now he has a chance.?

___

Information from: Reno Gazette-Journal, http://www.rgj.com

Article source: http://www.canadianbusiness.com/article/71909--reno-toddler-gets-ok-for-brain-cancer-treatment

Source: http://cancerkick.com/2012/02/21/reno-toddler-gets-ok-for-brain-cancer-treatment/

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