December 13, 2013 – Chemo Drugs

Cancer is characterized by rapid cell division/growth.  The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells.  The “normal” cells will grow back and be healthy, but in the meantime side effects occur.  The “normal” cells most commonly affected by chemotherapy are also cells that divide and copy quickly – blood cells, cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.

                           

Jess and I attended Chemo class this past Wednesday.  This 2-hour class is conducted by an oncology RN for patients and caregivers.  We each got an individualized loose-leaf binder with info on our specific chemo drugs.  Here are mine:

Taxotere is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug.  Taxotere is classified as a “plant alkaloid,” a “taxane” and an “antimicrotuble” agent.  It’s given intravenously.  Premedication with a corticosteroid pill starting a day prior to Taxotere infusion for 3 days is given to reduce the severity of fluid retention and allergic reactions.  Common side effects:

·         Low white blood cell count (increased risk of infection)

·         Low red blood cell count (anemia)

·         Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

o   Onset: 4-7 days

o   Nadir: 5-9 days

o   Recovery: 21 days

·         Fluid retention

·         Peripheral neuropathy (numbness in fingers and toes)

·         Nausea

·         Diarrhea

·         Mouth sores

·         Hair loss

·         Fatigue and weakness

·         Infection

·         Nail changes

The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).  Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Taxotere belongs to a class of chemotherapy drugs called plant alkaloids, and is cell-cycle specific.  This means it attacks the cells during various phases of division.  Antimicrotubule agents inhibit the microtubule structures within the cell.  Microtubules are part of the cell’s apparatus for dividing and replicating itself.  Inhibition of these structures ultimately results in cell death.

Cytoxan is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug.  Cytoxan is classified as an “alkylating agent.”  Usually given by intravenous, the following side effects are common:

·         Low blood counts (white and red blood cells and platelets) – increased risk for infection, anemia and/or bleeding.

·         Nadir:

o   Onset: 7 days

o   Nadir: 10-14 days

o   Recovery: 21 days

·         Hair loss

·         Nausea and vomiting

·         Poor appetite

·         Loss of fertility

Cytoxan is classified as an alkylating agent, most active in the resting phase of the cell.  This drug is cell-cycle non-specific.

Non-chemotherapy Drugs:

Neulasta is a biologic response modifier.  It is classified as a colony stimulating factor used to stimulate the growth of “healthy” white blood cells in the bone marrow, once chemotherapy is given. White blood cells help the body fight infection. This is not a chemotherapy drug.  It is usually given at least 24 hours after chemotherapy to stimulate the growth of new, healthy, white blood cells (WBC), and is given via injection.

Dexamethasone – corticosteroid used to mitigate fluid retention, allergies, arthritis, asthma and skin conditions.

Prochlorperazine – used to control severe nausea and vomiting.

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December 9, 2013 – Plan & Schedule Updates

This morning we met with Dr. Mary Ann Rose, Professor and Medical Director of UC San Diego Radiation Oncology.  She spent over an hour with us, going over the various procedures and timing.  Now that I’ll be starting chemo on December 9 (just got off the phone with the office), I won’t be starting radiation until mid-April.  So we’ll be going over most of this again at that time.  The chemo will run until mid-March, and then I get 3-4 weeks off to recover before starting 6 weeks of radiation, which should finish by the end of May. 

December 10 – Dye injection at 12pm, out to lunch, 2pm bone scan.  This is to ensure the breast cancer hasn’t spread to the bones (apparently breast cancer’s next favorite place to hide out).

December 11 – 3pm Chemo Class

December 12 – after a morning at the radio station, we’ll be meeting friends to go to Disneyland for a screening of the new movie, Saving Mr. Banks which is the story of how the movie Mary Poppins was made.  Mr. Banks is the father of the children taken care of by Mary Poppins, the original movie is really about his transformation from a curmudgeon to a warm and open family-man.   Walt Disney is played by Tom Hanks.  P.L. Travers was the author of the Mary Poppins books and is played by Emma Thompson. 

 December 16 – 9am Chemotherapy infusion (will take about 4 hours, prep delivered by IV).

December 17 – 11:30am Chemotherapy injection (will take about 30 minutes).

December 17 – 2:40pm Dermatologist to check suspicious moles for skin cancer.

December 24 – 10:30am Dr. Subramanian (chemo check-up & blood work).

December 26 – 8pm MRI of abdomen for cyst on right kidney.

Now I need to bone up on chemotherapy procedures, remedies, supplements and diets.  Stuff I hadn’t paid much attention to earlier since chemo hadn’t been part of the original treatment plan.  It’s kind of amazing how much time this all takes.  Once we get into January, things should settle down some because the extra tests will be done.  As I understand it, there will be a chemo injection every 3 weeks, preceded by infusion the day before, and a doctor visit with blood work about 8 days after the injection; for a total of 4 injections given over 12 weeks.

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December 7, 2013 – Gene Expression Profiling

Yesterday’s appointment with Dr. Subramanian yielded the news that my gene expression results indicate I will likely benefit from chemotherapy.  The oncotype test looked at a panel of 21 genes in the tumor tissue from my lumpectomy to calculate a recurrence score from 0-100.  It helps identify which women with early-stage, estrogen receptor positive (ER+) [HER2- and post-menopausal with lymph node negative (N-)] invasive breast cancer are more likely to benefit from adding chemotherapy to their treatment.  My current recurrence score is 19.  Based on the clinical validation study, that means that of 100 women with my specific diagnosis, 19 will experience a recurrence of breast cancer somewhere in the body within 10 years.  For those patients whose breast cancer is treated with 5 years of anti-hormone therapy with tamoxifen, the average rate of distant recurrence is 12%.  My course of treatment is surgery, radiation, and 5 years of anti-hormone therapy.  Including chemotherapy cuts that 12% risk rate roughly in half (5-7%).  

At the moment, I have to admit that I’m a little freaked out about the idea of chemo.  Previously, it had only been mentioned as a treatment option IF cancer was found elsewhere in my body.  Those test results aren’t all in yet -- in fact, some of them have only just been scheduled.  This test looks only at my genes to provide an indicator as to whether my type of cancer will return based on the statistics specific to this type of tumor.  The higher the recurrence score results, the greater chance that the breast cancer may return, and the more likely that chemotherapy will provide a better outcome.  

And I’m all for doing whatever will improve my numbers… I have a lot of things still on my to-do list and I’m not ready to start crossing things off because of a lack of time left to do them.  So chemo will start before Christmas, it could be as early as this week.  We are referring to this as chemo-light.  It’s a 12-week course, with me receiving 4 treatments, one every 3 weeks.  It’s not as many drugs and it’s much shorter than the more usual six-month or year-long course.  And yes, I will lose my hair, and my doctor has already given me prescriptions for nausea.  And I’m looking at recipes and food suggestions and other tips to help get through it.  Because I plan to.

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