Time for a Change

It's been a week since I received my latest scan results from Dr. C.  Haven't really felt like writing ... trying to let it all sink in and get my mind in proper "strong" mode in preparation for a (another) treatment change.  I'm usually able to do this rather quickly, but then as time goes by, I work out the various side effect scenarios and get myself all nervous.

In a couple of weeks, I'll be starting on the chemotherapy Taxotere.  Carboplatin and Gemcitabine have run their course and do not appear to be working as well as previously:  The CT scan showed fairly significant tumor growth and new tumors in my liver.  The lungs are mostly stable, as are the bones.  Also, my CA 15-3 tumor marker is elevated again.  It's been trending upward for a little while now.

What I expected was that the scan would show "slight" progression, but not significant enough to warrant a treatment change.  This seems to be the way my cancer operates.  Progressive, slow growth for a few scans, then at some point a determination that the slow and steady growth is clearly too much.  My liver metastases have never really been a concern.  My lung (the pleura=lining) and the pleural effusion (fluid in the lung) have always been the squeaky wheel.  As I mentioned in my previous post, I'm having no respiratory/lung symptoms/issues.  So I was surprised when Dr. Coscio showed us and described the CT results.  She handed me a copy of the report, which described in painful detail the cancer progression seen in my liver.  My liver!  Dimensions of several metastatic lesions were notated, and those were compared to their previous dimensions.

I was even more surprised when she outlined the options.  Number one:  Stay on Carbo/Gem and "wait and see" what the scans showed in 3 more months.  Number two:  move to a new drug -- not just new to me but a relatively newly approved drug-- which is given in combination with some type of hormone therapy.  Some of the hormonal options were drugs I've been on before and they either didn't work at all or stopped working at some time.  However, there is a possibility they could work or work again in combination with this new drug.  Option number three:  switch to a different chemotherapy drug-- Taxotere.  Taxotere is related to Abraxane, which I've been on before and actually had some success with.  I was on it for approximately 15 months so clearly it worked for a time or I wouldn't have lasted that long with it.  I also tolerated it pretty well, from what I recall.  It's really hard to keep track of all of the different treatments I've been on and their associated side effects!  Not to mention the effectiveness (or lack thereof) of each one.  It's not my job as a patient to manage all of this, but ... I do try.  I keep a running record in my iPhone notes of the names and dates of my cancer treatments.  Not each individual infusion, mind you, but what I'm on, when it was started and when it was discontinued.  More and more often, I am also adding notes of why they were stopped and what troubles I had with each.  Hard to believe I've been in cancer treatment of one form or another for 16 YEARS!  10 years as stage IV.

Option number one doesn't really sound good to me, and I don't think Dr. C approves either.  Although, if I would have wanted to stay on it another 3 months, she would have allowed it.  "Wait and see"?  I think not.  She explained that since there is growth in the liver metastases and slight growth in the lung pleura, it is only a matter of time before the lung starts producing fluid again (pleural effusion has been the bane of my cancer fight for the past year and a half.)  I get it:  We don't want to let the cancer get that kind of foothold again.  It was a miracle from God that I overcame the colossal fluid buildup, massive "tumor burden," and emaciating weight loss.  Let's switch now and hope for a fabulous response before the downward spiral to death starts again.

Option number two involves the latest and greatest drug for advanced breast cancer.  I could be excited about it, but I'm not because we'd have to add hormonal therapy to the mix.  Some of these didn't work at all.  Some worked for a long or little while, but at some point stopped working.  Along the course of "sampling" a vast array of different drugs to treat my cancer, we have already "revisited" hormone therapy (in other words, abandoned it because it didn't work, then went back to it at a later time) and it was unsuccessful.  So, I don't have much confidence in it as a whole.  As an aside, one of the hormonal drugs being considered is given as an intramuscular injection-- TWO OF THEM-- every 3-4 weeks.  I HATE injections!  The kicker, though, is that I've been on that particular drug (Faslodex) before, and not only was the delivery method painful and extremely stressful for me, but it didn't work on my cancer.  No motivation to continue on it then, and definitely no motivation to get back on it now.  I'm willing to tolerate a lot of side effects for a drug that's working, but, well, you get the idea here.  

Option number three ... Dr. C said that typically if one drug in the class is successful, others may be also.  Considering this and the above mentioned facts on my success with Abraxane, I chose #3, the Taxotere chemotherapy.  I will lose my hair again, but I'm okay with that.  Thin, sparse, and slow-growing though it's been, I've been enjoying my short 'do.  A single large bottle of shampoo is all I've purchased in the last year.  Just the other day, after getting the new chemo news, I had the following thoughts, in a span of about 3 seconds:  Hey, I'm running low on shampoo, finally ... Oh goodie, I think I'll buy a different kind/scent this time ... Wait ... I won't be needing more shampoo any time soon.  :(  So, sure, there's a little sadness about it, I'm not going to lie.

The other thing is-- and I've discussed this before-- that it's so OBVIOUS that you have cancer when you're bald.  There is no pretending that you're just a normal woman.  You are a cancer patient, and everyone knows it.  Additionally, once your hair is back, people think you're done with treatment and everything is looking up.  I'm going to AGAIN lose my hair, which will signal that things are not looking good, which in this case IS true.  However, having hair when you're a stage IV cancer patient doesn't mean that all is peachy. The Carbo/Gem combo I've been on for the past year has been very harsh on my body, even though it doesn't cause total alopecia.  I'm operating on extremely low blood counts (red and white cells,) platelets, magnesium levels.  It is amaing how the human body can adapt and get by fairly nicely on such out-of-whack insides (case in point:  how in the world did my heart continue to function when it was displaced to the right side of my chest?)  Even when my counts are "good," meaning at a level adequate to receive my next chemotherapy dose, they are still way, way below the "normal" range.  There is lots happening behind the scenes with me that are "invisible" to others.  My point is that just because a chemo drug causes hair loss, doesn't necessarily make it a "stronger" one than others.  The perception of outsiders is that losing your hair is the worst!  But it isn't.

In fact, Taxotere may be "tolerated" better than Carbo/Gem of the past year, as it doesn't always severely affect the blood counts.  The unknown is what is unnerving.  Only time will tell which side effects I'll have on this new drug.  I'll receive the infusion and wait and find out for myself.  Will I be tired?  Will I be nauseated?  Will my neuropathy worsen or improve?  Will I be plagued with persistent low blood counts and platelets?  Will my low magnesium level improve?  Will it cause diarrhea?  Who knows!  It will be an "adventure" of finding out just how I'll be affected and figuring out what will work to counteract the SE's.  Fun ... not.

On the plus side ... I won't have the "Carbo Glow" to deal with any longer.  This is the embarrassing reddish-purple face rash that I always get a couple days after my infusion.  And I won't have the extreme-tenderness-to-the-touch of my skin that follows the Carbo Glow.  And I won't have the sensitivity to sound and intolerance to anything remotely aggravating (such as my kids, family, and virtually anything that I deem an unsettling incident or situation.)  At least, I HOPE these things will go away!!  Hoping, praying that my time on Taxotere is low on side effects and high on effectiveness!!!