The side effect story
There’s a part of me that’s thankful that my chemo experience wasn’t a horror story. (Though there is a part of me that wonders if that meant I was under-dosed somehow and that the little bit I had actually did nothing to help my cause.) I did two dose dense regimens: Cyclophosphamide and Doxorubicin (also known as AC) every two weeks for four cycles and then three cycles of Taxol ®/ Taxotere ®.
The AC portion of the chemo was pretty easy on me. My oncology nurse told me at the first appointment to drink lots of water and take the anti-nausea drugs for the first few days even if I wasn’t feeling queasy. There were maybe two days during the time I was on the AC drugs that my stomach felt upset, but for the most part I felt fine. Of course I was tired, and of course there came a time that my short haircut needed to be shaved to the skull, but otherwise I was fine.
Taxol was another story entirely. I only managed to have one dose of it because it caused excruciating pain. I like to believe I have a pretty high pain threshold, I am, after all, the same woman who delivered her baby at home and immediately told the midwives, “that wasn’t so bad.” After a couple of days on Taxol I was on the phone requesting some sort of substantial painkiller for the oncologist. I spent several days in a morphine induced haze.
When it was time to get the next treatment, I told the doctor there was no way I could deal with that again, so he switched me to Taxotere. I did two treatments of that and put up with its unpleasantness – sporadic explosive diarrhea and periods that came out of nowhere – before I called “uncle.” I went in to meet my doctor the day of my last scheduled treatment and told him that I was done. He told me that it wasn’t required that I take the last treatment because the Taxol/Taxotere were “insurance” drugs anyway. We shook hands with him and went out for some long overdue celebrating. We all knew that it wasn’t going to be too long before I needed to schedule my second surgery.
Related Stories
POSTED IN: general commentary
1 opinion for The side effect story
Gregory D. Pawelski
Apr 12, 2007 at 8:37 am
Using the CellSearch technique that quantifies circulating tumor cells, German investigators have shown that neoadjuvant chemotherapy with paclitaxel (taxol) causes a massive release of cells into the circulation, while at the same time reducing the size of the tumor. The finding could help explain the fact that complete pathologic responses do not correlate well with improvements in survival.
Circulating tumor cells (CTCs) are cancer cells that have detached from solid tumors and entered the blood stream. This can begin the process of metastasis, the most life-threatening aspect of cancer. To metastasize, or spread cancer to other sites in the body, CTCs travel through the blood and can take root in another tissue or organ.
In the study, breast cancer patients undergoing neoadjuvant chemotherapy gave blood samples in which epithelial antigen-positive cells were isolated. Such cells are detected in most breast cancer patients but are rarely found in normal subjects. The investigators measured the levels of cirulating tumor cells before and during primary chemotherapy with several different cytotoxic agents.
What this recent study has shown is that in three different paclitaxel (taxol) containing regimens, as the tumor collapses (a clinical response, not cure), it produces the greatest release of circulating tumor cells. The study has not looked at any other combination regimens.
The tumor shrinks, but more cells are found in the circulation. This corresponds with a high pathologic complete response during paclitaxel treatment, but in the end, this is not reflected in improved survival. These cells are alive in the circulation. The results indicate that monitoring of circulating tumor cells can contribute to understanding of tumor-blood interactions and may provide a valuable tool for therapy monitoring in solid tumors.
The results of this kind of study are coming out slowly and quietly and indicate that taxol containing regimens didn’t prolong survival over other more conventional and less expensive cytotoxic drugs. It may indeed give clincial response (tumor shrinkage), sometimes impressive, however, these are mostly short-lived and relapses after a response to taxanes (taxol) are often dramatic.
Even if one or more chemotherapy regimen is identified as being likely to work on a particular cancer, has the science advanced to tell us whether application of the chosen chemotherapy regimen will not cause other changes that also cause cancer to later return and perhaps be even harder to treat? Is it a case of chemotherapy being bad, in cases where it apparently works? Traditional chemotherapy is mutagenic (changes in form), you might kill off a whole lot of cancer, only to cause a mutation in the remaining cancer, such that the remaining cancer behaves in a more agressive fashion.
Cancers that are a product of these genetic mutations release cells from the usual controls of proliferation and survival, making them so much harder to fight it. Following this mutation, the cancer cells acquire the ability to proliferate without the normal restraints. As the cancer grows, it may infiltrate and destroy the surrounding tissue, and metastasize by penetrating into blood vessels, lymph nodes, and body cavities. Distant metastasis via the bloodstream may affect virtually any organ (the lungs, bones, liver, adrenals, and even the brain).
These studies tell us that much more work needs to be done, and oncologists need to adapt treatment to the patient. There are over 100 chemotherapeutic agents, all of which have approximately the same probability of working. The tumors of different patients have different responses to chemotherapy. It requires individualized treatment based on testing individual properties of each patient’s cancer.
(Oncol News Int’l, Vol 14, #5, May ‘05)
Have an opinion? Leave a comment: