I had a question from a reader about my chemo schedule, and I agree, it's hard to understand. So I thought I'd try to outline it here, briefly. (Well, maybe not so briefly...)
I'm not on any kind of standard regimen--Tykerb is normally given with xeloda, for example, but I can't tolerate xeloda, so that's out--I'm on an out-there-past-the-clinical-trials, made-just-for-me regimen that my doctors devised.
That's what happens when you have had a lot of chemo, and also when you survive a long time with metastatic disease. You get your own personal clinical trial of one. I know other women in the same situation.
The Drugs
Tykerb--comes only in pill form. The standard dose is fives pills per day, all taken at the same time. I can't tolerate that dose, so I take two or three a day.
I take it every day, unless side effects are bothering me, then I skip a day.
Tykerb is a targeted therapy that, in theory, attacks only cancer cells. It actually gets inside the cancer cells, which is good, and also crosses the blood-brain barrier, which means it can help prevent brain mets, which are high on my nightmare list.
**********
Herceptin--a targeted therapy that has been around for a good 10 years now. I've been on it for most of the past seven years, since my cancer spread to my bones.
Herceptin can be given on various schedules, but I get it every three weeks, by IV. Side effects include damage to the heart, but so far my heart is fine.
There is some evidence that giving Herceptin and Tykerb together gives a double whammy, that's why I'm getting both even though the drugs are similar in how they work. They are also both very expensive.
************
Zometa--I don't write much about zometa. It's kind of the quiet drug in my cancer arsenal.
I've been on zometa, like Herceptin, for most of the past seven years. It works to strengthen the bones, making it harder for bone mets to grow (and until recently, I only had bone mets). There is also some evidence that it works against the cancer as well, but mainly I take it to keep my bones nice and hard.
When I've had DEXA scans, my bones are up there above 100 percent of the expected density for my age, so that's working. I like having nice sturdy bones.
There is one really nasty side effect with zometa that I prefer not to think about--necrosis in the jaw around the teeth. Not going to write about it here, because, as I said, I prefer not to think about it.
I get zometa every six weeks. The normal schedule is every four weeks, but my doctors adapted that so that I would get it every other time I was in for Herceptin, which is on a three-week schedule. We may also have been trying to protect my kidneys by giving it less often.
*************
Gemcitabine--is the new drug we added last week. It is what I call a conventional chemo drug, in that it works by whacking all fast-growing cells. That includes the cells that line the mouth and other membranes and also hair and blood cells.
I am supposed to get gemcitabine on a weekly schedule, but I think Dr. Lee said that schedule would actually be three weeks on, one week off, to give my counts time to recover.
The Calendar
Given the above, this is what should happen:
Week One: Herceptin plus gemcitabine, by IV
Week Two: Gemcitabine
Week Three: Gemcitabine
Week Four: Herceptin, gemcitabine--skip???, zometa
Week Five: Gemcitabine
Week Six: Gemcitabine
Week Seven: Gemcitabine, Herceptin
Week Eight: No treatment
And of course I'll be taking Tykerb at home every day.
Isn't this fun?
Read more:
@ Jeanne Sather 2009.
It looks like this schedule has changed already. Based on my conversation with Dr. Lee yesterday, when he held my chemo, I'll be getting the gemcitabine every other week, and a smaller dose. Fine by me.
I want the smallest possible amount that will keep this cancer in check. And I DON'T want another week like the past one--I felt so crappy that I wanted to just call a halt to the whole thing.
Don't feel that way now, of course, but I did then.
Posted by: jeanne Sather | March 07, 2009 at 10:17 AM