Chemo Update: end of first round of paclitaxel

I had my third infusion of paclitaxel, ending my first round of my third line treatment today.  I now have a week off, which will be much appreciated. 

This round went quite well; I only took one benadryl and no ativan, so I managed to stay awake long enough for lunch with Diane and my daughter afterwards.  Then home to a nap, interrupted a number of times by youngest son who had a flat tire that he was trying to get fixed.  Apparently Volkswagen no longer gives out with their VWs, that crank that loosens lug nuts, so he had to go to the VW dealer to get the lug nuts loosened sufficiently to go back to the tire company and get a replacement tire.  But, of course, tires should be replaced in twos I am told, so he will have to repeat the process tomorrow for the second tire. So, nap sufficiently disturbed after the 5th phone call, I got up and visited with friends who came to walk the dogs. 

I still have my hair, which is cause for amusement and rejoicing but also concern.  Does this mean that the chemo is not working in other ways?  Or is my hair, sufficiently immune because of the insults endured while I was on Tarceva, the epdermal growth factor inhibitor?  Curious minds would like to know this.

My daughter made dinner and we watched episodes of Sex and the City, a tv series I've never seen before today.  I showed her the open letter to the law school Dean posted in 1975 that  I wrote about in the post before this one, so she could decide if any progress has been made in the relations between the sexes, and it was concluded that yes, there has been.  Always room for improvement, however.

Chemotherapy Update

This is my second week on paclitaxel chemotherapy.  It is a single agent chemo, and as a result I am done with chemo in about two hours rather than the 6 hours it took with the 3 rounds of  cisplatin/alimta mix that I had back in late 2009.

I have to say that this week went far better than my first week.  No nausea or other neuropathy as far as I could detect.  I have to remember to eat, but food does not taste bad to me.  Fatigue remains, however, I was able to work from Tues-Friday.  

This was the week my hair was supposed to fall out.  I have the wig ready, and my friend, Jane, is knitting a lightweight cap to wear underneath to protect my bald pate.  Only my hair has not fallen out, yet (knock on wood).  It's gotten more fine and flyaway but it's not coming out in clumps like it did when I was on Tarceva.  So, we remain on alert at hair central here, with Odette agreeing to come and shave me when and if the moult occurs.  It's a peculiar halfway place to be in, but that's emblematic of my current situation anyway.

Third round of chemo is this Monday, and then I get a week off before starting another 3 weeks.  Many thanks to my friends Jennifer, Andrea, Peggy, and Renee who have come by this week to walk my dogs.  That has taken a load off my mind. 

Do you have your seat belts on?

This is a cleaned up version of an email I sent the medically oriented members of my family and friends tonight.



The news was not so good today. There's not a clear path to take for treatment and each involves major risks.

The first option involves surgery, including checking the right mediastinal nodes for additional cancer (though the PET scan was clean there) while trying to dislodge the left mediastinal mass as much as possible plus a lobectomy for the left lower lobe. Then possibly on to chemo and perhaps radiation. In this case my GH oncologist, Dr. N, wants to use a thoracic surgeon, Dr. L, from Virginia Mason but that would take about 3 weeks, if lucky, to set up and get through the surgical process.

The other option would involve starting chemo Oct 19, after the second opinion on Oct. 15 at Seattle Cancer Care Alliance with Dr. M, assuming Dr. M agrees with this approach. But Dr. N wants to use carboplatin-paclitaxel for the chemotherapy, and the latter part of the chemical equation can cause neuropathy. Hair loss is assured as well as some other side effects There's another drug out there, geftinib, which has shown better long term results if the adeno carcinoma is positive for the epidermal growth factor receptor gene (EGFR) mutation, but we don't know that's what my carcinoma shows because there was not enough material from the first biopsy to test for that. So we'd have to do another biopsy, which I thought was a possibility, but Dr. N didn't bring it up today except as an afterthought to the major surgery path. The following New England Journal of Medicine article looks interesting. I sent it to to Dr. N tonight and asked for comment.

http://content.nejm.org/cgi/content/short/361/10/947


The proposed chemo would take 12 weeks, and be administered once every 3 weeks. Then possibly radiation, then possibly surgery. When we met with Dr. N the first time, this was going to be the course of treatment if I was stage 4. Stage 3 would involve a combination chemo and radiation on a weekly basis. I have put the question to him via email tonight: why the change?

I meet with him tomorrow again at 4:40 pm to get the results of the brain MRI which is to be done at 12:30. So there will be more info later. And of course if the brain MRI shows something, then it all goes back into the cocked hat.

I'm the kind of person who reads the ending to mysteries if they get too tense because I can't stand the uncertainty. I'm still trying to figure out how to do that with my life. So far, reading horoscopes is not sufficient.