Catch-up: Off chemotherapy

“You’re not getting chemo today.”

For a variety of reasons, my doctor pulled the plug on this latest course of chemotherapy treatment. Wednesday’s blood labs showed low platelets again, which alone would have postponed this round of treatment, but in short, I haven’t tolerated it well at all, and it’s not working.

But that wasn’t the whole reason. My doctor was grinning.

“I was hit with divine inspiration. There’s a new drug. It’s experimental for melanoma and I can get you into the next round of study, but there’s a four week wait while they work up a genetic profile to see if you meet the criteria. I don’t want us to wait and we don’t have to. The drug has been approved for other forms of cancer, so it’s available commercially. I just wanted to talk to you about it first so I can have it overnighted to your house and you can start taking it tomorrow. I guarantee, by the time they can get the study done, we’ll know by your response if you fit the profile.”

She then proceeded to tell me about Gleevec.

Gleevec is not chemotherapy. It’s not toxic, has minimal side effects; it doesn’t cause you to lose your hair. It’s a drug that takes a different approach. Instead of targeting cancer cells and everything else in its path, it goes after specific proteins exhibiting a particular genetic mutation. A high correlation of response was initially noticed in patients with Chronic Myeloid Leukemia (CML) and certain gastrointestinal tumors (GIST), which tend to exhibit these defective proteins, the first case of proteins known to cause cancer.

Now here’s the kicker: studies are underway to find other cancers that exhibit the same type of genetic abnormality. In the case of most melanomas, Gleevec has no effect. But various independent studies have shown that there are a couple of forms of melanoma that start in “non-standard” areas, which do tend to have the defect. The first type is in moist areas of the anatomy, such as sinuses, mucosa, and vagina. The second type is when the primary lesion is on the palms of the hand and on the feet. If you remember, my initial lesion in 2002 was on the side of my heel!

My doctor’s excitement about this new drug is contagious. I took my first pill last night. There’s so much more to write about it, but I need to get some sleep tonight. Look for new posts tomorrow.

Side effects

Last week my chemotherapy-fuzzied brain confused the dates and I told several people that I was having treatment on Wednesday. It was actually scheduled for today. But when I got into the examining room after my blood work, my doctor told me there’d be no treatment today either; my platelets were too low.

“It’s totally to be expected, a result of the Carboplatin;” which is one of the drugs I got three weeks ago. “You’ll be fine next week,” she said, “so we’ll reschedule you for then.”

We still had a chance to talk about how I’ve been feeling, and frankly, I’ve been feeling pretty lousy.

I’ve had a lot of back pain due to the bone metastases visible on my last scan. There’s also pain in my upper arms and thighs. The pain isn’t terrible by itself, but it’s enough to wake me at least two or three times a night. Whether I get back to sleep right away or not, the interruptions ensure that by morning I don’t feel rested.

I’ve been controlling the pain with pills; initially with Advil, which is pretty good but doesn’t last very long, and then with Naprosyn, which lasts longer but isn’t as effective. She prescribed a 72-hour pain patch that I’ll start using tonight. I should see results in about a day.

Once I’m not dealing with pain all the time, I’ll get better sleep and hopefully have more energy and better appetite. I knew I had lost a few pounds since my first treatment three weeks ago, but was surprised to find that it was a loss of seven pounds, not the two or three I expected.

This back pain, by the way, is a most distressing development. It’s the first time I’ve seen symptoms of disease, rather than simply side effects of harsh drugs. Whenever I become aware of the pain, I’m reminded of its etiology and I get ever more bummed. So maybe the patch will allow me to go longer periods without wondering where this is all headed.