June 24 - Note: I wrote most of this a month ago, but haven't posted until now. Gives a good explanation of the chemo cycles I go through:
Chemotherapy is the treatment of cancer through medicines or drugs that attack and kill the cancer cells. It is a systemic therapy (unlike radiation or surgery) in that the treatment goes throughout the entire body. Most chemotherapeutic drugs are taken as a liquid injection into a vein, while others are taken as a pill. The cool thing about what's available to me today (as opposed to 20 years ago) is what are called combination therapies. There are many different chemotherapy drugs and often, they are used to treat the cancer more aggressively. It also reduces the likelihood that the cancer would become resistant to any single chemo drug.
Taking it a step further are targeted chemotherapy regimens, which are designed to attack specific cell pathways used by cancers to survive and grow. These new treatments capitalize on advances in understanding cancer at the molecular level. By interfering with the pathways, cancer cells are unable to grow, and instead commit a type of "suicide", called apoptosis. Also, blood vessels that grow and feed cancer cells are halted, called antiangiogenesis.
I have Stage IV Metastatic Colorectal Cancer (mCRC for short). What the doctors have set up for me, based on my tumors is a three-pronged approach using the following drugs: Fluorouracil (5-FU) plus Leucovorin calcium, Oxaliplatin, and the antiangiogenic drug Bevacizumab (better known as Avastin). Together, they call my treatment mFOLFOX + Avastin.
The 5-FU and Leucovorin is the more traditional chemotherapy for mCRC. This has been around for 40 years and works by binding to an
enzyme needed for making DNA. Cancer cells that no longer have this
enzyme available are more likely to die when they try to divide in two.
Normally 5-FU binds it for only a short time, which limits how effective
5-FU can be. Leucovorin causes this binding to last for a longer period
of time, which boosts the effect of 5-FU.
Oxaliplatin is a platinum-compound chemotherapy drug that acts as an alkylating agent. It stops the growth of cancer cells, which causes the cells to die. It is now used in conjunction with 5-FU. While it has been around a while, it really has only been in full use since 2009.
Finally, Avastin which is an antibody drug that binds to and neutralizes a specific protein directly related to the mCRC. It was approved in 2006 to be used in combination with mFOLFOX therapy. This is a wonder drug that is blasting away at my tumors.
How do I get these drugs? While I am at the hospital on the Wednesday, I get the half hour blast of Avastin through an IV connected to an IV "tower" that if you are not directly familiar, appears on most TV medical dramas. I also get the Leucovorin and Oxaliplatin through similar IVs, that also are connected to an IV Tower. These take a bit longer, from an hour and a half to two hours. I can take them all simultaneously through my cath-port which is convenient. They supply me with 8mg of Dexamethasone, a steroid that as mentioned earlier, stimulates the adrenal gland so I am not a zombie through this process, but can actively function from my hospital chair. I usually do a training course through RSI at this time, to help me acquire the necessary credits to maintain my Project Management Professional (PMP) designation. Because I am doped up on the one hand, and being drained by chemo on the other, I try not to do any "heavy-lifting" work wise - no detailed analysis or major decision-making that could affect my work. Training makes a good alternative.
Once the three iVs are complete, I am then hooked up to the portable infuser through the same cath-port. This will be hooked up to me for the next 46 hours, and then disconnected by Nurse Karla at home on the Friday. It also tends to drain me and cause some side effects, so I continue to take the dexamethasone, albeit is smaller quantities, over the next six days to help manage the "downs" associated with the chemo. As I have mentioned in the blogs describing each session, we seem to be getting to a point where the management of the ups and downs is quite successful, for the most part.
What is a cath-port? It's a small device (about the size of two quarters placed side-by-side) that was surgically implanted under my skin in the right chest area to carry medicine into the bloodstream. It has two small 'basins' that are sealed with a soft silicon top (the septum). The port connects to a small, soft tube called a catheter. The catheter was surgically placed inside one of the large central veins that take blood to my heart (so no need to search for veins every two weeks). The chemotherapy drugs are infused into my bloodstream through a special needle that is placed into the septum every two weeks. Medicine and fluids are sent through the needle and blood samples can also be withdrawn.
After my chemo session is over, Karla is currently hooking me up to an IV bag of saline to help with my hydration post chemo. After the IV fluids are finished, Karla cleans the port by injecting heparin through the needle - this prevents blood clots from blocking the port (heparin thins the blood). Once that is complete, she removes the needle, and apart from a slight bump on my chest, you wouldn't know I had the port at all. It's pretty cool that this is available to me - I have heard horror stories of nurses searching for veins for some patients. This also provides us with the ability to manage treatments from home without having to return to the clinic multiple times.
June 24 - Additional note: I will discuss this more in my next chemo blog, but on June 11, we stopped the use of Oxalyplatin and replaced it with a new drug called Irinotecan. I was developing too may side effect with the Oxalyplatin and the CT scans and my reactions to the drug drove my doctors to decide to move on to the next chemo regiment that included the Irinotecan. I should see less side effects, and hopefully an improvement in the progress against my tumors.
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