Perjeta

January 29, 2015

First Chemo Treatment!

It was a long day, a lot longer than I thought.  We got there on time for an 8:45 appointment.  Things got going with the puncture of the port – which is through the skin, obviously.  Some infusion centers spray a little novocaine or lidocaine to numb the port area, but not at PAMF.  The puncture was actually pretty bad, and while I adjusted to it, I was surprised at how much it hurt.  I’m no wimp, and I’ve been poked and punctured a lot – donating blood, blood tests, IVs for 5 major surgeries and sedation procedures – but this hurt.  I’ve now got a numbing cream, EMLA, ($45 later) to put on about 30 minutes before my next port puncture.

The first thing to go in was saline to flush the port.  That was for about 10 minutes, and then the pre-meds – no, not undergraduate students, but Decadron (steroid) and Zofran (anti-nausea) which took about 20 minutes.  So my first drug, Perjeta, didn’t get started until about 9:45.  That infusion took 60 minutes, which went just fine.  There was a 30 minute break, and then the second drug Herceptin, got started.  This first time, Herceptin was a 90 minute infusion.  The next chemo treatment the Herceptin will be 60 minutes, and then 30 minutes after that each time – which is good because that’s the targeted chemo drug that I will need to have for 52 weeks.

Each infusion is given mixed with a saline solution; that with all the liquid I’m supposed to drink meant that I went to bathroom a lot!  and I really should have taken a potty break between the Herceptin and the Taxotere!  Taxotere is the drug that the nurses watch very carefully while it’s being administered.  It was started right away, first with a saline flush, then a slow drip of 50 mls over 30 minutes, then increased to 100 mls for 30 minutes, then the last 220 mls or so over 45 minutes.  I was told to hold a cup of ice for possible neuropathy and asked if I wanted to put my feet in a cold bath to help with possible neuropathy, and then asked to eat ice chips.  The nurses asked if I was getting itchy or a rash, and whether I had any back pain repeatedly.  I had none of those symptoms, but by the end my face was flushed, as if I’d had a drink.  So they took my vitals, and decided to give me a saline flush for 30 minutes, then retake my vitals.  My vitals after the flush were more back to what they’d been all day (although the vitals right after the Taxotere weren’t terrible).  So it was decided that my face was flushed more likely from the steroid than the Taxotere.

After a quick break, the final drug of the day was given, Carboplatin.  Only a 30 minute infusion, it seemed to finish in no time flat.  Then it was about 30 mls of saline flush for the port, then Heparin in the port to prevent clotting, the needle removed, and I was pretty much good to go – at 4:45!  8 hours in the infusion center.  Wow.

Well, I was sort of good to go. I had to make an appointment to get a Neulasta shot for tomorrow. Neulasta stimulates the bone marrow, and can cause extreme bone pain. Fortunately, my friend Lori pointed me to recent research about taking Claritin with Neulasta, so I’m going to be proactive and take Claritin.  I’d rather avoid bone pain, thank you very much.

I also had to make appointments for my next chemo treatment, which isn’t as easy as you might think.  I have to have a blood draw at least 2 hours before a doctor’s appointment, because I’m choosing to have the blood draw through my port (although if EMLA doesn’t work, I may choose to having a regular blood draw) and generally the doctor’s appointment is the day before chemo.  And because it was suggested that Neulasta be given by the injection specialist in the infusion center, I’m going to have chemo on Thursdays, rather than Fridays, if I can.  Otherwise I have to receive the Neulasta shot at Urgent Care, and most likely not by an injection expert.  Neulasta is pretty thick and is best given in a really fleshy part of the body (my arms are way fleshy, so I think I’ll spare my butt).  So I’ll have doctor’s appointment on Wednesdays, chemo infusion on Thursday, and work from home on Friday with time for a Neulasta shot.  I was able to do some work today, and some knitting, but my sister and I talked a bunch, which was great.  Thank you notes and other work will have to wait until tomorrow.

The only thing that was disappointing today was I learned that Dr. Priya is on medical leave from February 9 until April 13, which means I won’t see her until right before my 5th treatment!  I’m so sad.  I just hope Dr. Kushlan is just as good.

I finally wrote out all the drugs and supplements I need to take from Day 0 through Day 7, because they all have times to be taken and different dosages.  I could probably keep it all straight in my mind, but it helped to write it all out.

I have so much support from all over, but I have to give kudos to my sisters for today. Lucy picked me up this morning and Chris met us at Oncology.  Lucy stayed for about an hour and then had to go, but Chris stayed until about 3:15.  Lucy came back around 3:30 until the end, and then took me to run errands and home.  It was great to have my sisters there for this first session.  I would have been fine, but it was awesome to have them there.  And of course, Ted was home with dinner and just made me cherry-mango popsicles, so the awesomeness continues.

Pretty long day, and I feel as if I should head to bed, but right now I’ve got Loa purring on my lap and the Sharks are beating the crap out of the Ducks, so life is good!

January 12, 2015

My world got rocked today.

My medical oncologist asked for an appointment, which was today.  I thought it was to discuss my HER2+ status more in depth, and I thought it was just to confirm that I’d need to have Herceptin for a year.  Well, the appointment was to discuss my HER2+ status more in depth, that’s for sure!

Dr. Priya would like to start with neoadjuvant therapy, aka start with chemo first. Surgery would then be after chemo, followed by radiation.  In a previous post I’d mentioned that I wanted to know if I was a candidate for Perjeta (pertuzumab)…well apparently I am.  Studies have shown that Perjeta before surgery is highly effective in treating 2 types of HER2+ cancers, and Perjeta has been approved for treatment before surgery. It has not yet been approved for therapy after surgery; while there’s nothing to say it’s not effective post surgery, because it hasn’t yet been approved for this, insurance won’t pay for it.  At $8000 per treatment, it’s not something I can afford out of pocket, so pre-surgery it is!

Having chemo before surgery will reduce the size of the tumor, which, if logic follows, means that during surgery less tissue will have to be removed.  Further logic follows that perhaps I won’t go from a C cup to a B cup, but maybe a C- or B+ instead!  🙂

What I did not realize is that because I’m HER2+, my chemo regimen is not 12 weeks, but 18 weeks.   Now I know some of you will think this crazy, but this change in my treatment plan actually is better for me at work.  We are in the middle of a huge database conversion and we go live on July 15; with this new plan, I will likely be done in June, and have some time to recover while we go live.  Because the tumor will be reduced, there’s not a huge urgency to have surgery, so I can honor my commitment to chair a conference in early August, then have surgery.  If I proceed with surgery on January 28, have a 6 week recovery, then 18 weeks of chemo, I’d not only miss critical times during conversion but perhaps would have to miss the August conference.

The chemo treatment plan is Perjeta plus TCH (as opposed to THC  🙂  ).  Taxotere (docetaxel), Carboplatin (paraplatin) and Herceptin (trastuzumab).  I had also misunderstood the Herceptin regimen:  while the treatment lasts 52 weeks, the infusions are every 3 weeks.  So I start the Herceptin along with the other chemo drugs, and I continue it while I recover from the other chemo, through surgery, through radiation.

There was discussion about whether there should be biopsy of the sentinel lymph node before I start chemo.  Dr. Priya says that current thinking, at least among medical oncologists, is that it’s not necessary; the chemo will reduce anything in the lymph node as well, and the lymph node will be removed during surgery anyway.  In my case, the MRI showed nothing in the lymph node, which Dr. Ching did not mention (or I forgot), so it’s especially true that I won’t need surgery to remove the lymph node before chemo.  I’m pleased to know that nothing showed up in my lymph nodes on the MRI; chances are that my cancer is Stage 1 with this news.  Pure speculation on my part, but considering the factors which decide stage, that’s what I’m going believe.

It’s all good, right?  I mean, no matter what I need 18 weeks of chemo, so I might as well have it first.  So why was my world rocked?  The way I’m able to deal with this whole cancer thing is to break it down into goals or milestones.  I was completely focused on getting through the surgery first, then I’d move onto chemo, and then onto radiation. I’m goal-oriented, and it helped me to think of my treatment plan this way.  Flipping chemo and surgery was just something to which I needed to adjust.  Now that I have, I’m good!