On Wednesday I took the last dose of my first cycle of Xeloda. I wish I could say something...anything...about if or how much it's working. But the nature of the business is that it takes time. The first obvious sign that things are working would be a decrease in my aches and pains...unfortunately, there's been none of that. No increases though, and since during the weeks leading up to beginning Xeloda my pain had been rising, I suppose we can take this as a modest positive.
I get a week off before seeing Dr. Grapski again next week. We'll probably start looking at my ca19-9 (my tumor markers) with some regularity, but it will take 2 measurements to have any kind of indications as to what's happening there. This will take, from today, 7 weeks, and by then I'll be about due for another CT scan. All of which is to say that the only "news" on the effectiveness of this treatment can come from an improvement in my pain. Here's hoping for the best there...
At the very least, this has to be the easiest chemo I've ever taken. I had some mild nausea over the past week, but it's been easily managed. Nothing even approaching what I've experienced on other regimens. I was told to watch for a reddening or blistering of the hands and feet -- something on the level of 2nd-degree burns at its worst -- which can be a common side effect of the Xeloda. Good news here -- I saw nothing like this. I suppose this is probably something to watch for as the treatment continues, though.
Thursday, August 23, 2007
Wednesday, August 8, 2007
Xeloda
And so it begins. This evening I start my new chemotherapy regimen, with 3 500 mg tablets of Xeloda. I'll take 3 tablets every morning and evening for the next 2 weeks, then I'll get a week off before starting again. Repeat till (1) we know it doesn't work or (2) we're fairly confident that my disease has stabilized. According the link, xeloda "is a prodrug that is enzymatically converted to 5-fluorouacil in the tumor by the tumor-specific enzyme PynPase, where it inhibits DNA synthesis and slows growth of tumor tissue." I've had 5-fluorouacil (5-FU) as part of the very first chemo regimen I took back in the Spring of '04. It's really hard to say how effective it was -- we know that there was no visible growth on my CT scans during that Spring, and that my ca19-9 (the best tumor marker we've got) was at a reasonably low 80 ("normal" is less than 35 or so...right now, my level is somewhere around 250) when I finished. We weren't tracking the ca19-9 during those months of treatment, not knowing till the first Sugarbaker surgery that this was a viable indicator of the level of cancer in my body. The main difference with xeloda is that the poison is activated in the tumor -- the highest concentrations, if I'm understanding things right, will be in the tumors themselves. I can imagine that this might lessen the over-all side effects, though I'll experience to some degree or other the "usual" -- fatigue, nausea, etc.
I'm always a bit anxious at the start of a new regimen. Never quite sure how well it's going to work...hoping that it works well, shrinking tumors and otherwise halting their growth for an extended period...fearing that it won't work at all, leaving me in 3 months with still larger tumors. And big questions about where exactly we might head next.
I'm always a bit anxious at the start of a new regimen. Never quite sure how well it's going to work...hoping that it works well, shrinking tumors and otherwise halting their growth for an extended period...fearing that it won't work at all, leaving me in 3 months with still larger tumors. And big questions about where exactly we might head next.
Saturday, August 4, 2007
A chronology
If you'd have asked me on January 4, 2004, I'd have told you I was in the best shape of my life. I'd spent the previous several months living cheap, and eating well (in quality if not quantity). In August of '03, I'd started graduate studies in philosophy at the Catholic University of America (CUA). I'd secured a stipend from the physics department, doing bits of analysis with the nuclear physics group, but $1000/mo (before taxes) doesn't go that far in Washington, DC. I was walking everywhere, playing ultimate frisbee twice per week (football when the weather turned), eating low fat (pasta and rice are cheap) with lots of fresh fruits and veggies (surprisingly cheap, certainly compared to frozen entrees and the like). I'd lost a few pounds, could run non-stop for a week, and was feeling great. Then everything changed, literally overnight.
During the night of January 4, I'd started feeling sick -- pains in my lower right side, combined with a nasty queezyness. As things got worse during the day on the 5th, I called 911. As they brought me to the hospital, it became clear that I had appendicitis. I'd wake up in a few hours after a routine surgery, spend maybe 2 days in the hospital, then go home to continue studying. I woke up early morning on the 6th -- much later than the couple hours I'd expected -- and was told I had adenocarcinoma of the appendix. My cancer started in my appendix, but by the time we'd discovered it, had spread throughout my abdominal cavity, growing on the surfaces of my organs. They could remove the primary tumor and several of the larger chunks, but there were too many smaller tumors (not to mention the unseen microscopic elements) to hope that the emergency room surgery could leave me cancer free.
From here I'll just hit the highlights: in mid-February, I started a chemotherapy regimen called FOLFOX. I took three months of this, with a one-month break before undergoing cytoreductive surgery with hyperthermic intraoperative intraperitoneal chemotherapy with Dr. Paul Sugarbaker of the Washington Cancer Institute (coincidentally, just down the street from CUA) on June 30, 2004. The short of it is, Dr. Sugarbaker cut me open, then spent approximately 8 hours over my wide-open abdomen, meticulously stripping my abdominal lining (the peritoneum) of any visible aspects of cancer. Then, before sewing me up, he poured chemotherapy into my open abdomen, heating it so that it might penetrate more deeply into my organs. In this way -- and only in this way, according to what was then (and presently) known -- was there some hope that my cancer could be completely wiped clean.
In August of '04, as I recovered from this surgery, I began a second chemotherapy regimen, with a drug called irinotecan. I took this for three months, before seeing Dr. Sugarbaker again in mid-December for a "second look". After this "second look" surgery, all signs looked good -- in Dr. Sugarbaker's experience, I should have had something like an 80% chance of full cure.
In September of '04, I interviewed for a position in Munich, Germany. A return to philosophy was out of the question, as I needed work that would provide insurance to cover future medical expenses, and would also likely finish '04 with extensive medical bills. When given a positive outlook for recovery, after the struggles of '04, I figured a European adventure would be fun, while also getting myself back on a career track. I left for Germany at the end of February '05.
In May of '05, during a routine staging/check-up (consisting of blood work and a CT scan) we discovered that my cancer had returned. This time, inside my liver and lung -- once the cancer appears inside the organs, we are beyond the reach of surgery. And for that matter, beyond the reach of a known cure. From this point, I take chemotherapy and seek other treatments to keep the cancer at bay, to maintain some quality of life, and hope, in the meantime, that a cure presents itself (and, as a man of faith, I welcome a cure either by natural or supernatural means). Starting in June '05, I began a chemotherapy regimen in Munich with the drugs carboplatin and taxol. I took this regimen through November of '05. My disease stabilized, and I was went till June of '06 before any new growth appeared.
In August of '06, I underwent a 4th abdominal surgery to clean out some particularly troubling tumors, then began chemotherapy again, with irinotecan plus the anti-body erbitux. In January '07, I returned to the US, beginning work outside of Washington, DC. Through April of '07, I continued with this same chemotherapy regimen. A mid-April staging suggested that my tumors were again growing, motivating a return to the carboplatin/taxol regimen. Shortly after beginning this new/old regimen, I made the move to Knoxville, where I am today. A recent (June) staging suggested that, while the treatment was working on some of my tumors, it was not working on others -- in particular, the tumors in my liver (the more dangerous of my tumors) were still growing.
And that brings us up to date. There remains one last untried "standard" treatment option (xeloda), which I expect to begin in the next week. There's really no telling how well it will work. While I hope that it can arrest the growth of my cancer, perhaps even stabilizing it to where I can get an extended break away from treatment, there are no guarantees. Regardless, my personal ambitions really don't (or at least, they shouldn't) change. That is to be a good man, a virtuous man, a man of constant, humble, prayer. I'm far from being such a man, but I'm giving it a shot, so long as I have one.
During the night of January 4, I'd started feeling sick -- pains in my lower right side, combined with a nasty queezyness. As things got worse during the day on the 5th, I called 911. As they brought me to the hospital, it became clear that I had appendicitis. I'd wake up in a few hours after a routine surgery, spend maybe 2 days in the hospital, then go home to continue studying. I woke up early morning on the 6th -- much later than the couple hours I'd expected -- and was told I had adenocarcinoma of the appendix. My cancer started in my appendix, but by the time we'd discovered it, had spread throughout my abdominal cavity, growing on the surfaces of my organs. They could remove the primary tumor and several of the larger chunks, but there were too many smaller tumors (not to mention the unseen microscopic elements) to hope that the emergency room surgery could leave me cancer free.
From here I'll just hit the highlights: in mid-February, I started a chemotherapy regimen called FOLFOX. I took three months of this, with a one-month break before undergoing cytoreductive surgery with hyperthermic intraoperative intraperitoneal chemotherapy with Dr. Paul Sugarbaker of the Washington Cancer Institute (coincidentally, just down the street from CUA) on June 30, 2004. The short of it is, Dr. Sugarbaker cut me open, then spent approximately 8 hours over my wide-open abdomen, meticulously stripping my abdominal lining (the peritoneum) of any visible aspects of cancer. Then, before sewing me up, he poured chemotherapy into my open abdomen, heating it so that it might penetrate more deeply into my organs. In this way -- and only in this way, according to what was then (and presently) known -- was there some hope that my cancer could be completely wiped clean.
In August of '04, as I recovered from this surgery, I began a second chemotherapy regimen, with a drug called irinotecan. I took this for three months, before seeing Dr. Sugarbaker again in mid-December for a "second look". After this "second look" surgery, all signs looked good -- in Dr. Sugarbaker's experience, I should have had something like an 80% chance of full cure.
In September of '04, I interviewed for a position in Munich, Germany. A return to philosophy was out of the question, as I needed work that would provide insurance to cover future medical expenses, and would also likely finish '04 with extensive medical bills. When given a positive outlook for recovery, after the struggles of '04, I figured a European adventure would be fun, while also getting myself back on a career track. I left for Germany at the end of February '05.
In May of '05, during a routine staging/check-up (consisting of blood work and a CT scan) we discovered that my cancer had returned. This time, inside my liver and lung -- once the cancer appears inside the organs, we are beyond the reach of surgery. And for that matter, beyond the reach of a known cure. From this point, I take chemotherapy and seek other treatments to keep the cancer at bay, to maintain some quality of life, and hope, in the meantime, that a cure presents itself (and, as a man of faith, I welcome a cure either by natural or supernatural means). Starting in June '05, I began a chemotherapy regimen in Munich with the drugs carboplatin and taxol. I took this regimen through November of '05. My disease stabilized, and I was went till June of '06 before any new growth appeared.
In August of '06, I underwent a 4th abdominal surgery to clean out some particularly troubling tumors, then began chemotherapy again, with irinotecan plus the anti-body erbitux. In January '07, I returned to the US, beginning work outside of Washington, DC. Through April of '07, I continued with this same chemotherapy regimen. A mid-April staging suggested that my tumors were again growing, motivating a return to the carboplatin/taxol regimen. Shortly after beginning this new/old regimen, I made the move to Knoxville, where I am today. A recent (June) staging suggested that, while the treatment was working on some of my tumors, it was not working on others -- in particular, the tumors in my liver (the more dangerous of my tumors) were still growing.
And that brings us up to date. There remains one last untried "standard" treatment option (xeloda), which I expect to begin in the next week. There's really no telling how well it will work. While I hope that it can arrest the growth of my cancer, perhaps even stabilizing it to where I can get an extended break away from treatment, there are no guarantees. Regardless, my personal ambitions really don't (or at least, they shouldn't) change. That is to be a good man, a virtuous man, a man of constant, humble, prayer. I'm far from being such a man, but I'm giving it a shot, so long as I have one.
Subscribe to:
Posts (Atom)
