Friday, July 6, 2012

Yay, I Get to Have Chemo!

After last week's low white blood cell cancellation, I willed my body to rebound and it did. I get to have Chemo! YAY?

There's another bit of exciting good (?) news today, but I have to go into teacher-mode to explain a whole lot of stuff before telling the news. If you want to cheat, the skip to the last two paragraphs.

Back in May, I found out that there are two different schedules for Taxol infusions for breast cancer patients. The first one, and the one that I was assigned to, gives Taxol at a low dose every week for 12 straight weeks. However, there's also a treatment that gives a higher dose only 4 times, every other week. When I heard about that option, called dose-dense, I did the math. 4 treatments biweekly would have me done with chemo in EIGHT weeks instead of 12. Seemed like a no-brainer to me.

It seemed like the reason I was put on the 12 week plan was because of a study I'm participating in about Herceptin, but I was randomized into a control group for that. (I'm a statistic in a study, but not receiving Herceptin, and I'll be compared to the women who get Herceptin. All for the good of science.)

So I did the research.

There is one study from 2008 which indicates that doing the 12 week plan decreases your odds of recurrence by a few percentage points. However, the study compared getting dose-dense paclitaxel (scientific name) every three weeks, not two, with my 12 week plan. There isn't a study about the two week plan, and maybe it's every bit as effective as every week, and I could be done in early August. I decided to ask the oncologist.

Dr. Kirshner is so laid back about this cancer treatment thing, and told me a story about breast cancer treatment. He said that back in the 60's and 70's, when they first started the AC treatment for breast cancer, the patients were put on a 2 YEAR plan of chemo. (Can you imagine?!?) Then, someone did a study comparing one year to two years, and found the recurrence rate was not affected by "only" doing year, so that became the standard. Later, someone compared 12 months of AC to 6 months, and the same thing happened. This continued to the point where we are right now, with my 4 treatments of AC. He said, "Nobody's ever done a study comparing 4 treatments to 3, but the standard right now is 4, so that's what you're getting. Who knows if you could've stopped after 3?"

Not an answer you'd expect from a doctor, but interesting nonetheless. So his answer about the Taxol 12 weekly vs. 4 biweekly treatments was, "It's up to you." When I mentioned the study, he said that one study doesn't have all of the answers. The ball was in my court.

Luckily, I had another secret source: My friend Eric from college is a pediatric oncologist in Virgina. I emailed him the whole deal and asked if I should base my treatment upon that one study, or go for the one that is convenient to my life. Eric had a bit to say, but one sentence was the kicker that brought me back to the 12 week plan: "The study developed the “standard arm” (which you randomized to) for a reason." Some group of doctors, somewhere in the country decided that their best bet on treating women with breast cancer was to do the 12 week plan and maybe give Herceptin. I decided that if I went against what a group of doctors were saying and then my cancer comes back someday, I'd totally blame myself.

So twelve weeks it was. All the way through to August 31, and then last week's change to make it September 7.

After the low white blood cell count prevented my treatment last week, the nurses had some ideas of what was going to happen to deal with that problem, but needed to speak to Dr. Kirshner first before giving the definite answer. I called yesterday to find out the verdict and was told that Dr. Kirshner wanted to discuss it with me before my treatment today, so I arrived here an hour early. Lo and behold, Dr. Kirshner says, without hesitance or sugar-coating, "Let's do the dose-dense Taxol with Neulasta shots."

So now, on doctor's orders, I'll be getting the treatment that's over sooner! Today is treatment number two already, so two more left! If everything goes well with these, my last infusion will be August 3! (My exclamation points should show my feeling about this.) Yes, I do have to get Neulasta again, but only this week and the next treatment. I don't have to have it the last treatment because they can just let my body heal itself then. And if something recurs in the future, I can blame my body or Dr. Kirsher and not myself! This is the Best Breast Cancer Ever.


  1. You totally! need! more! exclamation points!!!! August 3rd -- You're almost there!!

  2. This is very interesting, and casts a different light on something that has happened in New Zealand over the last few years. We have publicly funded healthcare, and the system is always slow to pick up new treatments, something will frequently be funded in Britain and Australia before it is funded here. So for awhile treatment with Herceptin was not funded, which people were naturally upset about. And then when Herceptin was broght in, it was funded for a 9 week treatment as opposed to a 12 month treatment which was considered standard in other places. The basis for this was a study from Finland that had shown that the recurrence rate for the 9 week course were the same as the 12 month one. Of course this was the observed recurrence rate, and because the Finish study was a bit smaller than some of the other Herceptin studies, the confidence intervals were a bit broader and it was possible that the 9 week course was a bit worse. So people thought the government was just being cheap and were up in arms about this, and eventually the 12 month course was funded. To me, knowing that other (most?) cancer drugs have gone through this process of reducing the number of recommended doses puts a very different complexion on this argument.

    1. I'd never considered the monetary perspective. That's very interesting to think about (and comforting to know my insurance was willing to cover either one). It's also good to know that the government gave in eventually, since that one small study would raise questions for me, too.

    2. You wonder how they get people to sign up for the 'is shorter just as good' trials, especially when its a big difference like 12 months vs 9 weeks. Maybe the most effective (if not entirely ethical) method would be to approach people with 1 treatment left and say 'sick of chemo? want a 50-50 chance of getting out of the last one? Enter our 11 month vs 12 month trial!' Anyhow, glad you are enough of a science nerd to want to talk about all this stuff.

    3. I agree. Maybe the shorter treatments are higher dosages? Or maybe older people who are wavering about whether they want to treat at all are signing up. But I wondered that, too.

      A little more nerdiness: the 12 month Herceptin actually is the standard here in the US for women with HER2+ breast cancer. My breast cancer cells only showed trace amounts of HER2, and are currently classified as HER2-. This study is to find out whether even trace amounts of HER2 respond to Herceptin, and had I been place in the study arm, I would've been going back for Herceptin shots for a year. Here's hoping they find that HER2- doesn't need Herceptin. If long-term results show a significant benefit, they'll call me back for my turn, though. (Actually, Herceptin can cause heart problems as a side effect, too.)

  3. You are my guiding light! I am proud to know you. Thanks for the book we cried and laughed. You're the best I don't care if you're bald:)

  4. Hi Shari,

    Your blog is inspirational, funny, and honest! Thank you for sharing your ups and downs with your fight against breast cancer. You are really kicking butt. I have just started a blog and would like to review your blog on it if you would be okay with that. I can send you a copy of the text before I post it if you'd like. By the way, one of my friends from high school led me to your blog when I told her I was looking for unique women writing their lives and struggles online. That's how I came to your blog. I'm so glad I did!

    Health and blessings,

    p.s. I'm not sure if this will post automatically or whether you will have to approve it first. You don't have to post it, I just didn't know of another way to get in touch with you.