Wednesday, May 21, 2008

Chemo Update

I had another dose of chemo yesterday: Liposomal Adriamycin + Herceptin + Tykerb. This is the one I had for the first time three weeks ago, which led to my sudden recovery with tumors shrinking and my breathing back to normal.

I had another round of scans last Friday (chest X-ray, abdominal ultrasound, echocardiogram) as well as a blood count, and went over the results with my doctor yesterday.

Chest X-ray: To check the lungs. The front view shows no change. The side view of the right lung, where most of the pain is and where the cancer initially started spreading, shows some improvement.

Abdominal ultrasound: To check the liver. The radiologist's report wasn't very clear, but it seemed to say there were fewer nodules (tumors) in this latest scan, but the larger nodules had not changed in size. My oncologist said she thought there were about 3-4 tumors visible in this latest scan, compared to the previous scan showing 7 tumors, several of which were 3 centimeters or more in diameter. She also pointed out that the film shows less contrast between the healthy liver tissue and the tumors in this latest scan, suggesting that the tumors might still be there, but they're starting to fade.

Echocardiogram: The chemo combination I'm getting is toxic to the heart, so I need to have an Echo fairly regularly. My LVEF, which is an indicator of how well my heart is pumping blood, was 60% in this latest Echo, compared to 65% on March 18. In a healthy heart, 50-75% of the blood is pumped out during each beat (Source: American Society of Echocardiography). This means the heart is able to deliver an adequate supply of blood to the body and brain. Many people with heart failure and heart disease pump out less than 50%. Heart failure (a.k.a. congestive heart failure) happens when the heart is unable to pump enough blood to provide adequate oxygen to the body. So I'm well within the normal range, but the LVEF has gone down 5 percentage points in two months, so we need to keep a close eye on this.

Blood count: All my counts were within normal range.

The plan: If I continue to show progress, I'll have two more doses of this current chemo combination, and then we'll switch to Xeloda + Herceptin + Tykerb. My doctor doesn't want me to stay on the Adriamycin for too long because of its cardiotoxicity.

Some good news: Preliminary reports came out last Friday for a clinical trial comparing Herceptin + Tykerb to Tykerb alone. Median progression-free survival was 12 weeks on the combo versus 8.1 weeks on Tykerb alone. This study didn't test these drugs with Adriamycin, which is what I'm getting, but it's still a good sign.


Francesca Giessmann said...

wonderful news!

Leighbee said...

How absolutely WONDERFUL to have read that news..........I am overwhelmed with the happiness and hope I feel. Keep fighting honey because I reckon your strength of mind is making that combo bash those tumours with extra impact!!!

Anonymous said...

How much does a dose of Liposomal Adriamycin + Herceptin + Tykerb cost?

Thanks for sharing the info on your progress and for explaining the results of the various tests.


Shin said...

Dear Anonymous,

Liposomal Adriamycin + Herceptin + Tykerb costs S$8,045 every three weeks. That's about US$5,927.

That's just the cost of those three drugs and doesn't include the supportive therapy (such as drugs for side effects) and doctor/nurse charges.

This is at Mt. Elizabeth Medical Centre. Charges at the subsidized public hospitals in Singapore would be less.

In the U.S., these drugs would cost much more. If anybody out there knows how much these drugs cost in the U.S., I'd love to know.