Wednesday, June 11, 2008

Chemo Update

We've changed drugs again. This is chemo drug regimen number eight this year. The new drugs are Xeloda (Capecitabine) + Herceptin + Tykerb. No more Doxil (Liposomal Adriamycin) because my doctor is worried about damage to my heart.

Yesterday's echocardiogram showed a decrease in my heart pumping function. This is measured by the "ejection fraction" which has fallen to 54 percent from 65 percent. I'm still within the normal range, but the fall suggests that the Adriamycin-Herceptin combo is damaging my heart. This is one of the side effects of this particular drug combination that can be fatal, so we're not taking any chances.

Yesterday's liver ultrasound was unclear because the doctor didn't compare this latest scan with the previous one. But based on the films alone, it looks like the tumors are still there, but the color has changed. In the previous scan in May, the tumors looked about the same color as the rest of the liver. In yesterday's scan, the tumors have a dark center with a ring around the outside. My doctor thinks the dark center shows tumor necrosis - dead cancer cells. She says dead cells are liquid, which turn up dark on ultrasounds. So her guess is that the last chemo was killing the cancer cells in the liver tumors.

She also said that ultrasounds may no longer be an effective way to measure the progression of disease in my liver. Targetted therapies like Herceptin and Tykerb kill cancer cells differently than chemotherapy drugs, so it's hard to tell from an ultrasound what's happening to the tumors. She said we could do a CT later on, but that might not show much either since liquid (dead cancer cells) takes up more volume than a solid mass. That's why a tumor can look bigger on a CT scan even when the cancer cells are dying.

Yesterday's chest X-ray showed some improvement in the lungs. But my cough came back a week ago and has gotten steadily worse, so I've increased my codeine dosage.

The main side effect I need to watch out for with the Xeloda is Hand-Foot Syndrome. If I have a mild case, I'll have tingling, burning, swelling on the hands and feet. If I have a serious case, I'll have blisters and sores on my palms and on the soles of my feet. And if I'm really unlucky, the skin on my palms and soles will peel off, so I won't be able to walk or touch anything with my hands.

I had my three-weekly dose of Herceptin by IV today. Tomorrow, I'll start on the Xeloda (oral) and continue with the Tykerb (oral). In three weeks, I'll have another round of scans (echocardiogram, chest X-ray, liver ultrasound) before my next dose of Herceptin.

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