2nd Chemo Treatment Today

I had my second chemotherapy treatment today and all went smoothly.  My friend Nancy kept me company and the time went by very pleasantly, thanks to her. 


The blood work looked pretty good.  A few things are just slightly above or below normal range, but Irene, my oncology nurse, is "0%" concerned about any of the results, so nothing to worry about.


Irene said my reaction to the chemo should be the same as it was for the first one.  That means I will likely feel some fatigue starting this Wednesday midday and continue to have some midday fatigue Thursday and Friday.  By Saturday, I should feel totally normal.


Next chemo, May 19th, will also include a CAT scan of the lung so we should get a sense at that time for how the cancer is reacting to the chemotherapy treatment.  Hopefully, we will see some reduction in number and/or size of the cancer lesions.


Stay tuned!

A Good Weekend

The last of the chemo fatigue wore off by midday Friday and so I had a very nice weekend with normal energy and activity.  If this is what the other cycles will be like, I can live with it.


I never had any nausea.  The fatigue I felt during the week was pretty mild and typically occurred midday and then went away by evening.  My sleep is also improving.


So a good weekend overall!

1st Chemo plus 3 days

OK.  So today I finally felt fatigued right around noon for the first time.  In spite of that, I still managed to walk the dogs for a couple of miles and ride the recumbent stationary bike for 45 minutes in addition to a couple of naps and couch time reading.


Up until this afternoon I was feeling pretty normal, other than some fitful sleeping.  I blame the steroids for that.  Only one more day on a steroid for this cycle and then I'll be done with them until the next round.


I'm hoping the fatigue subsides a bit for tomorrow as I have a lot of activities planned. I will cancel some of them if I need to but I'd rather not.


So it hasn't been bad so far.  Let's hope it doesn't get any worse.  :)

First Chemo Treatment is Done

Today I had my first chemotherapy treatment.  It went pretty well.  I had no discomfort.  The needle went in smoothly (hopefully, that means I won't need a port); there was no nausea or other effects I felt.  I am tired, but that may just be the stress of the day.


The real test of how I manage will be over the course of the rest of this week.  The fatigue and potential nausea supposedly kick in around Wednesday and may last as little as a day or as long as a week.  The drugs they gave me today included a couple to prevent nausea and boost energy.  I also will be taking pills over the next three days to do the same.


I will post at least once more this week to let everyone know how I'm coping with the side effects.

Lung Cancer Statistics You Should Know

Lung cancer remains the deadliest cancer for both men and women in the United States.  Yet the funds for lung cancer research are the lowest in funding per cancer death.


Click on this link for a quick summary of lung cancer statistics. 


In the United States for the year 2012, 73,000 women died of lung cancer while 40,000 died of breast cancer, one of the best funded forms of cancer.  For specifics on lung cancer in women, see the statistics here. 


For specific statistics on the occurrence of lung cancer is non-smokers, see this link.


Please share this information with others.  We have got to raise awareness, break down myths, and turn these trends around.


Please help!

A Setback

Regular readers of this blog may have noticed that I haven't posted anything new since the beginning of 2014.

This year has brought  new challenges that I needed to get my head around before posting about it.  In short, the lung cancer has recurred.

In my late January CT scan, there were very small, lightly scattered cancer nodules in both lungs.  Dr. Bonomi had me double my Tarceva dosage to see if that would be sufficient to stabilize the cancer.  I was very hopeful that it would.

On March 12, six weeks later, new scans showed continued growth.  Although not at all aggressive, there were more and larger nodules than before.  The Tarceva was no longer suppressing the cancer effectively.  The cancer had developed a resistance to it.  This was not unexpected.  It is typical for cancer to eventually develop resistance to Tarceva.  Tarceva worked more than twice as long for me as is typical for this drug.  I got greedy and hoped it would last even longer.  So it goes.

Dr. Bonomi offered three options:  traditional chemotherapy, a 2nd generation targeted inhibitor (a newer drug similar to Tarceva) and clinical trials.  His personal recommendation is traditional chemotherapy.

I was able to quickly arrange for second opinions from two highly regarded lung cancer oncologists - one from Northwestern Memorial Hospital, the other an oncologist for both Evanston hospital and University of Chicago.  I had consultations with each of them yesterday.  They were consistent with Dr. Bonomi in the three options, although added information about the pros and cons of each approach.  In short:

• The 2nd generation targeted inhibitor, Afatinib (in combination with another drug called Ceduximab for increased effectiveness) was just introduced for general use about six or so months ago.  Success is 30-40% with similar but likely more severe side effects to Tarceva. 
• There is only one clinical trial in the Chicago area for which I am a potential candidate, but it is in the beginning of phase 2 and has no record yet as to likelihood of success.  A major downside for this trial is that it requires a 24-hour stay at the hospital every week to administer the drug.
• A chemotherapy cocktail of Alimta and Carboplatin with an EGFR antibody called Avastin for 4 cycles of treatment.  Each treatment is once every three weeks (equalling one cycle) for a total treatment period of 12 weeks.  After that, maintenance chemo indefinitely every three weeks.  Given my history with the EGFR mutation, the doctors say this has a 50% success rate, twice as high as those without the mutation.

The two doctors who gave me second opinions each suggested I get another biopsy now as it will probably be needed if I decide to participate in a clinical trial - now or in the future.  The approach to the biopsy was radically different between the two doctors.  One wanted to use a local anesthetic with a needle to biopsy a lymph node near my clavicle.  The other wanted to put me under general anesthesia and cut into the right lower lobe of my lung.  I don't plan to participate in a clinical trial now, based on what's available. In the future, I probably wouldn't want to participate in one unless the cancer once again progresses.  If that is the case, there should be tumors they can biopsy at that time.  Dr. Bonomi didn't think I needed one unless I want to do a clinical trial now.  He was concerned that none of my tumors that are in accessible locations are big enough (> or = 1 cm) to biopsy anyway.

Dr. Bonomi believes that it is better to try a treatment approach different from the receptor inhibiting qualities of Tarceva since the cancer now recognizes these inhibitors and has developed resistance to them.  Additionally, since I increased the Tarceva dosage, the side effects of rash, itching and stomach distress have increased.   These effects could potentially be even worse with this second generation inhibitor.  For that reason, his first choice would not be using Afatinib.

He also says some people find the side effects for chemo easier to take than those for Tarceva.  He says some people "sail through" the chemotherapy.  The most likely side effect of chemo is fatigue a couple days after treatment.  Three to four percent of patients experience nausea in spite of the anti-nausea medication that is part of the chemo cocktail.  Before each chemo treatment, they do blood work to ensure the white blood cell counts don't get too low, which would make me susceptible to serious infection.  There is a possibility of nose bleeds from the antibody (Avastin).

Based on the information from the three doctors, I think I will go with traditional chemo.  I really had hoped to avoid chemotherapy and desperately wish one of these alternatives had more to offer. But it looks like the lesser of all evils so that's the way it goes.

My Article Promoting Imerman Angels

I was asked by a friend who is the co-founder of the Women Survivors Alliance to write an article about my cancer mentor role with Imerman Angels for WSA's online magazine, The Plum.  Here is a link to that article if you are interested in reading it.  It was published on March 11.