Anna's Book of Days

Roche Breast Cancer Drug Appears to Greatly Extend Patients’ Lives A drug used to treat advanced breast cancer has had what appears to be unprecedented success in prolonging lives in a clinical trial, researchers reported on Sunday. Patients who received the drug — Perjeta, from the Swiss drug maker Roche — had a median survival time nearly 16 months longer than those in the control group. That is the longest amount of time for a drug used as an initial treatment for metastatic breast cancer, the researchers said, and it may be one of the longest for the treatment of any cancer. Most cancer drugs prolong survival in patients with metastatic disease for a few months at most. Metastasis means the cancer has spread to other parts of the body. “We’ve never seen anything like this before,” said Dr. Sandra M. Swain of the MedStar Washington Hospital Center in Washington, the lead author of the study. “It’s really unprecedented to have this survival benefit.” Previous analyses of the clinical...

Nine days in, I'm still not experiencing much in the way of side effects. I've had a few fleeting moments of queasiness, but nothing severe (the first trimester of pregnancy was way worse!). Instead of my skin becoming drier as Maddie said it would, it has actually gotten oilier, and there are some faint red dots on my chest. None of these things are particularly desirable, but they are very minor annoyances in the scheme of things. The women I met at the support group yesterday who are getting regular chemo are really suffering - fatigue, bone pain, nausea, insomnia. Talking to them, I felt almost guilty that I'm feeling so good. ~ It's been exactly one month since I received my diagnosis. Only one month! Our whole world has been transformed in that time. 

In thinking more about my surprisingly uplifting experience on Thursday with my first treatment, I realized that another very important element of the positive environment is the "caregivers" (that's what they call the person you bring with you to chemo). It's not often that you get to be surrounded by people who all truly love each other, but that's what it felt like in the treatment room. I saw people of all different relationships - sister, friend, niece, wife, mother, and others that were harder to determine - but one and all, they were the people that the patients chose to have by their sides, and they chose to be there to support their loved ones. Seth, of course, was my "caregiver" - if I have to spend eight hours tied down to a chair, there is no one I would rather have there with me. He went home once to get me my iPad, which I had forgotten in the morning rush, and he went to Milo & Olive to get us lunch, but other than that he just staye...

Today I started my first cycle of treatment (it's tempting to keep calling it chemo even though technically it's not - because "antibody conjugate infusion" is not something that most people would recognize). It was a long day - eight hours from start to finish - but not a difficult one. It started with a nurse, Susan, taking my blood pressure and temperature, then connecting my port and taking a number of blood samples. As promised, the port connection was much nicer than a typical needle stick - I hardly felt it at all. Jean, one of the research assistants, came by and had me do a pre-treatment survey on a tablet (some of the questions were a bit ridiculous, like "In the past week, have you needed to rest?" Who doesn't need to rest in the course of a week?). Then I went down one floor and saw Maddie and Dr. Hurvitz, mostly just to check in and say hello. Maddie measured my tumors with what looked like a sewing tape measure - not very scientific, b...

I learned today that I have been placed in Arm B of the clinical trial, which is T-DM1 + Perjeta - no chemotherapy! Chemotherapy drugs work by targeting quickly dividing cells. Cancer cells divide much more quickly than most normal cells, so chemo is effective at halting or even reversing the progression of cancer. However, the drugs can't distinguish between cancer cells and other quickly dividing but normal cells, including white blood cells and hair follicle cells. That's why chemo compromises the immune system, causes fatigue, and makes the hair fall out. By contrast, T-DM1 (also called ado-trastuzumab emtansine or Kadcyla) is an antibody-drug conjugate, one of a new class of highly potent biopharmaceutical drugs designed as a targeted cancer therapy. T-DM1 consists of the monoclonal antibody trastuzumab (Herceptin) linked to the cytotoxic agent mertansine (DM1). Trastuzumab stops growth of cancer cells by binding to the human epidermal growth ...

Today I got my portacath placed. The port is a  small medical appliance that is installed beneath the skin, in my case an inch or so below my right clavicle. A catheter then connects the port to a vein in my neck. Under the skin, the port has a septum through which my chemo drugs can be injected and blood samples can be drawn many times with less discomfort than a more typical needle stick (which is particularly uncomfortable for me and my tricky veins). It will stay in place for the next year; at the completion of my treatment I'll need another surgery to take it out.  I was under twilight sedation for the procedure, which took about an hour. I thought "twilight" meant that I'd be pretty out of it, but I was actually very aware of everything that was happening, even from under the paper tent that they placed over my head. There was little pain, but I could feel the very strange sensation of the catheter being snaked up to my neck from my chest. Dr. Kee, the...

I hope it goes without saying that my first priority in my war against breast cancer is saving my life. There is nothing that I wouldn't go through or give up in order to ensure that I can continue to be Ike's mommy and Seth's wife for decades to come. However, as I've begun to understand that my odds of survival are good, my mind has turned at times to some of the other, less critical losses that come with cancer. Hair is an obvious one. For my most of my life, even as a baby, I've had a lot of hair - and even in the brief interludes when it was short, I've never had hair shorter than chin-length. If I am assigned to Arm B of the clinical trial, then I won't get traditional chemotherapy and will avoid many of the chemo-related side effects. Dr. Hurvitz says I won't lose my hair, which is nice, but for me it pales in comparison to the benefit of not having other side effects. Even with chemo, they now have something called cold caps, which have been succ...

Thank God. It doesn't matter so much for me - after all, I still have cancer - but for Julia and Lauren and Alysia and Erica, and for all the other girls in our family who are yet to be born, I am incredibly relieved.

I just heard from the clinical trial coordinator, Monica - I've been approved by Roche and admitted to the trial! Dr. Hurvitz has seemed very confident that I would be, but I'm very glad that it's formalized. I'm going in for my trial biopsy and lab work tomorrow morning. Once that is complete, they can "randomize" me - assign me to Arm A or B. Monica thought that would happen on Monday or Tuesday next week. And one way or the other, I'll start treatment next Thursday.  This all seems both to be happening very fast and very slowly, like a dream. I think this altered sense of time is going to be my new reality until I'm through this treatment.

My PET scan and brain MRI were clean! We were pretty sure that my cancer was non-metastatic based on my lymph node biopsy, but there was a small chance that the biopsy could have missed the cancer cells, so it's wonderful to have this extra confirmation.

In addition to Chemo Teaching, I also had an electrocardiogram (EKG) and echocardiogram (ECHO) on Friday. Treatment with trastuzamab (Herceptin) can cause weakness of the heart muscle, which leads to problems pumping blood and potentially congestive heart failure. In clinical trials, about two to three percent of those treated with chemotherapy plus trastuzumab had heart failure, compared to fewer than one percent of those treated with chemotherapy alone. B ecause of this, patients' hearts are monitored throughout treatment using EKGs and ECHOs. This first set of tests was to establish a pre-treatment baseline. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As it travels, the signal causes the heart to contract and pump blood. The process repeats with each new heartbeat.  The heart's electrical signals set the rhythm of the heartbeat.  An EKG is a simple test that records the heart's electrical activity. It  shows how  ...

Yesterday Seth and I had "chemo teaching" with Maddie, my chemo nurse practitioner. It was essentially a counseling session to educate us about what to expect during my chemo treatment. Maddie, who is a warm but matter-of-fact person, covered a huge amount of information in the ninety minutes we spent with her. Since we don't yet know which arm of the study I'm going to be in, we talked about both regimens. Arm B - T-DM1 + Perjeta Medications Prilosec - An acid reducer, used because the drugs can cause acid reflux. Compazine or Ativan - Anti-nausea medications, to be taken only as needed. Ativan can also treat anxiety and insomnia. Cipro - An antibiotic, to be taken in case of fever (indicating infection). Side Effects Dry skin and sun sensitivity Constipation or diarrhea Dry mouth Fatigue Lifestyle Limitations No pedicures or manicures No direct sun exposure No sushi, raw sprouts, mushrooms, salad bars, or buffets. No ...

I am among the 15% to 20% of patients with invasive breast cancer who have abnormally high levels of HER2. HER2-positive cancers tend to be more likely to spread than other types of breast cancer, particularly to the brain (HER2-positive metastatic breast cancer will spread to the brain in 30-40% of HER2-positive patients according to one source, or up to half according to another - startlingly high numbers). Because of this, Dr. Giuliano ordered a brain MRI. Dr. Hurvitz seemed to feel that this was overkill, and I read that it's not typically done for patients that aren't experiencing symptoms such as headache or memory loss. However, as  with the PET scan, Dr. Giuliano told me that he wanted the MRI not because he suspected that my cancer had metasticized, but rather to provide baseline imaging. Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to take pictures of the head. In many cases, MRI gives information that can'...

Positron Emission Tomography (PET) scans can detect areas of cancer by obtaining images of the body’s cells as they work. First, the patient is injected with a substance made up of sugar and a small amount of radioactive material. Cancer cells tend to be more active than normal cells, and they absorb more of the radioactive sugar as a result. A special camera then scans the body to pick up any “highlighted” areas on a computer screen. This helps radiologists identify areas where cells are suspiciously active, which can indicate cancer. PET scans are not used to screen women for breast cancer as the test has only a limited ability to detect small tumors. PET scans can be useful for evaluation after breast cancer has already been diagnosed, in a number of different ways: to determine whether the cancer has spread to the lymph nodes to determine whether the cancer has spread to other parts of the body, and if so, where (metastatic breast cancer) to assess whether metastatic breas...

Dr. Giuliano referred us to Dr. Sara Hurvitz, a medical oncologist at UCLA in Santa Monica. Initially, the soonest her assistant Diane would schedule us was next Monday, which seemed like an unacceptable delay. However, Diane called this morning and said that Dr. Hurvitz could fit us in at 1:00 this afternoon. We had been preparing to try to push buttons and pull strings to get in sooner, so we were elated to get the call. Dr. Hurvitz, like Dr. Miller, is a young woman who I immediately felt comfortable with and found easy to talk to. Consistent with the other doctors' recommendations, she said neoadjuvant therapy, then surgery, then postoperative therapy are necessary. (As an aside, she explained that the point of neoadjuvant therapy is to be able to monitor the tumor shrinking. If surgery happened first, no one would ever know if the postoperative treatment was effective. This is completely logical, but I hadn't thought of it that way before.) She explained the followin...

2013 Top Stories in Oncology: This Was the Year for HER2-Positive Breast Cancer Dr. Kimberly L. Blackwell, M.D.:  I personally think that we are going to see a lot less recurrent HER2-driven breast cancer, and that’s because we are now able to use highly effective antibodies, like trastuzumab and pertuzumab, in the curable or earlier-stage setting. We know that pertuzumab improves survival in the metastatic setting, and now that we are able to use it in our earlier settings, based on the neoadjuvant approval, I would hope that we’ll take a generalized cure rate of somewhere about 90% for all women facing HER2-positive breast cancer to an even higher level. These are pretty exciting times! At [the 2013 San Antonio Breast Cancer Symposium] this year, we saw a 97% long-term disease-free survival for small lymph node–negative HER2-driven breast cancers with the combination of paclitaxel and trastuzumab. 2  That is among the best cure rates we’ve ever seen in early-stage breast can...