Arm B!

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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 factor-2 (HER2) receptor. Mertansine enters cells and destroys them by binding to a protein called tubulin. Pertuzumab (Perjeta) is also a monoclonal antibody; it blocks HER2 in a different way than Herceptin. When given with Herceptin, it improves its ability to block the activity of the HER2 protein. Together, the three drugs are able to seek out and destroy cancer cells (because the antibodies target HER2, and HER2 is only over-expressed in cancer cells), while leaving normal cells intact. Because normal cells are not affected, the side effects of this treatment are typically much more limited than with standard chemo drugs.

I've been hoping so much to be in Arm B, it almost seems too good to be true. Although I know that T-DM1 and Perjeta are still extremely potent drugs that may affect me adversely (pulmonary, liver, and heart toxicity are risks), I'm so happy that my cancer can be treated without the chemotherapy drugs, not to mention Decadron and Neulasta. I'm very optimistic that this course of treatment will make our life much easier and more enjoyable for the next four months.

~

I had to have another ultrasound and mammogram today because the trial requires that they be done within 28 days of starting treatment (my previous ones would be 31 days old on Thursday, just outside the window). Perhaps because I knew what to expect this time, this mammogram was less horrifying, though still painful. What was surprising to me was that it has already been almost a month since that day when I first realized that I might have breast cancer. It feels like it was last week - but it also feels like a year ago. I know I've said something like this before, but each day I'm struck anew by how surreal the passage of time has felt through this ordeal.

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