Treatment Cycle 4 - Day 4

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Treatment on Thursday was easy and uneventful. The port connection was painless, my labs were good, and the infusions were simple. Four down, two to go!


We started the morning with my checkup with Maddie and Dr. Hurvitz, where we found Dr. Hurvitz ecstatic over Patient #1's success. Patient #2 had her surgery on Monday and the pathologist unofficially told Dr. Hurvitz that she too appeared to be cancer-free, although of course they won't know for sure until the full pathology report is done. Dr. Hurvitz referred to this trial as the "happy trial". It will be so wonderful if this treatment becomes the standard of care for all early-stage breast cancer patients soon - I would love to feel like I not only got myself cured, but helped a little bit to make this treatment available to other women too.

My questions this time were about about the amount of treatment that I'm getting - how was it decided that six neoadjuvant and twelve adjuvant treatments were the right amount? The answer, according to Dr. Hurvitz, is that is based on the amount of Herceptin that is required, one year (eighteen three-week cycles works out to about a year). In the early days of Herceptin, the treatment period of a year was determined somewhat arbitrarily, based on some mouse trials. Then a trial was established to test out six months, and it found a higher rate of recurrence as compared to the one-year treatment. Another trial tried two years of treatment, but it found no significant decrease in recurrence, and it did find a higher rate of heart toxicity. So one year turned out to be just right, and has been the standard of care ever since. Dr. Hurvitz said that she had been thinking about it just that morning, whether perhaps a whole year isn't necessary for T-DM1 since it's targeted and theoretically more effective than Herceptin alone. However, at this point the trial design is locked, so it is what it is. Perhaps the next trial will test out a shorter treatment period. I'm not looking forward to my twelve adjuvant treatments, but I would rather get too much of these drugs than not enough. I'm no longer worried about the cancer that I have today - between the drugs and surgery, I'm confident that it will soon be gone - so every decision I make now is focused on reducing my risk of recurrence.

~

On Friday I was a bit tired (I hadn't slept well the night before) and had no appetite, and on Saturday I was intermittently nauseated. Fortunately I was feeling well again this morning and have had no side effects all day.

Last week I was also had some skin issues, which Maddie and Dr. Hurvitz both attributed to the Herceptin and Perjeta. My skin is so sensitive under the best of circumstances, it's not surprising that the drugs would affect it, and though having eczema on my eyelid (of all places!) and breaking out like a teenager is somewhat embarrassing, it could be a lot worse. Maddie prescribed clindamycin for the acne and I used some of my regular eczema medication, Protopic, on the eyelid. Both conditions are much better today.

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