Time vs. Hair

I seem to be in a race of time concerning my hair loss. I keep losing about 8-10 strands at one time-hey, you should see my hairbrush!!

I talked to my oncologist last week during my check-up about the hairloss. She was also surprised that I hadn't lost much hair but said that many people on Taxol only see thinning.

I have a theory on that-I AM HAIRY!!! Meaning, I have more than the usual amount of hair growing on my head. Whether due to genetics or the PCOS heightened androgen levels, who knows?

Am I freaked? Yes and no. I don't want to be bald. But at the same time, I find it curiously interesting-the process of chemotherapy and it's effects on my body, in a very abstract type of way. Kind of like how I viewed my changing body during pregnancy. I AM MY OWN SCIENCE EXPERIMENT.

Study, Part: How Does This Apply to Moi?

First, you really need to read the whole darn thing.


Second, I am not part of the first generation or second generation in the study.

I'm part of the third generation, participating through US Oncology, a national oncology firm that runs Fairfax Northern Virginia Hematology Oncology where I receive weekly Taxol-only chemo. I also receive Herceptin, but that is not chemo, it's hormonal therapy.

Here's what the first and second generation parts of the study have shown that has effected me:

Much has been learned about the optimum dose and schedule for administration of paclitaxel and docetaxel from trials in patients with advanced disease. CALGB 9342 demonstrated that increasing the paclitaxel dose above 175 mg/m² every 3 weeks did not improve the response rate, time to progression, or overall survival.⁵⁴ CALGB 9840 and the Anglo-Celtic IV trials established that paclitaxel 80 mg/m² once per week was more effective than paclitaxel 175 mg/m² every 3 weeks.^55, 56 With regard to docetaxel, increasing the dose from 60 mg/m² to 100 mg/m² every 3 weeks was associated with an improved response rate and time to progression, at the expense of increased toxic effects.⁵⁷ The TAX 311 trial by the US Oncology Group demonstrated that 100 mg/m² docetaxel every 3 weeks was more effective than 175 mg/m² paclitaxel.⁵⁸

In the adjuvant setting, once-weekly paclitaxel at 80 mg/m² or docetaxel every 3 weeks at 100 mg/m² is superior to paclitaxel at 175 mg/m² every 3 weeks following four cycles of AC.⁵⁹ Two other studies by the MD Anderson and US Oncology groups also support the superiority of once-weekly paclitaxel over paclitaxel administration every 3 weeks. In the MD Anderson study, once-weekly paclitaxel followed by four cycles of FAC was associated with an increased pathologic complete response rate compared with paclitaxel 225 mg/m² every 3 weeks followed by FAC (28% versus 16%).⁶⁰ However, improvements in the pathologic complete response rate have not always been accompanied by a long-term benefit in DFS or overall survival.⁶¹ Similarly, the US Oncology Group trial demonstrated superior 5-year overall survival with doxorubicin and paclitaxel followed by once-weekly paclitaxel (AP→P1) compared with standard AC→P3 with paclitaxel administered every 3 weeks (90% versus 87%, HR 0.74, P = 0.04).⁶²With regard to sequential or concurrent administration, the BIG 02-98 trial demonstrated an improvement in DFS with sequential but not concurrent administration of docetaxel and anthracycline therapy.⁴⁷ Whether the timing of taxane therapy in relation to that of anthracyclines is important remains an open question, as most of the available sequential taxane trials administered a taxane following anthracycline therapy—the MDACC, FinHER and HORG trials are notable exceptions.

Here's the Study I'm In...

Taxanes: Optimizing Adjuvant Chemotherapy for Early Stage Breast Cancer

Please click on the link if you to read the study. This is just the abstract and key points.

Philippe L. Bedard, Angelo Di Leo & Martine J. Piccart-Gebhart  About the authors

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Abstract

Taxanes are among the most widely used chemotherapy agents for advanced breast cancer. Results are now available from 21 trials that randomly allocated nearly 36,000 women with early-stage breast cancer to receive first-generation taxane-based adjuvant chemotherapy versus non-taxane-based adjuvant regimens. Three recent meta-analyses suggest that taxanes are beneficial in the adjuvant setting, irrespective of the patient's age, lymph-node involvement, hormone-receptor expression, and HER2 status. Nevertheless, the optimal role for taxanes in the adjuvant management of early-stage breast cancer remains controversial. We review the results of the first-generation taxane trials and discuss possible explanations for the differences observed in these studies, including variation in the 'strength' of anthracycline therapy in the control arms; suboptimal timing, dosing, or schedule of the taxane regimen; a masking effect of trials that included patients with relatively chemotherapy-insensitive luminal A disease; and decreased representation of the putative taxane-sensitive disease subset. Inclusion criteria for future clinical trials must be revised to account for the molecular heterogeneity of breast cancer and further optimize the role of adjuvant taxane therapy in early-stage disease.

Key points

• Recent advances in genomic profiling have highlighted the molecular heterogeneity of breast cancer and the differential responsiveness to chemotherapy according to molecular subtype
• Cumulative anthracycline administration is associated with rare but serious long-term toxic effects
• The activity of taxanes in metastatic disease, partial non-cross resistance with anthracyclines, and unique mechanism of action of these agents provide a rationale for evaluating taxanes in the adjuvant setting
• Existing meta-analyses are limited and no clear conclusions regarding the efficacy of taxanes in various patients subgroups can be drawn
• Determination of ER or HER2 status alone is unlikely to reveal which patients are likely to benefit from the inclusion of a taxane as adjuvant therapy
• Incorporation of novel biomarkers into clinical trial designs combined with improved classification of molecular subtypes may help to predict which patients are likely to benefit from taxane treatment

Halfway Through Chemo...And I Know What I Want to Celebrate When It's Finished!

I've now had 6 of the 12 weekly chemo sessions with Taxol and the hormonal therapy drug, Herceptin. YAY!!!!

First, I'd like everyone to know:

1. It doesn't hurt. Like, at all, going in. At least not if you have a medi-port/Power Port . The IVs inserted into a vein can really smart.

2. I keep having to take more medication, for the side effects of the medicine/chemo I'm taking. Which got me thinking of the old HBO program of the 80s, Not Necessarily the News. They once had a mock commerical skit in which one of two women having lunch, complains to her friend about having a headache.

The friend pulls a bottle of headache medicine out of her purse for her friend.

Headache woman responds, "But doesn't that give you internal bleeding?"

"Yes, but that's why you take.....(reaching into her purse again) this!! It relieves the internal bleeding caused by -----."

"Oh, I've heard of that. Unfortunately, it can gas and bloating, right?"

And so it goes. By the end of the skit, there are sixteen bottles of medicine on the lunch table.


So, I've been thinking about what I'd really like (it's expensive) to celebrate the end of chemo/this phase of getting rid (hopefully) of breast cancer and reclaiming my body, blah, blah, blah, celebrate my womanhood, yadah, yadah, yadah, reward the "girls."

Really expensive lingerie!! (A shoutout to Hips and Curves store for plus size women!)

And you know, after what I've been though...I want the matching hat, too!!

I'm hoping CJ won't mind.

What Amazing Chemo Weight-Loss Plan?!?

Tell anyone you are getting chemo when you are still hairy and overweight and you get this look of total disbelief.

"I thought people lost weight on chemo."

Well, apparently not all of them do. In fact, I've put on 5lbs. in one week. (I have a feeling that is due to being more sendentary because I'm becoming more fatigued.)

People have trouble imagining that you still look "normal."

If you took my picture right now, placed it in a book with snapshots of thin, bald people, you could play a  sick game of "Where's Waldo?"  finding the chemo patient.

Things I'm Learning as I Go Along

I wish I could get more advice on how a weekly Taxol-only chemo regimen can effect you. Unfortunately, since I'm part of a study, it's just me at the ole' chemo lodge.

Here's the damage list so far:

1. Really Dry Skin
I thought my normal, painful dry skin in winter sucked. At least it's limited to my face.

I started to peel so I invested in an organic mirco-scrub. Then some heavy organic Vitamin C night cream, plus Royal Jelly creme for my eyes. Why all the organic? I found that SLS and parabens (especially those used for fragrance) HURT LIKE HELL. So, thank goodness cheap organic products.

I love:

1. Burt's Bees
2. Dr. Bronner's-my old fav.
3. Alba
4. Jason

These actually cost less than non-organic products.  This goes for all make-up products, too. I love Bare Escentuals.


2. I think my hair is thinning. It falls out at a normal rate only there is no normal replacement. I'd better invest in some mousse.

3. Chemo brain. It's not bad or sad. Just kind of floaty. And hampers my ability to carry on an interesting conversation with CJ or other friends. Never before have I been so on my 3 year-old daughter's conversational wavelength.

4. Fatigue

Oh, boy. When it hits, it hits like I'm back in the first trimester of pregnancy, only I'm loopy, unemotional, and single-minded-get me to bed!! Then the house can burn down, for all I care.

5. As the weeks pass, I'm getting a bit weaker and more tired for longer durations. Exactly as I expected. I'm almost halfway there. Tomorrow will be my 5th infusion.

The Right Time to Get Cancer?

The cliche answer is no, there is never a "right" or good time to get cancer.

Horse hockey. I feel incredibly blessed to to have good timing/recent advances in science just happen this past year, for me to benefit from:

1. Digital Mammograms. They weren't around 10 years ago and they saved me for much worse. The digital mammogram was able to focus in on little rice-grain-like specks in my left breast. Specks that I naturally assumed stemmed from two burning cases of mastitis.

2. DIEP Flap Breast Reconstruction Procedure. A tummy-tuck and a new boobie rolled into one. But it really is all you. So I can still claim, like Teri Hatcher's character on Seinfeld, "They're real and they're fabulous!!" (And now they won't end up heading south, like two giant rye loaves.)

3. The FDA expanding the use of Herceptin for early stage breast cancer after primary therapy. My survival rate just shot up 46%. Thank you, Goddess. With all my heart.

Of course, technology will keep advancing and maybe one day lasers and pills will be able to take care of everything. Then everyone will stay healthy, disrupt the natural order of things, and the planet will impode, utterly out of resources. For now, I'm pretty glad I was diagnosed so early and at the current forefront of mondern medicine.

I'm still not going to be "Pink Warrior" or do any Breast Cancer Walks. I feel more committed to other charities. But they keep calling me....and they know who I am....it's getting creepy. I wonder if there is some "Pink Warrior" hit squad for recalcitrant breast cancer patients who refuse to buy pink stuff?