Mr. T and I showed up for my appointment with Dr. D, my
oncologist, on December 5th for the results of my MRI and PET scan
that I had had previously. The results were neither good nor bad: essentially there had been no change in
either the size of the tumors or their metabolic activity since the last series
of exams. Dr D. immediately explained
the options for the next treatments that she could offer me. She always seems to have several cards up her
sleeve that she only pulls out as needed.
She mentioned two avenues of treatment, the first being the
molecule “Caelyx” which is the treatment that we had tried to obtain back in
March to be used in conjunction with the Yondelis. Unfortunately, it had been out of production
for some time and no supplies were available.
It seems that in the interim, small batches were once again being
produced but there was no guarantee that she could obtain enough for a complete
treatment cycle.
The second approach was to sign me up for a clinical trial
that will be starting in about three months.
This trial combines two known chemotherapy molecules with an adjuvant, a
PARP inhibitor. PARP is a protein that
aids in DNA repair. Thus a PARP
inhibitor prevents the repair of DNA leading to cell death that is exactly what
we want for those nasty cancer cells.
“Drugs that inhibit PARP1 cause multiple double
strand breaks to form in this way, and in tumors with BRCA1, BRCA2 or PALB2 [6] mutations these double
strand breaks cannot be efficiently repaired, leading to the death of the
cells. Normal cells that don't replicate their DNA as often as cancer cells,
and that lacks any mutated BRCA1 or BRCA2 still have homologous repair
operating, which allows them to survive the inhibition of PARP.”
I was very excited about this news since I had read how
effective the Caelyx could be and was also interested in participating in the
clinical trial that is supposed to be targeted for cancers of genetic origin,
such as mutations in the BRCA-1 and BRCA-2 genes.
In October, we had met with the geneticist at Bordet who had
done a family medical tree and agreed that I needed to be tested for BRCA-1 and
BRCA-2 mutations. These mutations
results in significant risk of increase of both breast cancer and ovarian
cancer. Since the DNA testing is
expensive and time –consuming, we are still waiting for the exact results. The results of these tests will be
significant not only for me in terms of the type of treatments that I may
receive, but for my family members, daughter, grand-daughters, aunts, cousins,
etc. since these mutations are dominant.
If you have them, then you pass them on and they will be expressed.
We agreed with Dr. D that if she could locate enough of the
Caelyx, then I would start the treatment on the following Tuesday (the 11th)
and if not, then on the 18th.
I felt so relieved that not only did I not have to have a chemo
treatment that day, but that I had a good chance of going to Brittany the
following week to help out Alec and Virginie on their house renovation project. I had really been looking forward to that and
since I had not a treatment for three weeks, I was in fine form.
Unfortunately, Dr. D contacted me on the following Monday to
say that she had not been able to find a sufficient stock of the Caelyx, and
that she would have to start me on another drug while waiting for the clinical
trial to start. Every molecule that she
proposes has been shown to be effective against ovarian cancer, but the
reaction to the molecule is very individual.
She can never know if a particular drug will be effective for me. One of my main preoccupations is knowing what
the side effects can be. The substitute
she proposed definitely causes hair loss, which I have managed to avoid with
all of the treatments since my relapse.
I just couldn’t bear to think of going through that again, and could
just picture myself having to explain this to Charlotte again.
So I left for Brittany, with a heavy heart and a ray of hope
since Dr. D said that she would call me if she did manage to find the Caelyx.
I threw myself into the renovation project with Alec, while
Martine, Virginie’s mom, performed her domestic miracles, cleaning, organizing,
shopping, and best of all, cooking. She
keeps us all going being the force behind the machine. Virginie is so great with child (Baby Girl is
expected on December 26th) that she must take it easy. I whitewashed
and painted walls AND ceiling, no small affair, and cut up firewood with their
newly acquired chainsaw, an excellent exercise for staying in the present. Lo and behold, Dr. D called me on Thursday to
inform me that she had indeed found enough Caelyx for 4 cures! I really had something to look forward to
upon my return.
Side effects for the Caelyx are typical for many chemo
drugs: nausea, vomiting, fatigue, chance of hair thinning or loss (but not
guaranteed as some of the others), and the peculiar “hand-foot syndrome”
resulting in a rash on the palms of the hands and feet that can be painful even
to the point skin loss.
I had my chemo this past Tuesday and am vigilant to see if
any of the symptoms arise. Mr. T and I
went to the movies last night and then to our regular post-cinema restaurant. I only managed a few bites of my meal and
then felt the need to go outside for some oxygen. I ended up by vomiting in the gutter, dashing
home in a taxi and then having diarrhea.
Was this the result of the Caelyx or just a simple stomach bug? Impossible to say since I feel fine today.
One thing is certain, it was not the end of the world !
