Breast Cancer and Herceptin (Trastuzumab)

During my treatment for breast cancer, I was part of a medical trial in relation to the effecacy of the drug Herceotin (Trastuzumab). Herceptin is a drug that belongs to the group of drug treatments called targetted or biological therapies. It stops specific ways that breat cancer cells divide and grow. I was treated with Herceptin because my cancer cells were found to have a higher than normal level of the protein Human Epidermal growth factor receptor 2 (HER2) on their surfaces. That stimulates the cancer cells to breast-cancer-s10-photo-of-her-2-genegrow. Herceptin works by attaching itself to the HER2 receptors so that the cancer cells no longer grow. it also stimulates the body’s immune system to fight the cancer cells.

I am one of the 20% of breast cancer patients to benefit from Herceptin as my tumours were the fast growing ones that are HER2 positive. I was given the Herceptin along with chemotherapy after my surgery in order to reduce the chance of the tumours spreading or returning. If your breast cancer is not HER2 positive or, indeed, HER2 negative, Herceptin will not be effective to you.

The Herceptin treatment I was given for my breast cancer was given to me intravenously through my Hickman line on the same days as my other chemotherapy. I was treated every three weeks as an out patient. However, the days were long, as the Herceptin was given over 90 minutes with additional time taken to give me saline solutions and my chemotherapy. I had to stay in hospital for several hours in case I was allergic to the treatment. Luckily I was not. However, like all drugs, Herceptin has side effects.

The common side effects of Herceptin include: feeling like you have flu, nausea and diarrhoea. I had all of these. I felt pain in my muscles and joints and often felt breast-cancer-s2-breast-cancer-illustrationlike I had a temperature so I swung between feeling hot and cold. I also had to have treatment with anit-sickness drugs for the servere nausea I suffered. I also got medecine from the hospital to counter the diarrhoea that I suffered.

The trial I was part of was looking into reducing the period of time that women are treated with herceptin, to see if it makes a difference to the efficacy. The usual period for getting Herceptin is about a year. I was treated with it for 9 weeks. I found the hospital visits and the side effects very draining, so, although I had initially felt diappointed that I was only receiving the treatment for a shorter period, in the end I was quite glad to get to the end of the course of Herceptin.

Valerie Penny

 

 

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Information about Taxotere (Docetaxel)and Breast Cancer

During my treatment for breast cancer, one of the drugs that I was treated with was Taxotere. It is also known as Docetaxel. It was used for me to treat primary breast cancer that had not spread to other parts of the body. It was used in combination with other drugs in combined chemotherapy. Docetaxel is also sometimes used to treat breast cancer that has come back after treatment or spread, for example, into the lymph nodes.

It works by interfering with the development and growth of cancer cells. Docetaxel blockshickman line.jpg part of the cancer cells before they divide and grow. This makes the cancer cells die off at an early stage.

When I was given Docetaxel, it was gven to me intravenously through my hickman line. I had three weeks between each round of chemotherapy. So, just about the time I was feeling normal again, another dose of the drugs was given.

Docetaxel has side effects. All drugs have side effects. Some people are more suseptible to them than others.Amongst the common side effects of Docetaxel are: bone marrow suppression, hair loss and nausea.

The bone marrow supression was the side effect that worried me most, because this means that I had an increased risk of getting infections when my white blood cell count was low. As a result of this, I was unable to go out and mingle with friends or relatives after my treatment. It made me feel isolated and lonely. My resistance was lowest around 5-10 days after I had had my dose of Docetaxel. So for about one week in every three, I had to be particularly careful to avoid infection. I was warned that, if I did feel unwell during this time, or if my temperature ever did go up over 38C then I was to get medical help or go to the hospital.

I managed to avoid having to go into hospital, but I did find that I bruised more easily and had nose bleeds that were difficult to stop and did suffer from anemia.I did not need any blood transfusions, but I did take iron tablets to boost my red blood cells.

Nausea was a problem for me, however, I was given medication to control this. The anti-sickness tablets were very effective and I was grateful for that. I also noticed that the taste of many foods changed while I was on chemotherapy. Much tasted like tin. However, I am glad to say that my sense of taste has returned to normal since my chemotherapy cancer-101-s8-tnm-stagingtreatment has finished. I was told that I might suffer from diarrhoea, however, my body reacted differently and I suffered more from constipation than diarrhoea.

The other side effects I suffered when being treated with Docetaxel tiredness, fatigue and pain in my muscles and joints. I still suffer from these over a year after termination of my treatment. When the pain is severe, I take pain relief or anti-inflammatories, but I try to avoid them as far as possible. Common practice says that gentle exercise improves the fatigue. I find it merely replaces it with exhaustion!

All in all I found chemotherapy difficult, but it is miles better than the alternative: no treatment: no recovery.

Valerie Penny

Physical Effects of Chemotherapy

It is hard to imagine that I am already more than half way through my course of chemotherapy and I have now moved from the docetaxel to FEC.  

FEC is named after the initials of the chemotherapy drugs used, which are:

  • fluorouracil which is also known as 5FU
  • epirubicin
  • cyclophosphamide

FEC treatment can usually be given to you as a day patient. Before you start treatment, you’ll need to have a blood test on the same day or a day or two beforehand. You’ll also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.  The first time I went for my FEC, though, the hospital was installing a new computer system, so it was over 5 hours before my therapy reached the ward.  Isn’t progress wonderful?!

The nurse will then insert a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn’t take long. Some people have their chemotherapy given through a thin, plastic tube that is inserted under the skin and into a vein near the collarbone. This is what I have, a Hickman line.  A line can also be  passed through a vein in the crook of your arm instead. This is Known as a PICC line.

You’ll be given some anti-sickness (anti-emetic) drugs as tablets, or more usually by injection through the cannula, which is often connected to a drip (infusion).

The chemotherapy drugs are then given separately:

  • Epirubicin (a red fluid) is given as an injection along with a drip (infusion) of salt water (saline) into your cannula or line.
  • 5FU (a colourless fluid) is given in the same way.
  • Cyclophosphamide (a colourless fluid) can be given either as an infusion or as an injection alongside a drip of saline.

The chemotherapy will usually take about an hour, but it may take longer.

Although the epirubicin is often given first, the order in which the drugs are given won’t alter their effectiveness.

If you’re having your treatment as a day patient you can then go home, and the cannula will be removed before you go. If you have a central line or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You’ll be shown how to look after the line or the District Nurse will call in once a week to maintain it for you.

You’ll be given a supply of anti-sickness drugs to take home with you. It is important to take these regularly as directed by your doctor. I was advised to start them right away even if I wasn’t feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it starts.

I have found, so far that the side effects of the FEC are not so debilitating as the docetaxel, but they do exist.

I am not mentally tired, but I do get physically tired.  I am not a patient patient, so when I have some energy I tend to charge around and do as much as I can until I can do no more. It is then I often need a rest or sometimes even an afternoon nap. I should really pace myself, but I am not good at that and really feel excited when I feel I have the energy to accomplish something. I go at it until I finish, or until I run out of energy whichever comes first.

My urine is very dark and smelly but that is not as much of a problem as the constipation. That makes me feel bloated and sore, so laxatives are the order of the day!

My eating is also a bit unpredictable. There are times when I am not hungry and other periods when I graze constantly.  I also find myself craving salt, fruit, vegetables and strong flavours.  I fear I am the only cancer patient who has not lost weight, but the consultant tells me he does not want me to lose weight so he is happy. That makes one of us.

One of the most noticeable side-effects that continues to have a daily effect on my life is hair loss. My hairdresser came to the house when my hair began to come out.  She took my hair down to a number 1. This stopped it coming out all over my pillow and also stopped it clogging the drains when I had a shower!  The most obvious thing is that sometimes my head gets cold! I am also quite self-conscious of not having much hair. It has still not come out completely, but it is very thin on top (although it seems to be growing a the back).  I do have a wig but only wear it if we have visitors or I am going out. Otherwise I mix it up with my “wee hair”, my bandanas and my beanie hats.  My husband is wonderful and so supportive. He had his hair cut to a number 1 too. So now he has the same hair cut as me. The only reason for this is solidarity.  I appreciate it.

One of the things my cancer nurse told me to expect was losing the hair all over my body, not just on my head. This has saved me time and effort shaving my legs! However I have also lost all the hairs in my nose so it feels like it is permanently dripping.  I have mucus running down the back of my throat all the time and I seem to be constantly sniffing or wiping my nose. I am very self-conscious of this.

Another most unpleasant side-effects of the FEC is nausea.  It also causes vomiting in some people. That is even more unpleasant. One of my friends who had already had 2 courses of FEC while I was undergoing treatment with the docetaxel warned me about this and told me the hospital would give me anti-sickness tablets. My friend advised me to start taking them straight away.  The nurses in the oncology ward echoed this advice and I took it. I was glad I did because I did feel a bit nauseous, but never got sick so far.  I am glad of this.  I hate being sick. (Nobody enjoys it, but I really hate it.)

So there you have it, my physical side-effects with the new drugs I am being treated with are not as bad as I had feared, but I was on 21 tablets a day for the first few days after my chemo therapy!  14 of those were for the chemo side effects and the other 7 were my regular ones for my under-active thyroid and my depression. What a life! I plan to live it for as long as I can. 

Valerie Penny

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