Moving forward

We finally have a plan!

It's not exactly the course of action I was seeking because that would have involved the added kick of a clinical trial drug, but I'm happy to be moving forward. Next week I start carboplatin and paxlitaxel chemotherapy. These are the same two drugs I've taken for my past two chemotherapy treatments, and they're considered the standard for treating ovarian cancer.

We're proceeding with these two drugs because they've worked in the past to kill the cancer, and the docs in both London and Hamilton believe it has a great chance of working again, especially since I have the BRCA gene mutation. Research shows ovarian cancer in those with this gene mutation tends to respond positively to chemotherapy treatment (positively for the patient, but not for the cancer cells because they die). My London oncologist did point out this responsiveness tends to slow down at some point, but he's optimistic the chemo will work again this time.

Yesterday, I had an appointment with Dr. W, my London oncologist who also coordinates clinical trials. He patiently discussed the pros and cons of the various treatment options available to me - the ones Dr. H suggested, as well as a few more of his own. While two clinical trial drugs sound promising - the P53 inhibitor and a different PARP inhibitor - both studies are in the approval phase with no clear sense of when they're going to start. It could be a couple of weeks or a couple of months.

I'd prefer to take one of these in conjunction with my chemo, but I can't wait. I feel like I've been stagnant long enough, allowing the cancer to grow inside me. I have to start sending my stealthy ninja warriors (aka the chemo) back in to hack, slice and defeat those cancer cells. Luckily, I found out yesterday that while I have "lots of cancer" inside me, the CT scan reveals it's still on the surface of organs and hasn't penetrated any of them. So I need to get some chemo in there, shrink those tumours and distract them from trying to invade new organs.

While Dr. W and I decided to go with the carboplatin and paxlitaxel combination, I also had the option of trying a different chemotherapy option with approximately the same success rate - carboplatin and gemcitibine. Paclitaxel is a more toxic chemotherapy, producing nausea, neuropathy (tingling and loss of feeling in hands and feet), joint and muscle pain, etc. Gentle Gem, has fewer of the nasty side effects, although its more common ones are fever, joint aches and rash. Approximately five per cent of patients find the Gem's side effects intolerable.

Part of me would like to go the Gemcitibine route because of these gentler side effects and because it won't necessarily make all my hair fall out. I know, it's a stupid reason and one I didn't really use to make a decision, but it'd be a bonus.

Another plus would be the ability to skip the pre-chemo steroids to prevent nausea. Dr. W said they may not be necessary with the Gemcitibine. Given the steroids may have caused the ulcer (if that's what I had), I'm a little leery of them now. Although when I talked to the pharmacist during my stint in the hospital, he said a couple of big doses, which is what I'd take with chemo, are more easily tolerated than a small dose over a longer period of time. But they still make me nervous.

Another option Dr. W discussed was coming in for a weekly dose of Paclitaxel chemotherapy. Research shows it tends to be better tolerated and works well to combat cancer. But I'd have to be on steroids and go into the cancer centre every week with this treatment regime. I turn into Bitchy Tina on steroids, so having this unpleasant side effect weekly would be hard to tolerate. I can't stand myself when this happens and I feel extremely sorry for my family.

The weekly Paclitaxel treatments are currently being studied in conjunction with a clinical trial drug, but I don't even qualify for this study because I've had surgery within the past six months. In fact, Dr. W said I may be excluded from some future clinical trials because of my bowel perforation. It disappoints me enormously that some potentially life-saving treatments may not be available to me now.

So I considered all these options and the recommendations of Dr. W and Dr. H, to determine my plan of attack. I'm going to go with the paciltaxel and carboplatin chemotherapy. I think it's the best choice from the options available to me today, despite its potential toxicity. I've also been through the chemo combination before and know what to expect. It's not pleasant, but I know I can get through it.

Now I'll anxiously wait by the phone for the call telling me which day I'll start treatment next week. Believe me, I tried to push for an appointment in the chemo suite for this week, but hospital staff are off because of Remembrance Day on Friday, so no such luck. Perhaps that's for the best because starting next week means I should feel okay for Christmas. (Yes, I've examined the calendar in detail.)

By going with this treatment option, we'll keep the gemcitibine combination and all the other potential treatment options in our back pockets to use if this treatment doesn't prove effective this time around or in the event of reoccurence. But hopefully, when that happens, the timing will be right for me to participate in another clinical trial that may prove effective against this aggressive and deadly disease.

Tina