The drugs
The chemotherapy protocol I'll be doing is called FOLFOX. It's the standard in the US for colon cancer. This has 3 drugs:- FOLinic acid (aka Leucovorin); It's not a chemotherapy drug itself, but helps the next drug be more effective.
- Flourouracil (aka 5-FU
). Chemotherapy agent that hinders DNA replicaiton. - OXaliplatin. Another chemo agent that hinders DNA replication. This one has the side effects we worry about.
Along with this, I'll get two anti-nausea drugs through IV.
- eMend (aprepitant)
- dexamethasone (a steroid)... The steroid helps improve the effectiveness of eMend.
I also have prescriptions for Zofran and Phenergan (both pill based anti-nausea drugs I can use at home to supplement the IV drugs).
The port
On April 6, I have to have a minor surgery to install a port. It's a small disk (about the diameter of a quarter) that will be slipped under the skin in my chest. It will create a raised ring on my chest that the nurses use to draw blood, infuse drugs, and blood transfusions if necessary. The disk will have a tube than runs to a vein into a vein in my neck, and will drop down toward my heart. So drugs that go in will get to the heart and distributed from there quickly.
Timeline
FOLFOX goes in 2 week cycles, and I'm scheduled for 12 cycles (roughly 6 months), which is the standard for all stage 3 CC patients. Cycle 1, Day 1 for me is Tuesday April 14. Here's what the cycle looks like:
- Day 1, spend most the day at hospital getting IV infusion of anti-nausea meds, and OXaliplantin and FOLinic acid. Leave the hospital with a pump setup to deliver 5-FU for the next 46 hours.
- Day 2. At home, with pump.
- Day 3. Brief appointment to disconnect pump, and another blast of anti-nausea drugs. Go home.
- Day 4-14. Recovery.
Side effects
I guess first thing to say is that side effects hit every patient differently, and as I'm writing this, cycle 1 is still a couple weeks away. So who knows how it will effect me. Having said that, my oncologist team has given me the following expectations for how it hits a majority of patients.
- Nausea/Vomiting - TV/Movie portrayals of chemo usually lead with this, and I'm like most people, HATE to be nauseous or throw up. However, I've been lead to believe that they do a pretty good job of controlling nausea with anti-nausea drugs. I'll be given IV anti-nausea drugs when the cycle starts, and also when the pump is removed day 3. I'll also have two prescription meds for home. For MOST patients, late day 3, and day 4 are the worst for nausea. I don't tend to get motion sickness, and I don't tend to get sick after anesthesia, so my doc said that lowered the risk for severe nausea for me.
- Low energy/malaise - Again, day 3 & 4 are the worst for this, typically.
- Hair loss - FOLFOX usually doesn't generate significant hair loss. I guess that's a win, but I wasn't worried about this much, as I tend to keep a pretty smooth nugget.
- Red Blood Cells - A reduction in RBC count can happen. This will manifest itself as fatigue and shortness of breath, as RBCs move oxygen around the body. If it gets low, transfusion can help.
- Platelet count - This is the component of blood responsible for clotting. I'll need to be more careful shaving (switch to electric), etc... if it gets too low, again, transfusion can help.
- White Blood Cells - This is the infection fighters. So, as they reduce, my immune response gets weaker. If it gets too low, there are some drugs that can help. But I must be diligent about avoiding cooties.
- Neuropathy - This is the big one. OXaliplatin causes this, and it tends to get progressively worse each cycle, and for some, can become permanent. So, we'll be keeping a close eye on this one. The hope is this fades toward the second half of each cycle. Neuropathy manifests itself in these ways:
- Numbness/Tingling in hands/feet. This can create difficulty doing things like buttoning buttons, or I can stumble more while I'm walking, or have just general difficulty walking.
- Cold sensitivity. My understanding is that for the time I'm on OXaliplatin, I can give up drinking cold drinks. It can feel like drinking broken glass. Even reaching in the fridge to get something can feel very painful on your hands. I've been told to wear gloves to reach into anything cold, or having someone else do it.
As I started talking about at the end of my Lab Details post, my lower-risk situation suggests that I can get by with less chemo. The oncologist has generally agreed with this notion, and we're targeting to drop the OX in FOLFOX after cycle 6. This will significantly reduce chances of permanent neorapathy.
That's what I know right now. I'll probably do at least one post per cycle, just to keep up with this blog. I'll also keep a daily log of symptoms in a spreadsheet, that I will share in this sidebar as well.