We met with medical oncologist Dr Melvin Chin and his registrar Dr Jessica Su today (20 September 2024). This consult discussed the benefits and side effects of a course of treatment using combination chemotherapy and radiation therapy. Essentially the combination therapy is the best treatment option for lung cancer like mine (locally advanced adenocarcinoma).
As you might imagine, I had done my homework and was as well informed as a lay person could be about the range of potential combo treatments. I was very interested in the exact drugs and the delivery schedule being proposed. There is no avoiding the reality that ALL chemo options are unpleasant and have side effects of differing intensities and duration – so which regime for me?
The most common combo for advanced lung cancer is cisplatin and etoposide. A common alternative is carboplatin and paclitaxel. The cisplatin + etoposide combo is a toxic mix and people feel really unwell and have heavy side effects when it is used. The carboplatin + paclitaxel is also heavy going for patients but not as hard as cisplatin/etoposide. As my case was locally advanced adenocarcinoma Dr Chin proposed using cisplatin with another drug, pemetrexed. He suggested this option because pemetrexed has shown itself to be effective against, you guessed it, locally advanced adenocarcinoma.
The good thing about the cisplatin/pemetrexed combination is that it not only acts against adenocarcinoma cells, it often has milder side effects (and generally does not result in hair loss!).
At 11am on Monday 23 September 2024 I will have the first of two intravenous cisplatin/pemetrexed combination infusions. Three weeks later, the second (and probably last) infusion will be administered on Monday 14 October 2024.
Dr Chin did not beat around the bush. He said that I am likely to feel lousy in week 5, as if I had stayed in the sun way too long and got a bad case of sunburn. I told him that I understood the cumulative impacts of radiation and chemo therapies. I also told him that I expect my oncology team to be on top of it all and to supply lots of drug support to get me through the pain, nausea, and any other side effects that come my way!
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David Errington says:
Melvin explained that the purpose of the chemo is to line up the cancer cells so that the radiation can blast them most effectively. The second chemo dose does this again for the cells that haven’t been blasted already. For this reason the chemo will probably only be two rounds.
Den says:
That’s right David. The “take home” is that the first cycle of combo therapy is directed at adenocarcinoma cells that have already matured enough to be attacked and hopefully destroyed. The second cycle targets adenocarcinoma cells that were not at the stage of development to be attacked during the first cycle.
Lynden White says:
And what did he say about the support – what can they give you to help?
Den says:
Hi Lynden. Seems that the most likely first side effect will be nausea. I now have anti-nausea and vomitting tablets to take (dexamethazone). I am hoping that drug will be able to control and limit the nausea. Won’t know until the treatment starts.