Wow, after reading about a recent French retrospective study, I’m feeling even better about having been treated with chemo and Herceptin. Researchers looked at ~4-year outcomes for 276 breast cancer patients at clinics in France. This particular cohort of patients was diagnosed with Her2+ breast cancer tumors under 1cm in size and without lymph node involvement (T1abN0).
Within that group, 129 patients underwent Herceptin and chemo, 19 chemo only, 5 Herceptin only, and 123 had no treatment. The Herceptin-chemo treatment group was notably linked to an initially (that is, prior to treatment) worse prognosis because it represented a larger proportion of hormone receptor negative (ER-, PR-) tumors. In general, ER/PR- tumors are riskier because patients don’t respond to drugs like Tamoxifen and Femara.
How did they fare? In the do-nothing group, 13 patients out of 123 relapsed. In the Herceptin-chemo group, 2 out of 129 patients experienced a recurrence. A single chemo-only patient and none of the Herceptin-only patients relapsed. Of the 16 total recurrences over all groups, 9 were distantly located. In terms of sheer survival, 9 patients from the do-nothing group had died by 40 months compared to a single death from the Herceptin-chemo group. In summary, even though the patients in the Herceptin-chemo group were expected to do worse, they fared significantly better in both survival and disease-free survival after adjuvant treatment than did the patients who did nothing.
This recent study is significant for me in at least a couple of ways. First, it bolsters the results from the retrospective Kaiser study that I reported on last year which presented a less dire situation than depicted by other scholarly articles. Second, though the Her2+ cases represent a small data set (but comparable in size to the Kaiser study’s 237), the probability of disease-free survival for the entire group is 0.94, which is consistent with the Kaiser probability of recurrence for all subjects (with and without adjuvant treatment) of 0.063. Breaking the French result down, the probability of disease-free survival is 0.98 for the Herceptin-chemo group and 0.89 for the do-nothing group. If you apply these results to my own T1abN0 case, by enduring 12 months of adjuvant treatment, I reduced the probability of recurrence from 11% down to 2%.
The day I’ve been anticipating for almost 1.5 years has finally arrived. Today’s infusion closed the book on active treatment. I am now in maintenance and vigilance mode. I can take a deep breath, knowing I’ve done everything I can to prevent this menacing disease from ever returning. Totaling 26 infusions in all and representing almost 80 hours in the infusion clinic, my investment of time for adjuvant treatment has been well worthwhile because I have roughly halved the risk of recurrence. I am now free from needles, free from pharmaceuticals, and, I fervently hope, free from cancer. Free at last!
I was called in for a periodic checkup today with Dr. Semien, who gave me a physical and then gave me my marching orders. Since next Tuesday’s infusion is my very last, I can curtail visits to Kaiser. I will no longer need MUGA scans, check-ups will be reduced to once per six month period, and I will continue to be vigilant. In particular, I will be looking for any breast changes or swelling of the lymph nodes (loco-regional recurrence). I will also keep an eye out for bone pain, nausea, headaches, or persistent cough (distant recurrence in bones, brain, lungs, etc.)
According to Dr. Semien’s online risk calculator, my 10 year risk of recurrence has dropped from 21% (prechemo) to 12%, following adjuvant treatment of Taxol and Herceptin. She whittled this statistic a bit further, saying my otherwise excellent health paired with the diminutive size of the invasive tumor make that 12% figure a high estimate.
Down and up. Up and down. It’s all probably within the margin of error, so I will strive to not overanalyze. I had my fifth MUGA scan this morning to check on heart health while I’m still taking Herceptin. The result: 73, down a tidge from the last reading of 76 (and before that in reverse order: 73, 70, 77). It’s still a respectable number and more than enough to give me the go-ahead for my final infusion in 2 weeks.
In other news, Roche announced the results of its recent study examining whether 2 years of Herceptin might be better than just one. Although two years of treatment per patient would materially improve Roche’s bottom line, Roche researchers reported that patient mortality does not improve with extended treatment. Meanwhile, to what must be Roche’s relief, a French study showed 12 months of treatment is probably better than a shortened 6 month term. All in all, I’m feeling comfortable with my own 12 month schedule.
I finally understand what the fuss is over Starbucks. I’m not a coffee drinker, but I found myself in a predicament at last week’s penultimate Herceptin infusion. I had arranged for a ride to/from my appointment but through a miscommunication found myself in charge of my own transportation. The Benadryl premed administered to prevent allergic reactions to the Herceptin tend to knock me out and this last appointment was no different.
After the nurse pulled out my I.V., I groggily pulled myself out of the infusion chair and headed out to my car, thinking I could at least grab a nap in the parking garage before driving home. As I left the medical building, I looked to my right and spied a little coffee shack, administering caffeine shots to a steady line of customers. $5.41 later, I walked to my car with a chai latte and an oatmeal raisin cookie the size of South Dakota. I downed my drink and gobbled up the cookie on my way home and was wired until bedtime. Unlike last time, thankfully, I was able to fall asleep normally.
Later in the afternoon I received a call from the nuclear medicine folks saying I need to report to duty for another MUGA scan. That delightful procedure is scheduled for next Monday.
Twelve middle-aged women, all loosely tied together by our children’s elementary school or swim teams but bonded by a love of running, gathered together in a dark school parking lot hours before sunrise, on what would have otherwise been a leisurely Sunday morning. Shivering in the early morning chill, we separated into two large capacity vehicles and caravanned the ~30 miles to Half Moon Bay. Some were running a 10K, fewer the half marathon, and a smaller yet group would go the full marathon distance.
The route wound down and back up the coast, either on paved pathways skirting rolling sand dunes or narrow meandering packed dirt trails on dried grass covered hills. Our hard work was cooled by ocean breezes and periodically rewarded by stunning ocean views. At the end of the race, each was awarded a celebratory finisher’s medal, wrapped in a mylar thermal blanket, and directed toward refreshments.
I had stepped up my meager running training minimally over the past couple of weeks. In a typical week, I try get in a couple of 5 mile runs + one to two 5 mile hikes. Two weeks ago I added a couple of miles to the 5 mile run and last week I ran an 8-miler, hoping that would be enough preparation. Looking for timely tips, I eagerly “thumbed” through my Kindle copy of Danny Dreyer’s “Chi Marathon,” a follow up to the book that changed my running style early last year. I was encouraged by Dreyer saying that a strict adherence to correct mechanics could compensate for a lack of training hours on the road. Yesterday’s race bore that theory out.
I was keenly attuned to my posture, legs, and arms throughout the race. I maintained a forward lean from the ankles, knees low and bent, and back straight, and perhaps more importantly, focused on keeping everything from my knees down as loose as possible. This allowed me to navigate the tilted, narrow, twisted dirt tracks without twisting an ankle and absorb the force of the road on my legs without having pain from my legs force me to the side of the road. The result: 2 hours, 6 minutes, 38 seconds, which was good enough to put me 12th (out of 40) in my age group and fast enough for a personal record, beating my only other official half marathon time of 2 hours, 12 minutes, 56 seconds in San Francisco in late 2011.
After my last infusion appointment a couple of weeks ago, I’m in the home stretch with just two more treatments to finish up. Just to keep things interesting, it seems, my body is throwing in a curve ball or two. Unfortunately, I forgot to pack tonic water to try to prevent the restless leg discomfort I experienced at my last appointment. I mentioned the restless legs to my nurse who knew exactly what to do: slow down the benadryl drip to half the usual speed. And it worked!
As usual, I had dutifully reported to the infusion clinic having taken an antihistamine pill, to then receive an additional antihistamine and steroid via I.V. These soporific supplements typically prod me into a decidedly drowsy state for the next several hours, after which I return to a normal sleep/wake pattern. Not so for the last installment in my adjuvant treatment saga, alas, because after I awakened from that day’s Benadryl nap, I couldn’t fall back to sleep … the entire night (or at least it seemed like that). The next day, I could practically feel the additional quarter pound of fluid suspended beneath each of my eyes. Throughout the day, I periodically attempted to nap, thwarted by the chemical concoction I had submitted to in the name of preventing anaphylactic shock. By bedtime, I was simply exhausted and blissfully blacked out before my head hit the pillow.
Dr. Bitar clarified my “mammogram” notification via email earlier this weekend with the complete MRI report. No abnormal changes were observed with the exception of a 7 mm “enhancing focus within the skin” which “may be related to inflamed skin process, such as inflamed sebaceous cyst.” I was impressed and relieved to know that both the radiologist and Dr. Bitar were able to remotely yet accurately assess something I had already locally observed, an ordinary pimple.
To celebrate this bill of good health, I upgraded my entry at the upcoming Half Moon Bay race in late September from a 10K to a half marathon. To be honest, I don’t have any business running a half marathon since these days I typically log no more than 12 running miles and 10 walking miles per week, but I can blame my exuberance on the rush of a good MRI result.
Last week I traveled to San Jose for my second breast MRI and the first since having had surgeries. I am now on a vigilant semi-annual schedule of mammogram in March and MRI in September. Because I am still actively receiving Herceptin treatment and because I have been periodically poked and prodded by various specialists over the past year+, I have not been unduly nervous about the result from this last MRI. Indeed, today’s mail included a benign looking boiler plate postcard from Kaiser stating my “mammogram” findings were normal. Mammogram? Needless to say, I quickly shot out an email to my breast surgeon asking for the full MRI report so I could be sure I hadn’t dreamed up the entire claustrophobic, cacophonous experience.
Could the definition of middle age be the point beyond which life’s happy milestones are outnumbered by unhappy ones? This summer has turned out to be full of life changing events for friends and relatives. On a significantly happier note, two beautiful babies have been born (not to the same parents) and a friend has entered into wedded bliss. On the flip side, I have had to bid a final mental farewell to five individuals, whom I have had the pleasure of knowing during different periods of my life: a dear cousin, a high school classmate, teachers to our children, and a business associate of Earl.
Here’s the math:
Happy Milestones Sad Milestones
2 births + 1 wedding = 3 < 5 deaths
Without exception, all of those in the second column experienced an inappropriately early demise. Of note, in recent years, two had been diagnosed with cancer and then successfully fought it off through surgery and adjuvant treatment. They had both reigned triumphant over the scourges of breast or brain cancer and had retreated to normal lives after cancer. While both had managed to achieve every cancer patient’s dream (death not from cancer but from one of a myriad other garden-variety, every-day causes), in retrospect that dream needs a slight but significant reword: death at an advanced age not from cancer but from one of a myriad other causes …