13. Back to the Future – part quatre!

Back to the Future The Future is Now

So, to return to Chemotherapy. It’s as good as it gets, of course, (Allusions to Jack Nicholson coming on!) but we cancer patients tread that very fine line between current and future practice.

As good as it gets

Jack Nicholson in “As Good as it Gets”. One of my favourite menacing actors – “Five Easy Pieces”, “A Few Good Men”, “Witches of Eastwick”, “Bucket List” to name but a few. I might return to this – though I have run out of the “Back to the Future” series films for a link!

Through years of research drug ‘Chemo Combos’ are formulated on experience and experiment. Despite best efforts (and because cancer is a collection of diseases, not a single disease), there is no one best ‘cure’ or treatment.

Hopefully, this situation may improve in future. aka: “The Future is Now”. That’s what us cancer patients want!

Meantime, Research Scientists and Medical colleagues are constantly trying to improve outcomes for patients, drawing not only advances in chemotherapy, but also surgery, radiotherapy, biological therapy and maybe in the far distant future (Deep Space), nano-technology, including lasers (that advance even CyberKnife research?) to do more for those whose outcome is probably known but not always talked about until “after”.

This means we are sometimes entered (or can choose anyway) to take part in a clinical trial to determine whether the latest research will translate into more effective treatment: longer survival, fewer deaths – decreased mortality, fewer complications – less morbidity or side effects; or improved quality of life – while it lasts. All of these are worth having and as a desperate patient (I was predicted to have 6-8 weeks without treatment, recall!), I’d certainly be up for volunteering. This does present a dilemma for clinical oncology research. Most people who volunteer for a ‘trial’ are likely to be in a poor state, and on their last hopes (who isn’t with ‘cancer’?), but a lot more patients are fitter and better off psychologically too. So trials have to be very carefully planned and executed via ethical protocols (see all my previous references to this too). As a consequence, although there was not a trial available for me to enter, I would have. Let’s see how it might have worked:

I, along with other patients, with stomach cancer would be offered a ‘trial’ having had explained in advance how everything would work, and I would have signed-off on a consent form. The clever bit is to ensure that two groups of us cancer patients (stage of cancer – severity; previous treatment history etc) are as matched as possible. Each group of patients is then assigned to the best ‘old’ treatment (control group) or to the ‘new’ treatment group where a substitute compound may be introduced, say, as an alternate to one of the best medicines in a Chemo Combo like my EOX. Let’s say there has been preliminary findings that X can be replaced by W (Weetabix springs to mind here!) and so we now have two groups of patients that are about to receive either EOX or EOW. Now here’s the tricky part.

Which group gets what, and who knows who is getting what? This is where the double blind clinical trial idea comes in. Patients are assigned randomly (usually by computer lottery-type software) to one or other groups which are then called group A (say, gets EOX) or B (say, gets EOW) but the patients won’t know which, (though the Pharmacist would, somebody has to!). The Oncologist(s) won’t be informed either which of the groups are receiving EOX or EOW, so that their own expectations can’t be foisted on to patients, or so that any patient should be treated differently. Because the patients and the doctors both don’t know who is receiving what, this is the double-blind aspect!

After the course of treatment, the group (A and B) drug assignment ‘code’ is broken, and the medical and research staff are then in a position to compare outcomes for the two treatment regimes without being accused of dealing with biases or false positive (or negative) data. Group A may well turn out to as good or better than Group B, but this would mean, in this case, that the new compound W (Weetabix, in my fictional study!) has no beneficial effect. It would join the scrap heap of hundreds or thousands of other such trials carried out in Medicine globally.

The even more problematic part for us patients is thinking as follows in what is known as a “Think aloud”. “I will get on board with this trial, but wait, I won’t know if I am getting the new ‘magic’ stuff (nor will my wonderful Prof P); and by the end of it W might have been the first ‘cure’ for my type of cancer – but I didn’t actually get it for that one year trial! What the “f***”?

Anyway, we all know this already because we signed the informed consent paperwork, but it doesn’t seem fair, does it?

Now, I’m actually sitting here hovering above my coffin contemplating the brilliant party Elaine has planned for my wake – playing the following hit list:

Driving home for Christmas”. Chris Rea.

All right now”. Free.

A Hard Day’s Night”. The Beatles.

Little Wing”, followed by “Angel”. Both by Jimi Hendrix.

These five tracks form the ‘backdrop’ to the ‘service’ part of my ceremony– where everyone dances around my hand-woven basket coffin, and as many mates as would like to, as well as family, say exactly what they thought about me!

And you think I might be a Christian? As Billy Connolly says, “You can never find a bloody Lion when you need one”!  Speaking of Lions, what about this track, “Lions” from the eponymous, first Dire Straits album?

Dire_Straits

Now, back to my plot …..

Here’s more Biology as well as Chemistry (I did these subjects and Mathematics for my A Levels!).

Chemotherapy targets dividing cells, particularly cancer cells (but also cells in ‘normal’ tissues that retain dividing capacity for growth or repair of the body). So it is important to understand how cells divide.

Cell Division

Cell Division.jpg

http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@cah/@gen/documents/image/cr_125029.jpg

Different chemotherapy drugs affect different components in the cell division cycle. For example, some drugs damage cells at the point of splitting; some damage the cells while they are making copies of all their genes before they split. So, it is usual for different combinations (my ‘Chemo Combo’, EOX, for instance, will include drugs that damage cells at different stages in the process of cell division). So, perhaps I’m in good shape here?  I have a three drug combo (plus my Weetabix, on my Readybrek, of course – randomly spread by blind or closed-eyed people– C’mon, why? Protocol – keep up!). With more than one type of drug, there is more chance of killing more cancer cells.

So what happens if the ‘Chemo’ works? Well, the good news is that I may go into complete or partial remission?

[Complete remission means that the cancer can’t be detected on scans, X-rays, or blood tests, etc. Doctors sometimes call this a complete response. Partial remission means the treatment has killed some of the cells, but not all. The cancer has shrunk, but can still be seen on scans and doesn’t appear to be growing. The treatment may have stopped the cancer from growing. Or the treatment may have made the cancer smaller so that other treatments are more likely to help, such as surgery or radiotherapy. This is sometimes called a partial response”].

Another term used is ‘stable disease’. This can mean that the cancer has stayed the same size or has only grown by a small amount. I have been told that I will possibly go into a period of ‘dormancy’ (not remission), perhaps after 4 or 8 rounds of three week cycles of EOX (as per earlier), ie 3 or 6 months of ‘Chemo’. What does that mean? I am not sure, though I suspect it is not as optimistic as ‘remission’ or ‘stable disease’Damn it!!

I have my Chemo in three week cycles over three to six months because it allows the chemotherapy to kill more cancer cells and rest between treatments allows my body to recover from any side effects.

“At any one time, some of the cancer cells will be resting. Chemotherapy only attacks cells that are in the process of splitting into two (dividing). So resting cells will not be killed. Some of the cancer cells that were resting during a first treatment will be dividing by the time your second comes around and so they will be killed off, and so on, for each cycle. Normal cells usually repair the damage from chemotherapy more effectively than cancer cells, so damage to cancer cells should progressively build up without causing permanent damage to normal cells.”

Also, the exact treatment plan (regimen) depends on a number of factors such as: type of cancer you have; where it is located in your body; and, if it has spread, and to where? General health and fitness, as well as age matter! I should have been ok. At least I would have been two months ago – still running about 30 miles per week, gardening 6 hours per day, DIY – like anytime! However, I have shed three and half stones since then! Some drugs are more effective (or toxic) than others so it is important that your specialist oncologist (Dr P is very special – to me anyway!) judges how able you are at the start of treatment to cope with any side effects. Nevertheless, I started my Chemo (EOX) nearly two weeks ago – lucky me!

OK, so EOX stands for Epirubicin, Oxaliplatin and Xaloda (EOX). These are obviously chemotherapeutic drugs used to treat cancers, and they are my ones (love ‘em or hate ‘em!). But what are they, and how do they work, and importantly for me, what are their side effects, and how bad can it get – damned-right! I’ll be brief here, I’m getting bored now. In fact I am going to be so brief I’ll give you another link to follow for the really interested saddos amongst you!

http://www.cancerresearchuk.org/

But I’ll end on a side effect note, or rather, a poetic ditty!

I have been to the loo, for a number two

In the last two weeks or so, my guts have rumbled more

But to no avail, and I’m still feeling ill; more laxative she suggested, what about a pill?

Finally, the earth shook on more than two occasions;

And yesterday ended in several, disastrous explosions!

 

diarrhoea

 

 

Diarrhoea, eh? I wish!

Colin’s little book of poetry contains only 1 poem.

 

So that’s it folks.  Tomorrow I’ll be looking at the latest research on novel therapies and will report again on Thursday, so ’til then, bye for now.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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