Need for chemotherapy resurfaces
by Paula Levy
published: February 18, 2004
The first time we met Rosanne Himmelman about seven months ago, she was beginning chemotherapy to fight metastatic colon cancer. Through periodic updates, Rosanne is sharing her experience. This is part six of her journey.
Disappointed is how Rosanne Himmelman described her feelings when she found out that she needed to go back on chemotherapy so soon.
Recently the metastatic colon cancer patient was told that her break from chemotherapy has been short-lived because the cancer in her body has become active.
"I am disappointed. I did want a longer break," said Rosanne about not being fully recovered from her last treatment. However, she does admit the cancer journey is a bumpy road.
"It doesn't always go well from Day One. There are dips and valleys. This is just a minor set-back," she said.
Halifax oncologist Dr. Danny Rayson said her latest CT Scan on January 21 confirmed that tumours have grown significantly in eight weeks and resuming chemotherapy treatment was her best option.
Dr. Rayson suspects that the secondary cancers have learned to bypass her current chemotherapy drugs. He hopes by administering the treatment in a different way, the cancer cells will be tricked into once again responding to chemotherapy.
Dr. Rayson suggested administering the chemotherapy through an Infusor Infusion Pump. Rosanne will receive the same chemotherapy drugs but now when she finishes chemo at South Shore Regional Hospital (SSRH), she will take additional 5FU with her in a pump that will be attached continuously for two days. During the time the additional chemo will be released slowly.
"It's basically the same medicine, but given in a different way," said Dr. Rayson, noting the new regimen is called Folfiri. "We're hoping to sort of trick the cancer cells by giving them this infusion. It's a bigger total dose of the 5FU, but given over a prolonged period of time. And that tries to take advantage of how these cells work."
He said by extending the time that chemotherapy is in Rosanne's system, it will catch the cells at different cycles thereby increasing the effectiveness of chemo.
||X-ray technologist Anne Sifton prepares the machinery for Rosanne Himmelman's CT Scan which determined that the cancer is once again active.
"What the risk is, is when you keep going back to the same medicines, there's a possibility that the cells will become resistant. That's one of the reasons for the break, to help prevent that from happening. So cancers learn how to bypass chemotherapy. There is a risk of that happening. But we're trying to trick them by using the drugs a different way, but they're still the same medicines. That's why we're getting the CT Scan much earlier to make sure that we're not dealing with resistant cells."
Rosanne admitted she gets a little frustrated there seems to be so few new chemotherapy drugs or treatments available for metastatic colon cancer.
"You never hear about new things for colon. It's been almost two and half years for me and I'm on the same chemo that I was to begin with. There's no new breakthroughs," said Rosanne.
But Dr. Rayson said there is another option if the disease is not brought under control with the new regimen.
He said after six weeks, she will have a CT Scan to determine if the new regimen is effective. If it is not, changing one of the anti-cancer drugs to another called oxaliplatin will be his recommendation. That regimen is called Folfox. He said the drug has been in existence for five or six years but only finished its clinical trials in the past two years.
"In Canada it's being used in exactly this situation," he said. "In your case, what we certainly could see is that these cells have learned how to bypass...The different drug will trick them again if we need to."
Dr. Rayson also reassured her there are other therapies coming within the next few years. "There are more options coming down the line quickly," he said.
Rosanne's goal is to have the tumours regress to give her time until newer treatments become available.
"You have not lost all the ground," he encouraged Rosanne about what she has gained from the last rounds of chemotherapy. "My fear is that if we wait another three months, you will have. So that's why we're hopeful that a new way of delivering this stuff, hopefully we can really turn the clock back and get you back to where you were."
Dr. Rayson said ideally, he would like to see Folfiri keep the cells dormant for 18 months.
"That is ideal. When we have a change in a shorter time period of stopping chemotherapy, it's less than ideal. It tells us the cancer cells are activated again earlier than before. But absolutely there is still plenty of hope in terms of trying the same drugs in new ways and different drugs."
For the time being, Rosanne plans to surround herself with positive energy and back off a little in emotionally supporting other cancer patients while she deals with the set-back to her own health.
Oncology nurse Barb Grant told Rosanne to keep her spirits up and minimize stress in her life. She told Rosanne that she needs to focus and take care of herself right now.
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