I have received my pre-chemo and chemo support drugs. Between these drugs and the drugs I received during diagnosis I have a pretty nice pharmacy at home. ;)
As mentioned in my last post I was given Prednisone and Cyclophosphamide (100mg each per day for several days) to ease the inflammation and symptoms of HL. These have done a magnificent job. Within two days of starting the drugs the lymphadenopathy in my neck has reduced greatly and I am no longer suffering from fatigue, night sweats or fevers.
The only side effect I have noticed thus far (I am on day six of seven) is an insatiable appetite (common side effect of corticosteroids, in this case Prednisone). From three to four days after starting the Prednisone I have been unable to satiate my appetite no matter how much I eat or how full my stomach is. No matter what, I always feel like eating. Yesterday, after eating far too much food during the day, I went to Players Chop House for dinner. Apparently the largest prime rib on menu, the 16oz Player size, was not big enough for me. I ordered the “Texas Player Size” (I named it that after telling the waitress I was from Texas).
The meal was so large that every server in the restaurant came by to examine my progress and note their amazement. I ate the entire plate of food, plus half a dish of additional mushrooms, plus half of a dessert. I also drank two beers. This is after eating a considerable amount during the day leading up to the event.
My chemo protocol will consist of three support drugs and the ABVD chemo regimen.
Chemo Regimen:
Adriamycin - Comes from a fungus which is found in soil. It works by stopping DNA replication. It is also known as Doxorubicin or The Red Devil due to its colour. Side effects of Adriamycin include: nausea, vomiting, heart arrhythmias, neutropenia (decrease in while blood cells) and alopecia (hair loss). Once dosing reaches 550 mg/m2, Adriamycin can be cardiotoxic.
Bleomycin - Also from a soil fungus. This one acts by breaking up DNA. The most serious side effect of Bleomycin is pulmonary fibrosis (hardening of the lungs) leading to permanent lung impairment. This should be avoidable by monitoring pulmonary function and correct dosing. Other side effects include: fever, rash dermatographism, hyperpigmentation, alopecia and Raynaud’s phenomenon (discoloration of the fingers and toes).
Vinblastine - Interferes with cell mitosis (mitosis is half of the process of cell division). It is a vinca alkaloid similar to Vincristine but with fewer side effects. It comes from a Periwinkle plant native to Madagascar. Common side effects of Vinblastine: bone pain, constipation, depression, diarrhea, general body discomfort, headache, jaw pain, loss of appetite, nausea, stomach pain, and vomiting.
Dacarbazine - Breaks up DNA and RNA and prevents their synthesis. Dacarbaize can be painful when given intravenously. Often it is diluted with saline to ease the pain. If the needle is not in the vein correctly it can also cause muscle/nerve damage. This should not be an issue for me as I will receive my drugs via a port. Side effects of Dacarbazine: possible permanent sterility (mitigated through prior deposits), immune suppression, nausea, headache and fatigue.
The combination of drugs increases the likelihood of developing Acute Myleoid Leukemia 5-7 years after treatment. Short term or permanent peripheral neuropathy (numbing of the fingers/toes) is also a risk with the regimen.
Support Drugs:
Ondansetron (pre-chemo) – Is used mainly and an antiemetic to treat nausea and vomiting from chemotherapy. It has little effect on vomiting and nausea caused by motion sickness. Ondansetron is a well-tolerated drug with few side effects. Constipation, dizziness and headache are the most commonly reported side effects associated with its use.
Dexamethasone (pre-chemo and two days following) – Is a strong corticosteroid 4-5x more powerful than Prednisone. It is anti-inflammatory and immunosuppressant. Its primary use for me will be to augment the effects of Ondansetron. Apparently Dex is popular among Bangladeshi prostitutes because it helps them gain fat easily, which is attractive in the poor country. Most common side effects: weight gain due to increased appetite, immunosuppression, psychiatric disturbances, including personality changes, irritability, euphoria, and mania. Withdrawal is common issue with Dex.
Metoclopramide (As needed) - Is an antiemetic and gastroprokinetic agent (it enhances gastrointestinal motility). Common side effects include: restlessness, drowsiness, dizziness, lassitude, and/or dystonia.
I have discussed switching the Dexamethasone with Aprepitant. My Oncologist would like to wait until we see how infusion 1A goes before deciding to switch, as Dex is the standard given by the BCCA. Aprepitant has far fewer side effects than Dex but is very expensive; however, given my medical coverage this will likely not be an issue.
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