Plan D

When you get MBC, you are given a package with an unknown number of plans inside.  There’s a limit to the number of plans available to those of us with MBC.  I don’t know how many there are in my package, but for now, we are on to Plan D.  The CT scan showed the increased pleural effusion, which we knew from the x-ray.  It also showed that I have 2 lesions in my liver.  They aren’t big, 1ish and 2ish centimeters, but they are new.  I was kinda bummed at that news.  That basically means that the cancer has invaded the four main areas:  bone, brain, lung, liver.  Alas.  The bone scan impression said:  elevated uptake in the bones could be from a healing response or from persistent metastatic disease.  Real helpful, right?  “Ma’am, either you are dying, or you’re healthy.”  We are hoping that this ambiguity will satisfy the insurance company’s requirement that “previous pictures were unclear in their results”, and then maybe they’ll approve the PET scan.  In the meantime, though, we know new stuff is going on an my doc was like “I’m not waiting for the insurance company to get their act together.  We need to start treatment right away!”

Plan D is chemotherapy (Taxol) and immunotherapy (Keytruda).  The chemo kills the cells at any point in the growth cycle, which is why I’m going to lose my hair again, probably have some mild stomach issues – although nothing like the previous chemo – and possibly a few other mild side effects.  This chemo is weekly, and I’m told it’s a very easy chemo to deal with.  So far, so good.  The immunotherapy works differently, but I’m not sure I totally understand how it works.  It only kills cells at a particular part in the cycle, so it’s not toxic, but somehow it teaches your body to kill the cancer cells.  Yeah, I have no idea how that works.  The “I’ve just been diagnosed with cancer” me would have gone out and done research.  The “I’ve had MBC for 18 months” me has no intention of doing research =)  I’m just taking the medical professionals’ word for it!

So Plan D was put into place on Monday.  I was at the cancer center the. entire. day.  Seriously.  I walked in at 7:15am to get my blood drawn (my blood draw from Friday showed low Hgb, which explains why I basically slept the whole weekend), had an appt with the doc at 7:45, then went back to chemo at 8:15.  There’s a fair amount of hurry up and wait with chemo infusions.  For example, they gave me Benadryl, which took 15 minutes, but then they had to wait like 45 minutes for it to really soak in to the tissues before they could give me the next med.  Rinse and repeat, and we finally got the chemo going.  The chemo itself took about an hour to infuse.  The immunotherapy only took about 20 minutes.  Once all of that was done, I had to get a unit of blood (remember the low Hgb values?)  I walked out of the cancer center at 4:15!  Next week won’t be as long because I hopefully won’t need another blood transfusion, and I won’t be getting the immunotherapy, as it’s every 21 days.  I just can’t be spending an entire day at the cancer center once a week!  That’s too much!

The one thing about Plan D that is interesting is that we are now working off label, in experimental land.  The immunotherapy has not been approved for breast cancer nor have any studies been done on it’s use.  It IS approved for lots of other cancers, just not breast cancer.  Combining chemo and immunotherapy also hasn’t been studied in this combination for breast cancer.  There are other studies that have shown that adding immunotherapy to chemotherapy has made both more effective, so we are extrapolating that out to breast cancer.  I’m kinda pleased that the oncologist is willing to go off the beaten path and to try new things.

Let’s pray that Plan D will be the long-term plan.  Plan C actually worked quite well.  The problem with that plan is that it had a finite life span, and as soon as I reached the end of it’s life span and spent 2 months without treatment, the cancer went bonkers again.  So continual treatment is the name of the game for me.  So Plan D, let’s get it!