Visit with oncologist & treatment plan

Thanks for your patience in getting this update. Our appointment yesterday went for over three hours and we felt pretty overwhelmed by the time we got home, and the kids needed us.

We talked with the oncologist for about 45 minutes, then with a patient navigator and a nurse navigator discussing all the ramifications of the treatment plan that the doctor suggested. Dr. Curley wants to begin chemotherapy next Friday (May 29th) and it will continue for about six months. Before then, I will need to get a port put in, through which the chemotherapy will be administered. The port is put in just under the skin and will require a minor outpatient surgery to complete. We are trying to schedule this for Wednesday or Thursday. I will also need to get an echocardiogram done because some of the meds can have side effects on the heart, and I will need to do a ton of bloodwork. Because Monday is a holiday I will need to get everything done between Tuesday and Thursday.

Dr. Curley said because I have triple-negative breast cancer with a tumor that is greater than two centimeters (mine is over six cm) he recommends doing six months of chemotherapy first without any breaks, followed by surgery four weeks after completing chemo and then radiation after that. The type of breast cancer I have is inherently more aggressive, cells divide more haphazardly and more erratically. As the cells divide quickly, they open up their DNA and expose themselves to the chemotherapy, which is why he wants to be very aggressive with the treatment. He wants to hit the cancer whenever it makes itself vulnerable. Dr. Curley’s goal is to completely eradicate all cancer cells by the end of my six-month chemo. His treatment plan includes:

First 12 weeks:

• Carboplatin (every 3 weeks)
• Taxol (every week)
• Pembrolizumab (every 3 weeks)

Second 12-week cycle:

• Doxorubicin (every 3 weeks)
• Cytoxan (every 3 weeks)
• Pembrolizumab (every 3 weeks)

There will be a four-week break and then we will do surgery of some kind. Depending on how well I respond to the chemotherapy, I may be a candidate for a lumpectomy vs a mastectomy, but we will have to discuss later. Genetic testing will also be a factor in looking at the surgical options. If my genetic tests back with BRCA 1 or 2 genes the surgeon would probably recommend a mastectomy to prevent reoccurrence.

Pembrolizumab is a new drug available since the end of February this year. It is an immunotherapy drug that stimulates the immune system to help fight the cancer by “decloaking” the cancer cells and making them visible to the body's own immune system so it can fight them. Dr. Curley is the first one in his group using this drug since a study and drug were released in February, which show really positive results in early triple-negative breast cancer patients. He has one other patient who started with the immunotherapy several months ago and is doing very well with it. I will continue with the Pembrolizumab for a few cycles after surgery as well and some radiation treatments that we are still learning about.

We spent a lot of our time talking about side effects from the medication with David, the nurse navigator. I will lose all my hair probably within 2-3 weeks of the start of chemotherapy and it won’t begin to grow back until after surgery. They made us aware of boutiques where I can get a wig, but for now I don’t plan on using one due to the temperatures of the summer. Wigs can be very hot, so I anticipate maybe just wearing a cap of some kind or scarf after I have to shave my head. Other side effects will be fatigue and nausea, and I will need to watch for signs of neuropathy and anemia, which may require a blood transfusion. We talked with the kids this morning about beginning chemotherapy next week and we are still trying to assess the needs of our family. When I asked the doctor about when he typically saw the greatest need for help from family and friends, he said that it all depends on how I react but certain it would be immediately after surgery.

I will need to be careful about the number of people coming in and out of the home as my immune system will be compromised. While I am receiving the chemo treatments at the clinic, I will not be allowed to have anyone with me because of COVID-19. In the past, they have allowed one person to go with the patient and hopefully that will change in the next few months.

If, after reading this update, you feel like we did after our marathon appointment and want to clarify or ask anything, please feel free to comment on the blog and we can try to respond as we are able.

We love you and expect these next few weeks and months to be very challenging. If you would please keep us in your prayers, we know that will make all the difference.