I work at Facebook as a Program Manager for Global Marketing. Currently I’m on medical leave from work and I’m focusing 100% of my efforts on treatment and conserving my energy, but well… I miss work! You can take the girl out of project management, but you cannot take the project manager out of the girl, and so even for my treatment I have a project plan and a Gantt chart. Below you can read more about my chemotherapy treatment plan.

The Treatment Plan

My treatment plan consists of two regimens:

Regimen 1: Taxol + Herceptin + Perjeta (THP)

For the first 12 weeks of treatment, starting from September 3, I will be receiving THP.

Taxol is the chemotherapy drug, which I receive every week. Herceptin and Perjeta are targeted immunotherapy drugs aimed at battling my specific subtype of breast cancer, which is HER2 positive.

I receive Herceptin + Perjeta every three weeks during Regimen 1, and will then continue with these two drugs in the last stage of my treatment (post surgery and radiation). Herceptin and Perjeta are awesome inventions. The drug combo has only been available for a few years and they are quite literally lifesavers for people with my type of cancer. I will write a separate post about them, because they are so amazing they deserve to have their own space (also they are technically not chemo, and this post is all about that).

Regimen 2: Adriamycin + Cyclophosphamide (AC)

Starting from November 26 (my birthday!!), I will switch to the second chemo regimen: AC. I will most likely be receiving it every two weeks on Fridays, but this is still TBD depending on how I continue responding to the first regimen.

The Drugs and How They Work

✨MAGIC SCIENCE ✨

Caveat that I am not a doctor or a scientist, this is just what I’ve learned so far since becoming a cancer patient.

The science behind chemotherapy is actually super interesting. There are different types of chemotherapy drugs, each one does something slightly different, and the type of drug is chosen by the doctors depending on type of cancer, the patient’s resilience and desired outcomes of the treatment. I’ll just talk about the ones in my regimens.

Taxol (non-brand name: paclitaxel)

This drug works by interfering with the cell division process of cancer cells (known as mitosis). Cancer cells replicate uncontrollable, because they have mutated to not die like regular cells.

Each cancer cell goes through the mitosis cycle at its own rate. At any given point in time, some proportion of the cancer cells will be preparing for cell replication and division by duplicating their DNA and creating a tiny construction site in the cell called a mitotic spindle, to pull apart the newly duplicated copies of DNA. The mitotic spindles are made of a material called microtubules.

Taxol works by specifically damaging the microtubules in rapidly dividing cells and so the cells cannot complete their division and end up dying.

Taxol is cell-cycle specific, which means it only kills the cells that are about to go into mitosis. I am receiving weekly rounds of paclitaxel, so the assumption is that during the 12 weeks of the first drug regimen, all of the cancer cells in my body will be going through mitosis at some point, and will be killed off.

AC

AC is one of the strongest, most effective chemo drug combos ever invented. It’s been around since the 1970s and is still to this day widely used to treat breast cancer and other types of cancer as well. It’s so strong that it has plenty of unpleasant side effects. The pet name for AC is “the Red Devil” because of the colour of the drug adriamycin. This is the “stereotypical” scary chemo you mostly see in movies.

Adriamycin is non-cell cycle specific which means it whacks at all the cancer cells at the same time, regardless of where they are in the mitotic cycle. It works specifically by inserting extra molecules in between the base pairs that make up the DNA ladder. As a result, the DNA strand in a cancer cell becomes wobbly, distorted and broken, and it cannot become replicated. No replication = cell death.

Cyclophosphamide is another cell-cycle specific drug, but this one works during the resting stage of mitosis (i.e. not during replication). It works by creating extra “cross-links”, kind of like bridges, between strings of DNA in the cancer cells. This also causes the DNA ladder to become distorted and broken, disabling further replication and leading to cell death.

How Does the Chemo Make the Tumours Shrink?

The end result of all of the drugs I am receiving is the same: the cancer cells cannot replicate which means two things: (1) the tumour stops growing, (2) it starts shrinking too.

This is because:

(1) Not being able to replicate means the original cancer cell does not create two new ones in its place. Result: the tumour growth is stopped.

(2) Not being able to replicate forces the cell to die. Regular healthy cells have cell death programmed into their life cycle, which means they will die whether or not they can replicate. Cancer cells do not die. That’s what makes the little fuckers so dangerous. They are quite literally immortal. The only thing that can make them die is if they are not able to replicate. Result: a portion of the cells in the tumour dies, making the tumour shrink (and in an ideal world, eventually disappear).

What About the Side Effects?

Great question!

Most early stage breast cancers do not really hurt or cause any major side effects in the body (apart from the obvious existence of the tumour). What is really damaging to our health and wellbeing as cancer patients is the treatment, including chemo. Chemo is really tough on the body, because it impacts all rapidly dividing cells. That includes cancer cells, which saves our lives, but it also includes the healthy cells in our bodies that happen to be rapidly diving, e.g. the stomach lining, bone marrow, hair follicles and others.

And hence the side effects.

Everybody experiences chemo differently, but some common side effects which will affect most people undergoing the treatment are these:

• Fatigue, i.e. a sense of tiredness and exhaustion that does not go away with resting and sleeping.

• Hair loss. This is because chemo targets the hair follicles.

• Nausea, feeling and / or being sick.

• Reduced white blood cell count, which leads to a suppressed immune system and a higher risk of infection.

• Reduced red blood cell count, which leads to anaemia and exacerbates the fatigue and tiredness.

• Changes to bowel movements, either diarrhoea or constipation, or both at the same time.

• Menopause and infertility (sometimes temporary, sometimes for good).

• Muscle, bone and joint pains.

Most people will not experience all side effects at the same time, or even throughout their entire treatment plan.

I’ve been very fortunate so far. Eight weeks into chemo, my side effects are primarily around feeling tired all the time and just a bit of muscle pain, which doesn’t feel any different to post-exercise aches. My blood results have kept at very healthy levels so far, my hair is still mostly sticking to my scalp and I am able to function relatively normally on a daily basis, although I am struggling with managing my energy and pacing myself to not burn out two hours after waking up in the morning. Effects however have been cumulative, and since I’m only halfway there, I do anticipate the experience to get a bit worse with time.