The Chemo – Cycle 2 Begins

Day 1 of cycle 2 is complete, and I’m feeling good! I know that the chemo is going to hit me harder this week since I go in every day Monday through Friday. By tomorrow night I will probably be napping in my ugly ass amazing recliner!

I wanted to fill you in on my chemotherapy regimen and give you a little bit more info and what my treatment is like. My oncologist prescribed three cycles of BEP chemo, where each cycle is three weeks, or 21 days. BEP is short for Bleomycin, Etoposide, and platinum, or as it is commonly referred to now, Cisplatin. These three drugs in combination are HIGHLY EFFECTIVE at curing testicular cancer. BEP chemo in combination with the surgery I might need afterwards has a 95% CURE RATE. That’s the highest cure rate of any type of cancer. Pro tip: if you have to get cancer, choose testicular cancer, it’s the best. Sorry ladies!

Three chemo drugs in total on a 21 day cycle. The infusion schedule based on the day of the cycle for these drugs is as follows:

• Days 1 through 5: Cisplatin and Etopiside (Monday through Friday every day during the first week of my cycle)
• Days 2, 9, and 16: Bleomycin. On day 2 Bleomycin is an additional infusion along with the Cisplatin and Etopiside.

I just completed the first cycle yesterday, Sunday March 31st, and today, April 1st, I started cycle two. Today was cycle 2, day 1 so it was only Cisplatin and Etopiside and the side effects haven’t quite kicked in yet, hence why I feel so good.

So how do these chemo drugs kill cancer you might ask? Great question!

Basically, Cisplatin – a chemical composed of platinum, ammonia, and chlorine – is the heavy hitter in my treatment. Cisplatin works by interfering with DNA replication, which effectively kills any and all fast growing cells in your body. Obviously that includes cancer cells, since they grow fast, but also includes things like hair, white blood cells, stomach lining, the outer layer of skin, and taste buds. Hence, many of the worst side effects of this drug. Also, Cisplatin has the potential to damage the kidney.

Fun fact about Cisplatin: the use of this drug to treat testicular cancer was pioneered in the early 1970’s by Dr. Lawrence Einhorn, a researcher at INDIANA UNIVERSITY!!! BOO, IU SUCKS! Note for those who didn’t know me in my Purdue days: Purdue and IU are bitter rivals and generally dislike or hate each other. Purdue hates IU so much they chant “IU SUCKS!” at home football games, regardless of the opponent. This past season though, for Tyler Trent, they changed the chant to “CANCER SUCKS!” I like to think they were chanting for me even though I didn’t know I had cancer yet, haha.

Before Dr. Einhorn started using Cisplatin to treat testicular cancer, the overall survival rate was only 5%!!! An article on the IU website summarizes his groundbreaking achievements and contributions to cancer research:

” Dr. Einhorn minimized the extremely toxic side effects of treatment; shortened the duration of two years of therapy to nine to 12 weeks; and established a model for a curable tumor, which has served as a research roadmap for generations of oncologists.”

Marking a Milestone: Dr. Einhorn discovered testicular cancer cure 40 years ago”, https://cancer.iu.edu/news-publications/Einhorn.shtml

Anyways, Dr. Einhorn was the dude that discovered that Cisplatin works really well when treating testicular cancer and I am ETERNALLY GRATEFUL for his discovery despite the fact that he is (still) at IU. That means 50 years ago this cancer would have probably ended up killing me. Thanks IU! Just so you know, I will probably still chant “IU SUCKS!” when Purdue plays them but I will try to be nicer now.

Ok, moving on. The second drug, Etoposide – a partially synthetic drug made from the mandrake tree rhizome – is more complicated, but basically screws with the DNA sequencing of cancer cells. I’ll just quote wikepedia because it summarizes how Etoposide works better than I could:

“Etoposide forms a ternary complex with DNA and the topoisomerase II enzyme (which aids in DNA unwinding), prevents re-ligation of the DNA strands, and by doing so causes DNA strands to break.^[8] Cancer cells rely on this enzyme more than healthy cells, since they divide more rapidly. Therefore, this causes errors in DNA synthesis and promotes apoptosis of the cancer cell.”

“Etoposide”, Wikipedia, https://en.wikipedia.org/wiki/Etoposide

Yeah, more cool science bro, it’s saving my life here.

Finally, the third drug, Bleomycin, is some really crazy stuff. It’s a “nonribosomal peptide,” which is essentially a chain of amino acids that are produced by bacteria and fungi. Researchers don’t fully know how this drug works, but it basically causes cancer cells to split, then the Cisplatin and Etoposide attack and kills these cells. I’m not gonna quote wikipedia here because the article is too intense. You can read it if you’re interested though.

The side effects of Bleomycin are different than the last two drugs. Bleomycin is the drug that gave me a fever during week 2 and sent me to the ER. It also causes scar tissue to form in the lungs that might make breathing difficult and potentially cuase long term lung damage. The Oncologist is closely monitoring my lungs to hopefully make sure this doesn’t happen. So far I havent’ had any issues with my lungs from the Bleomycin. I read tonight that Bleomycin causes a long term increase in toxicity to Oxygen, so I will need to tell that to any doctor if have surgery and need general anesthesia. It also means I probably shouldn’t ever scuba dive again. Bit of a bummer but I’m not a huge scuba diver.

That’s the summary of my chemo drugs and how they work. All of these drugs are given intravenously, which means I have to get an IV every day I have an infusion, or try to keep the IV from the previous day (or days) overnight. I HATE getting the IV. It’s probably the worst part for me. One nurse had to poke me three times on the third day of cycle one and then my arm was all bruised up. Ugh. But keeping the IV overnight presents a different challenge: I can’t get it wet, so showering is problematic. I ended buying some arm cast bags today on amazon so I can try and shower and keep my IV dry.

The benefit of the IV though, is that they give you the chemo drug slowly over the course of an hour so it doesn’t all immediately hit your bloodstream. If taken orally, the 45mg of Cisplatin I get every day would likely cause me to barf my guts as soon as I digest it and it enters my blood. So that’s the benefit of the intravenous infusion. I have to sit there all day but side effects are minimized.

I also get an extensive cocktail of drugs to manage the side effects: kytrol, steriods, and amend. These are given intravenously prior to the first chemo drug (usally Cisplatin). Additionally, because Cisplatin can mess up my kidney, they give me a full liter of intravenous hydration (basically saline solution) at the beginning and end of each infusion on days 1 through 5. On these days my schedule at the infusion center will typically look something like this:

1. Arrive at the infusion center, check in, and wait (depending on how busy it is).
2. Take my vitals: blood pressure, temperature, oxygen level, weight.
3. Get called back to the infusion center, start an IV if I don’t already have one.
4. One liter of intravenous hydration over the course of an hour.
5. Pre-meds (the three drug mix above for side effects above) for half an hour.
6. Cisplatin, typically 45mg dissolved in a liter of saline, for one hour.
7. Etoposide, weight based, somewhere around 1mg per pound of body weight, dissolved in a liter of saline, for one hour.
8. Bleomycin (days 2, 9, and 16 only), for 15 minutes or so. I don’t remember the dosage. I also get tylenol to help counteract fever and also Zyrtec for some side effect, not sure what that is, ha.

BOOM, that’s it folks! Today the above treatment (no Bleomycin today) took just under 5 and half hours. In addtion to the standard treatment above, I had to get blood drawn to make sure I was healthy enough to start cycle 2 and also visit the Oncologist to check in on me and make sure everything is ok. Turns out everything was fine so I started cycle 2! The blood draw people were running behind by an hour, which pushed everything else back today. My infusion ended at around 7:20pm and we got home just in time to see Elliot before his bedtime.

Even though today was a long day and ran late it was a really good day, much better than day 1 of cycle 1 where I was emotional wreck. Now I know what to expect so it was easier mentally and emotionally. I felt great and full of energy all day so I got some stuff done (still writing this blog post as of 11:50pm!), but better yet I had VISITORS! Five of my co-workers drove half an hour from the office to see me! Peter, Jon, James, and Scott stopped by for an hour and a half to chat, see what my typical day at the infusion center is like, and lift my spirits. It was a great visit. I’ve gotten nothing but love and support from my company during this time, they are really taking care of me well! I’m thankful I have a good job and work for a company that’s supportive and just wants me to get healthy.

My good friend Philip also came by infusion center later to hang out, shoot the breeze, and give me crap. That’s how Philip loves on me, by teasing me. I have other friends who do this as well. YOU KNOW WHO YOU ARE. It was also great visit with Philip and I was glad he got to come by and experience my new normal.

Anyway, I’m up to over 1700 words now on this blog post. Kudos to you if you’re still reading! I’ll post another update soon with details on my brother and sister’s trips and some fun photos with them. Until then stay tuned!

-B