The Politics of Cancer Drugs

Another gorgeous day with The Mountain. We’re having a lucky string of beautiful days, but it can’t be Indian summer yet (she says, fingers crossed) because we haven’t had a frost.

The happy drugs are still at work, so I feel good and managed to do this morning ALL those dastardly exercises I’m supposed to be doing every day.  I’ve been frustrated at the slow progress of regaining full arm motion and getting rid of residual numbness and pain. The surgery was back in mid-June, after all. But the physical therapist says chemotherapy slows everything down, so she thinks I’m doing fine.

The Popsicle Report:  Doesn’t matter what shade it is — light, medium or dark — green is a yucky flavor.

I passed the halfway point of chemo yesterday (yeah!) with the last infusion of the Adriamycin, and will finish off the Cytoxan this week. White cells are at 3.8, a little low, but still manageable for continuing treatment.  I should be getting a flu shot, but would like to wait till the white cells are back up into normal range.

My next lesson in chemistry comes with the drug I switch to next week — Taxol.  This drug was developed beginning in the 1960s from the bark of the Pacific yew tree (a more appealing source than the red dirt Adriamycin came from!). The original tree, Taxus brevifolia, was found in a forest north of the town of Packwood, out here in Washington, so it seems I’m in the neighborhood of its origin. But there were delays along the research road, which included fights, even in Congress, over who had fair claim to it and its trademarked name, and ecological concerns about the destruction of the trees for the sake of collecting the bark. So the drug only came into use in the late 1980s. Fortunately, alternate sources for Taxol have been developed, so the Pacific yew tree is safe once more.  Taxol is also used to treat lung, ovarian, and head/neck cancer.

The messy details of the drug’s development give some credence to the claim by pharmaceutical companies that drugs are expensive to research and produce (thus justifying their high costs), but it’s sad to see how politics and greed get in the way of important drugs reaching patients.  On the other hand, there’s the problem of drugs being released before there is sufficient follow-up data to be sure they’re safe. A recent example are the reports that are starting to surface about the Gardasil vaccine for the HPV virus. This one doesn’t affect me directly, but my daughter falls into the age group it’s being recommended for.

As with Adriamycin and Cytoxan, Taxol goes after rapidly dividing cells, so again there are the side effects of hair loss and mouth sores, along with the added possibility of neuropathy (tingling, burning and other nerve problems) in fingers and toes. The infusion will take about an hour, longer than what I’ve been having, but I don’t know if that time includes a Popsicle. There are other side effects, some of which are related not to the drug but to the solution the drug is suspended in for infusion. So along with my happy drug, dexamethasone, I’ll also have to take some Benadryl and Zantac before the infusion to prevent an allergic reaction. The nurse said she’d need to sit with me for the first 15 to 20 minutes of the first infusion to monitor for any reaction. Apparently, if it’s going to happen, it happens the first time, but not after that.  (Gee, nothing like a little heightened anxiety for making the switch.)  But she also said that, compared to the drugs I’m on now, Taxol is “a walk in the park.” Makes you wonder what kind of parks these nurses walk in.

As cancer-treating drugs go, Taxol does seem a bit safer than Adriamycin and Cytoxan, which both show up as known or probable carcinogens on the list put out by the American Cancer Society. If you want to see what else is on the list, you can find it at:  http://www.cancer.org/docroot/PED/content/PED_1_3x_Known_and_Probable_Carcinogens.asp

You’ll recognize some of the standard elements we’ve heard about: asbestos, formaldehyde, radium, and mustard gas.  But there are some surprising items listed too: betel nut, Chinese-style salted fish.  And chimney sweeps and furniture manufacturers beware — your whole profession can induce cancer.

Other cancer-fighting treatments show up on the list as well.  Tamoxifen, widely used in treating certain types of breast cancer (but not mine) is there, as is arsenic, which the infusion nurse tells me is used in minute amounts for a certain type of leukemia.  People undergoing that treatment get a small dose every day (including weekends) over the course of a year.  This idea of using cancer-inducing substances to treat cancer is a bit like the “hair of the dog” cure for a hangover. “Here, take some of what can make you sick. You’ll feel better!”  (By the way, alcohol consumption shows up on the carcinogen list too.)

Two other items that show up on the list are birth control pills and hormone replacement therapy (HRT), estrogen being the culprit behind both. If you look at lists of risk factors for breast cancer published for the general public (for example: http://www.mayoclinic.com/health/breast-cancer/DS00328/DSECTION=risk-factors), you’ll see HRT there. But the use of birth control pills is conspicuously absent from that list. So here is yet another gray area in the world of medicine and science with respect to cancer. What do we really know about the causes (because all of us with this diagnosis rack our brains trying to figure out how we got it) and why is there so much conflicting information about it?

The harder you look, the more elusive the answers.

So I comfort myself by looking at the surprising connections arising from my situation.  During a bout of warm sunny weather a few weeks back, I was basking out on the deck, head uncovered, taking care of paperwork, phone calls, etc. The hummingbirds had no interest in me this time, but the next morning I noticed my scalp was pink.  A bit of a sunburn there.  As I was describing the situation to my dad on the phone later that day, he said “Yeah, that happens to me every year.”  And in a different phone conversation, my brother admitted that he has the same problem, adding “just wait till it starts to peel.”

Never thought I’d be commiserating with my male relatives about a sunburned head.

Better Living Through Chemistry?

Happy first day of autumn.
Out here, we’ve taken a trip back into summer — gorgeous day, 80 degrees.  Last night, we refilled the hummingbird feeder, hoping to prolong the little guys’ visits. We had four this year and the kids named them: Fred, Bob (or Bobette, we’re not sure of the sex), Noodle Neck and Clementine.  So now along with begging for a cat, a rabbit, a snake, or another pet, my son also wants a hummingbird to keep.  Too bad.  He’s stuck with just a dog. Unless he wants to make pets out of the spiders. It’s spider season here.

The Popsicle Report:  Yesterday’s flavor — purple.  Not grape.  Not raspberry.  Just one of those popsicles whose flavor is its color.  Purple.

We weren’t sure what to expect with the infusion yesterday.  The cold my son brought home last week he shared first with my husband and then with me, and I’m still coughing. We weren’t sure if they could do the infusion under the circumstances, but since I haven’t been running a fever and the white cell count looked “beautiful” as the doc put it (I’m sure he meant that in the scientific not the aesthetic sense), the routine continued.  I talked with Dr. L at length about the rollercoaster pattern of the white cell count.  He said it’s not unusual during chemotherapy, and not necessarily something to worry about, unless it forces a significant delay in the schedule.

So we’ve figured that 2 shots of Neupogen a week are sufficient — 3 being an overabundance and 1 being obviously not enough.  We’re trying not to be “wasteful” (as the doc put it) with the Neupogen — given that a month’s dosing (at 3 shots a week) is $6,000.00.  (Yes, that price is right.  There’s no generic version.)  Thankfully, our insurance coverage brings our co-pay down to $25 per order. We’re not sure if I’ll still need it after the switch to Taxol in a couple weeks, so I have to call in a refill order that’s as precise as possible. The pharmacy doesn’t take back leftovers, but the doc says if we don’t use it all, he can pass the extras on to those who need but can’t afford the drug.

As I was thinking about all these drugs I’m taking, I decided to do a little research. Not into the side effects, since I was overloaded with information about those at the beginning, but into the genealogy, so to speak.

Adriamycin caught my attention primarily because of the name (Its generic name is doxorubicin; Adriamycin is the brand name).  The -mycin part gives it away as an anthracycline/antibiotic, and it’s used to treat a variety of cancers: prostate, breast, lymphoma, ovarian, and others. It works by short-circuiting the DNA of cancer cells so that they die. The drug was developed in the 1950s in Italy from soil microbes, and got its notorious cherry-popsicle color from the red soil the microbes were taken from.  The prefix Adria-, as it turns out, indicates the geographic region of Italy where the microbes were found — near the Adriatic Sea.

Now isn’t that a lovely image for a drug whose nicknames are “red devil” and “red death.”

Cytoxan, the drug I take daily in pill form (generic name: cyclophospamide), is also used to treat diseases besides cancer:  autoimmune disorders like lupus and rheumatoid arthritis, something called Minimal Change Disease (a kidney disease in children), and multiple sclerosis. It too works by stopping cell growth, and was first developed and tested in the 1950s.

Neupogen (generic: filgrastim) is the magic drug to build white blood cells, specifically neutrophils.  It’s used primarily for patients undergoing cancer treatment, but also for anyone exposed to dangerously high levels of radiation. On the box, it says the drug is a recombinant granulocyte colony stimulating factor (rG-CSF) derived from (can it be?)  E. coli. This is the first I’ve ever heard of E. coli being a useful thing.  Think of that the next time you contemplate your spinach.

My “happy drug” — the steroid I get just before the infusion — is dexamethasone (brand name: Decadron). It prevents inflammation and suppresses the immune system, and they give it to patients like me to prevent any reactions to the Adriamycin infusion and enhance the effects of the antinausea med.  But it’s used for a wide range of situations, anything from dental work to altitude sickness and even ear infections in dogs. With prolonged use, it can make you gain weight (though those shots of olive oil might be the better choice), and has a host of other nasty side-effects with long-term use. I haven’t noticed any “‘roid rage” on the minimal dose I get, but I sure can get grouchy a couple days after the infusion as the drug flushes out of my system. A friend of mine said that, if she had only 6 months to live, this would be the drug she’d take because of its mood-enhancing effects.

The one other drug I take (besides the Ativan at night for sleep) is Zofran (generic: ondansetron). It’s strictly an anti-emetic, meaning it prevents vomiting, and is a fairly new drug, being patented in the 1980s and FDA-approved in the ’90s.  The first generic appeared in 2006 (which maybe explains why I’ve taken 3 different versions of this drug — one round and yellow, one oblong and white, and the flavor-coated, fast-dissolving one they give me before the infusion). Other, off-label uses include treating schizophrenia, sleep apnea, Parkinson’s disease, addiction to opium, and alcoholism.

With all these drugs and the supplements the naturopath suggested (probiotic, fish oil, CoQ10), I rather wonder how much of my blood is really blood. Advertisers did once promise us “better living through chemistry.”  I wonder if this is what they had in mind.