Q. I’m having TCH chemotherapy for breast cancer. What is it?
A. The chemotherapy drugs Paclitaxel (Taxol) or docetaxel (Taxotere) and carboplatin, paired with a biologic therapy, Herceptin, comprise the most common treatment for women with HER2-neu-positive (HER2+) breast cancer.
Q. Can we backtrack a minute? I know I’m HER2+, but what does that mean, anyway?
A. Cells do three things: they grow, they rest, and they repair themselves. Genes inside the chromosomes in your cells regulate their activity, telling them when to grow, and when to stop growing and rest. If the genes malfunction, the patterns of growth/rest/repair are disrupted.
In HER2+ breast cancer, there’s an excess of HER2 genes in the chromosomes of some of your cells. These genes tell the cells to grow extra protein receptors on their surface. With these extra receptors, the cells keep getting signals to grow, rather than to rest or repair. They grow much faster than the cells around them; this wild, uncontrolled growth turns them into cancer cells.
Q. So, what do all these drugs do?
Taxol/Taxotere slows or stops cell division, or keeps enzymes from making the proteins cells need in order to grow. Thus it slows down (and hopefully stops) cancer cells’ out of control growth.
Carboplatin, a so-called alkylating agent (and similar to the very common chemo drug Cytoxan, if you know anyone else who’s had chemo) stops cancer cells from replicating by sticking to their DNA. Basically, it gums up the works; which is a good thing, where cancer is concerned.
Herceptin (trastuzumab) is a bit different. Called a targeted therapy (or immune targeted therapy), it manufactures antibodies that “target” specific properties of cancer cells: their production of protein, their use of enzymes, or their ability to form new blood vessels to support growth. These antibodies leave healthy cells alone, which is a plus.
Herceptin attaches itself to a cancer cell’s protein receptors, effectively blocking the “grow” message. Herceptin can also signal your body’s immune system to destroy the cell to which it’s attached itself – so it packs a double punch.
Q. So, how do I take these drugs? They’re intravenous, right?
A. That’s right; they’re given by what’s called “infusion” (which is why you might see your hospital’s chemotherapy area called an “infusion suite” or “infusion room”).
Delivery methods and schedules vary, as the pharmacology is constantly changing. That said, you'll probably have a total of four to six treatments of Taxol/Taxotere and carboplatin, delivered at three-week intervals; though recently, some oncologists have changed the regimen to lower doses, delivered weekly.
The usual procedure is a slow infusion of Taxol/Taxotere by IV into your hand or arm, which takes about 3 hours; followed by about 30 minutes of carboplatin, delivered the same way.
Why does it take so long to administer the Taxol/Taxotere? Because you’re much more likely to experience an allergic reaction to it, than to carboplatin; and the slower the infusion, the less likely a bad reaction.
If you have trouble with your veins (i.e., blood drawing is a challenge), you’ll probably be offered the option of a port: a line inserted into a vein, usually in the collarbone area, which remains in place for the duration of treatment. When you’re not actively receiving drugs, the port is capped; it’s inconspicuous under your clothing.
And what about Herceptin? Oncologists used to wait until TC was done before starting Herceptin. But these days, it’s fairly common to administer all three at once.
Herceptin is given intravenously, like the other drugs. The first injection takes about 90 minutes; after that, injections take about 30 minutes each. The usual course of treatment is 1 year; either weekly, or a higher dose administered every 3 weeks.
When you’re planning your chemo schedule, add the ride to and from the hospital, the blood tests before (to make sure your white cells are up to snuff), and the inevitable waiting around, and you're looking at the better part of a day each time. Bring stuff to distract or amuse yourself: books, a mobile device, a friend or family member. You don't want to just sit around and twiddle your thumbs the whole time.
Q. Might as well ask about side effects…
A. The news you hate to hear… but need to know.
•Nausea and vomiting: These can occur – CAN occur – within about 24 hours after treatment, but they aren't nearly as prevalent a side effect as they are with other chemo regimens. You may be given medication to take directly after your treatment, and this should reduce any nausea to general queasiness, if not eliminate it completely. You may be one of the unfortunate women who gets sick anyway, but take heart; you should start feeling better after a few days.
•Hair loss: You’ll probably lose some or all of your hair. Again, this isn’t a given; some women describe their hair simply becoming thin/brittle, while others lose it all.
Hair loss will probably happen two to four weeks after your first injection. Prepare by deciding on a wig, head gear, or if you're simply going to ”go naked.” It also helps to cut your hair short before it falls out. Somehow, going from short hair to no hair is easier than long hair to bald.
•Increased risk of infection: You'll be losing white blood cells; the drugs will destroy some of them, along with the cancer cells. You’ll get a blood test before each infusion to make sure your white blood cells aren't TOO depleted, putting you at too great a risk of infection. You may also receive an injection of Neulasta, a drug that helps keep your white blood cells healthy, a day after your chemo infusion.
What can you do about this increased risk of infection? The usual things you do all winter to prevent a cold: avoid crowds, wash your hands often, stay away from people who are sick. Remember, an infection you get now will be more serious than a cold, so use your common sense. Don't put yourself at unnecessary risk.
•Sores in your mouth, on your lips, or in your throat: Imagine cold sores inside your mouth – OUCH! These may crop up within a few days of treatment. Try to prevent them by chewing on ice chips during the first five minutes or so of your injection; this works for some women.
Avoid spicy foods, or anything that might irritate your mouth – including strong mouthwash. If you do get these sores, don't figure you have to just live with them; ask for some medication. It's best to try to knock them out before they get a good foothold (or mouth-hold, as it were).
•Fatigue: As you advance through chemo, you'll probably find yourself feeling more and more tired. This fatigue can range from mild (increased difficulty climbing stairs) to major (staying in bed all day).
Try some gentle exercise, no matter how bad you feel; even walking helps. And eat enough to keep your strength up. Not eating and not exercising make you feel tired even when you're not undergoing chemo, so going hungry and being inactive exacerbate chemo's fatigue even more.
•Joint pain: You may have pretty significant bone/joint pain that (hopefully) lasts just a couple of days, but may stretch beyond that. Ibuprofen, taken at fairly high doses, usually helps with this. Ask your doctor how much to take.
•Nail issues: You may lose some of your fingernails and toenails; or they may darken, and/or become loose. Some chemo nurses recommend applying nail hardener, in an attempt to keep your nails intact; ask your nurse what s/he recommends.
•Tingling: You may have tingling in your hands and feet (peripheral neuropathy). Not much you can do about that; it's annoying, and can affect your balance if it's in your feet (since it feels like your feet are asleep); but it should (hopefully) go away once you're done.
•Cardiac issues: Herceptin may affect the ability of your heart to pump blood; up to 7% of women taking Herceptin experience anything from mild heart failure up to stroke and life-threatening congestive heart failure.
Thankfully, this heart failure is usually reversible. Your doctor will make sure you have an echocardiogram or other heart test before starting Herceptin; if for some reason s/he doesn't, make sure to ask about it.
This all seems daunting, doesn’t it? Luckily, it’s extremely unlikely you’ll suffer all of the side effects mentioned above. But whatever you do experience, if it irritates you, be sure to ask your doctor for something to treat it. Don’t suffer in silence, or keep a stiff upper lip. Speak up – your medical team wants to help you, but they won’t know you need help unless you tell them. Good luck to you.