I Can't Thank You Enough

So it appears I really DID run out of words for a bit.

I've calmed down a little, but then I have moments -- frequent, frequent moments -- where I am not okay all over again. My grief and fear come out in irritability, anxiety, and more goddammits than I'd like to admit. I find myself out of patience more often than not, short with Chris (or worse, Quinn) more than I'd like, and then hard on myself for how shitty these episodes make me feel.

This weekend, Chris was out of town and our new puppy peed on the kitchen floor approximately 45 paper towels' worth of times and Quinn might be going through a growth spurt because he wants to eat all of the things all of the time. And -- oh, man -- his whininess. And my grouchiness. And and and.

Our cat is on Prozac, and this weekend, I thought of borrowing a couple of his pills for myself. (I'm joking. Kind of.)

Last night, Quinn needed help brushing his teeth, and called for me. I was moving the dog's crate into my bedroom and didn't respond immediately. My hands were full. Quinn got cranky and snapped at me a couple of seconds later, a full-on yell with a little bit of desperation in his voice: "MOM, I SAID I NEEDED HELP!!" I was already on my way to his bathroom door, showed up a second later, and asked him to remember his patience. "I'm doing the best I can, buddy."

But am I really? I yelled approximately eighteen times yesterday, exhausted and at the end of my rope and just over it.

Quinn is my mirror. These are my faults reflected back at me. Sometimes I really don't like what I see.

My resolution for 2016? Work on my patience. Breathe more. Be mindful in my relationships at home. See less of "mean mommy," who is angry and scared and prone to swearing in front of her 4-year-old, sometimes about dog pee, which is really not his fault in the slightest.

***

On the drive to my oncologist's office this morning, I listened to Diane Rehm interview Carly Simon about her memoir Boys in the Trees. Simon was talking about a song she co-wrote with her son after an argument between them in which he'd said something quite hurtful. He'd immediately followed her upstairs to apologize. She was crying, and sat down with her guitar to come up with the first verse of "I Can't Thank You Enough." When she sang it to him, he asked if he could help write the rest of it.

So of course I was a blubbering idiot driving to my doctor's office (where I'm now sitting getting my thrice-weekly infusion of Kadcyla). But this came exactly when I needed it, and might be the song I request to dance with Quinn at his wedding. In the meantime, I'll listen to it when I need a reminder to be more careful with my words...or a good cry.

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To all of my friends and family who've stepped in the last couple of weeks, the last few years to help me out and entertain my son and feed our family (sometimes all three things at once), I'm not sure I say it often enough: from the bottom of my heart, thank you. You are exactly why our family has been able to make this chemo thing work while also raising a baby/toddler/preschooler and having a spouse who routinely travels for weeks at a time for work.

Yesterday was a chemo day for me, but also a holiday, which meant Quinn's school was closed. And it's one of those times that Chris is out of town while I need my infusion. I didn't exactly know how I was going to pull it off, and came close to rescheduling my appointment til later in the week. But it turns out I just had to ask. My friend Julee could step in to take Quinn for a few hours. "No problem!" she said. Quinn could play with her son, one of Quinn's best friends, while I went to my infusion center and received treatment.

Then, in the afternoon, Quinn's friend Sydney's dad brought her over for a playdate that relieved me of my obligation to sit hunched over on our hardwood floor, crashing cars with my boy. They even brought popsicles! Sorry, rest of the country where you currently feel like a popsicle.

Thank you, friends, for keeping me afloat.

Again, I've been a little remiss in posting this little series, but that's what single parenting has done to me. But hey, our laundry is folded and our teeth are brushed and I even sent my manuscript to my agent last week. So some things are getting accomplished.

To Wit: The FDA Approves Another Treatment for Metastatic Breast Cancer

"The drug’s efficacy was demonstrated in 165 postmenopausal women with ER-positive, HER2-negative advanced breast cancer who had not received previous treatment for advanced disease. Clinical study participants were randomly assigned to receive Ibrance in combination with letrozole or letrozole alone. Participants treated with Ibrance plus letrozole lived about 20.2 months without their disease progressing (progression-free survival), compared to about 10.2 months seen in participants receiving only letrozole. Information on overall survival is not available at this time."

And the Mayo Clinic is Planning Trials on a Vaccine for Triple Negative B.C.

Oh, how my fingers are crossed on this one.

"Donna Deegan, a WTLV- and WJXX-TV news anchor, is a three-time breast cancer survivor. She was diagnosed with the cancer at age 38.

"For women with triple negative breast cancer, if this works, it could be a game changer," Deegan said.

Perez said that in the past, she was not optimistic about the chances for success of a breast cancer vaccine. However, that has now changed."

Harnessing the Immune System to Fight Cancer

"But scientists recently discovered that cancer takes a page from Harry Potter: It puts on a kind of invisibility cloak.

"Cancer can keep the immune system from recognizing that it's bad and keep it from attacking itself," Brahmer says.

Now scientists have found a way around this.

"The breakthrough is in therapies called 'checkpoint inhibitors,' " Brahmer says."

New Delivery System for Chemo Drugs Shows Promise

"A new device that delivers cancer drugs directly into tumors without relying on perfusion via the bloodstream, could increase life expectancy for patients with pancreatic, breast and other solid cancers, say researchers."

3D Printed 'Phantom' Tumors Could Help Deliver Radiation More Precisely

"Scientists in London are using 3D printed replicas of tumors and organs, called 'phantoms', to show how drugs will pass through tumors and give them a better understanding of how that will be replicated in individual patients."

Certain Her-2+ Tumors May Only Need Chemotherapy (sans Herceptin)

"A study suggests that HER2-positive breast cancer tumors with high levels of tumor-infiltrating lymphocytes had a lower risk of the cancer coming back (recurrence) when treated with chemotherapy alone compared to HER-positive tumors with low levels of tumor-infiltrating lymphocytes treated with only chemotherapy.

This means that HER2-positive breast cancers with high levels of tumor-infiltrating lymphocytes might be able to be treated with chemotherapy alone and avoid Herceptin (chemical name: trastuzumab)."

I had ZERO side effects from Herceptin, so I was happy to take the kitchen sink approach. But I know what a pain it is to continue on infusions for a year (or longer for those with metastatic disease). Would you skip Herceptin if you could?

A Promising Drug Target for Certain Breast and Ovarian Cancers

"The Food and Drug Administration's recent approval of the drug olaparib for ovarian cancer patients with inherited mutations in the genes BRCA1 or BRCA2 came as welcome news to the thousands of women now eligible to receive it. A new study by Dana-Farber Cancer Institute scientists indicates that the pool of patients who can benefit from the drug is potentially much wider -- and offers a ready means of identifying them.

The study, published in the journal Nature, found that an enzyme called polymerase q (or POLQ) is the active agent in the protein "pathway" that olaparib targets within tumor cells. The finding suggests that breast and ovarian cancer patients whose tumor cells carry abnormally high levels of POLQ are likely to respond to the drug -- and that POLQ itself is an inviting target for future therapies."

Lastly, This is Making the Rounds in My Circles: Would You Try It?

One naturopath's take: "Although it is clearly uncomfortable not eating for a total of 72 hours, the research is indicating that this is a worthwhile sacrifice. The discomfort from hunger will actually decrease the severity of the side effects from the chemotherapy. It is also important to keep in mind that this starvation state is triggering a powerful metabolic shift in your cells that protects your cells while making the cancer cells more vulnerable to the chemotherapy."

I am fairly strong-willed, but I don't think I could voluntarily go without food for three days. What about you? Would you try this? Have you? Or is this guy a total coconut?

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As you probably heard, sports anchor Stuart Scott died of cancer over the weekend. The immensity of Scott's love for his daughters is palpable in this ESPY award speech. He calls his girls his "heartbeat." Like almost every parent, I can relate. And watching this (just fair warning), I cried big, ugly tears. A reminder that even though cancer research has come so far, we still have miles to go before we sleep.

 

Here is some of the research I've seen over the past few weeks. If I've missed anything over the holidays that you think should be included, please send me an email and I'll add it next week. Now that I'm done stuffing myself with gingerbread and dark chocolate candy cane bark, I have time again for sifting through articles online. Because, ahem, THAT CANDY CANE BARK WASN'T GOING TO EAT ITSELF.

Zinc Test for Early Breast Cancer Looks Promising

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"For the first time, a study shows that breast cancer cells process zinc isotopes differently to normal cells - leading researchers to suggest this might be a way to detect the cancer early."

No Surprise: Herceptin Improves Long-Term Survival for Her-2+ Patients

"The results show that the 10-year survival for HER2-positive breast cancer patients who received chemotherapy without Herceptin was 75%, whereas for those who also had Herceptin, it was 84%."

Two Pre-Surgical Drugs Improve Survival for Triple-Negative Breast Cancer Patients

"We found that adding either carboplatin or bevacizumab to standard preoperative chemotherapy increased pathologic complete response rates for women with basal-like cancers -- that is, it increased the proportion of women who had no residual cancer detected at surgery."

Disease Progression Delayed by a New Drug Combination in Some Advanced Patients

"A new combination of cancer drugs delayed disease progression for patients with hormone-receptor-positive metastatic breast cancer, according to a multi-center phase II trial.

'Because the study showed a statistically significant benefit among patients whose disease progressed on an aromatase inhibitor, a larger phase III study comparing this combination to other approved therapies used after initial therapies fail, like exemestane and everolimus, should be done.'"

Updated Results of MARIANNE Study for Advanced Her-2+ Patients

"The study assessed the feasibility of three different regimens targetting HER2 in people with previously untreated (first-line) advanced HER2-positive breast cancer. Patients enrolled in the study received one of the three composites: Kadcyla (ado-trastuzumab emtansine) plus Perjeta (pertuzumab), Kadcyla alone, and Herceptin (trastuzumab) plus either docetaxel or paclitaxel chemotherapy.

Results from MARIANNE trial showed that all the three regimens were feasible in progression-free survival (PFS) for a similar amount of time."

Development of Most Cancers Is Beyond Our Control, Study Finds

Notably, breast and prostate cancer were NOT included in this particular study. So the jury's still out as to whether those might be controlled by environmental factors.

"In a groundbreaking paper published in Science, the duo describe a new factor, a tissue’s stem cells, that may explain as much as two-thirds of the difference in cancer risk among different tissues."

What's Blowing Up the Breast Cancer Blogosphere This Week

In case it's not obvious, I'm in total agreement with Ms. Schattner on this one. No amount of whisky could ease the pain I would feel if treatment wasn't an option for me. There were other great articles countering Mr. Smith's blog post -- if you're interested, here are a couple that resonated with me.

"The image of a person retching or in pain, afraid to ask questions of his doctor and not being offered palliative care is outdated by several decades.

Today, cancer surgery and medicines can extend and improve the lives of people who live for years and decades after treatment. Malignancies that were notoriously hard-to-treat just a few years ago, like some forms of lung cancer, melanoma, T-cell lymphomas, Her2+ breast cancer and other conditions have become, in many cases, manageable." (emphasis mine)

Miracles Do Happen (What I Was Thinking About Over the Holidays)

We know very little about spontaneous remission except that it's extremely rare. Most doctors refrain from mentioning it to avoid giving false hope to patients. But the allure is undeniable.

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I had chemo today. A friend I hadn't seen in awhile came to sit with me and catch up. She knows my upcoming scans are on my mind, and asked me if and when I'd opt to quit taking this drug, assuming my scans keep coming back clean.

But here's the deal: I don't know of any other targeted treatments, if cancer were to rear its head again. I keep looking for the research, but it's not there yet. So, even with my (relatively mild) side effects, I will remain on this drug as long as it is working or until something better comes along. A gentle reminder that forgoing treatment altogether is NOT typically recommended for metastatic breast cancer patients, even those of us who are extremely fortunate.

Here is the research I did find on the web in the last week. Have you seen anything you think I should include here? Please send me an email!

The Problem Is, I'm Not Sure This News Is Going to Make Anyone Sleep BETTER.

"According to a new study, cancerous tumors may grow faster at night, during the hours typically taken up by sleep. Their discovery may point the way toward new, circadian-aligned strategies for treating cancer."

Why Has This Not Been Done Before?

"One of the tragic realities of cancer is that the drugs used to treat it are highly toxic and their effectiveness varies unpredictably from patient to patient. However, a new “tumor-in-a-dish” technology is poised to change this reality by rapidly assessing how effective specific anti-cancer cocktails will be on an individual’s cancer before chemotherapy begins.

“This is the first time the 3-D culturing method has been used to predict the effectiveness of different drugs on tumors from individual patients,” said graduate student Alex Walsh, who has played a key role in developing the test."

New Drug Combination May Work as a One-Two Punch On Breast Cancer

"We found if you put the two drugs together, you have much better ability to kill tumors than applying either drug alone," Keri said. "That's the major discovery. Prescribing both is much better than just selecting one or the other."

And Another Promising Treatment Option for Triple-Negative BC Patients

"However, the researchers found that the biggest improvement was in women with advanced TNBC. Overall, this group of women's survival improved by almost 5 months."

Scientists FTW: Getting Lung Cancer Cells to Self-Destruct

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"The discovery, although still in its infancy, could revolutionize the way doctors approach cancer. 'Igniting the fuse that causes lung cancer cells to self-destruct could pave the way to a completely new treatment approach – and leave healthy cells unharmed,' lead researcher, Dr. Henning Walczak, from University College London Cancer Institute, explained in the press release."

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Here's what I found on the web this week. Every week, I hope it will be the cure, but I do believe we are getting closer. Let's just get there faster.

Is This Why Brain Mets Occur? Is This How We Can Stop Them?

"Now Memorial Sloan Kettering researchers have found that a protein called cathepsin S may play a key role in the spread of breast cancer to the brain. A complex interplay between breast cancer cells and certain surrounding cells called macrophages induces both cell types to secrete increased levels of cathepsin S, an enzyme that promotes the cancer cells’ ability to metastasize.

In addition to potentially helping doctors predict which breast cancer patients are at increased risk for brain metastasis, the discovery, published recently in Nature Cell Biology, suggests that cathepsin S could be an important target for new drugs."

Why We Need More Words to Describe Living with Cancer

What words do you use to describe your breast cancer journey? Battling? Thriving? Surviving? Suffering? Treating? All of the above? 

For the most part, I think to each her own when talking about cancer and otherwise, but I do think the author here is right: Amy Robach, by virtue of her position as a journalist, has a special responsibility to choose her words more carefully.

Public Service Announcement: Pfizer Initiates Expanded Access Program for Treating Certain Advanced Breast Cancers

"Under its expanded access programs, the U.S. Food and Drug Administration (FDA) works with companies to allow access to investigational therapies to patients with serious or life-threatening illnesses who do not otherwise qualify for participation in a clinical trial and for whom there are no comparable or satisfactory alternate therapies."

This particular drug, palbociclib, is for hormone-positive, HER-2-negative breast cancer patients.

Breast Cancer is Really (at Least) 10 Different Diseases

While it's inspirational to hear, "My aunt had breast cancer 10 years ago and is doing great now!" it probably doesn't have any bearing on how someone else diagnosed with breast cancer today is going to fare. As I keep reminding myself when I see my friends dying -- whose cancer is, on paper, very similar to my own -- every disease blueprint is unique.

How Much is a Cancer Drug Worth? The UK is Reevaluating.

"Big manufacturers set to be affected by the changes include Roche, which came under fire this month from Nice [National Institute for Health and Care Excellence] for failing to cut the price of Kadcyla. The £90,000 per course drug is for women with advanced breast cancer. Nice rejected the drug as failing to offer value for money at that price."

I am eternally grateful for the quality of my health insurance.