The first slap

The first slap
This photo was taken the day after I was diagnosed, and it is my first bitch slap at cancer. I'm the one with the icepack symbolically placed on my boob. My teammates changed our team's uniform to pink at the last minute, and I came off the soccer field that night with one goal and a whole lot of love. Several of these women are my close friends, but they are all warriors, and they all helped me set the tone for this fight.

Tuesday, December 10, 2013

Introducing Taxol, Pertuzemab, and Herceptin

Good morning, friends and family. And it is a good morning because yesterday I began chemotherapy. To be honest, getting chemotherapy is quite boring. You basically just sit there for hours hooked up to an IV. I should be able to get lots of reading or writing done while I'm there.

Taxol, illustrated by Nate Lundstrom
I've included a few images here for your viewing pleasure. The first one (on the left) is Taxol, illustrated by my son Nate. It's a chemotherapy that I will get in weekly infusions over the next 12 weeks. Taxol is a very standard chemotherapy for breast cancers that are ER/PR positive. I'm not 100% sure about how it functions, but Nate's illustration gives you a sense of how I imagine it functioning: In a whoop-ass sort of way, hunting down and targeting those ER/PR receptors on the cancer.

I am on two additional drugs, which I get infused every three weeks for the next 12 weeks. These are not technically chemotherapies, but rather, biological agents. One of these drugs is called Pertuzemab, and here is an illustration Nate made that to me just shouts out, "Hello, my name is Pertuzemab, and I'm here to eviscerate your cancer!"

Pertuzemab, illustraed by Nate Lundstrom

I do not yet have a clear image of Herceptin (Nate is working on a visual rendition of it, but it's not yet complete). However, it is a widely used biological agent that, like Pertuzemab, is targeted toward HER 2 Positive cancer. I will be getting Herceptin for a whole year, every three weeks. (To clarify, Nate drew the green one to be a general "cancer killer," but I named it Taxol. He did the second one at school, before my diagnosis, but I named it Pertuzemab.)

I have to say that while I have already had a wee bit of stomach upset last night caused by the Taxol, I love the idea of these nasty drugs coursing through my veins offing little cancer cells here and there assassination style. And the doctors have given me some anti-nausea medication should I need it. I woke up feeling engergized, and I also exercised, which is something I hope to continue during chemotherapy.

Both Craig and Mom came with me to my first chemo yesterday, so here are a couple of photos. (You'll note Grace is peeking out of my shirt pocket.)  It seems weird to snap happy looking photos of chemotherapy, but again, I am feeling good about getting my treatment underway, and having both Craig and my mom there were really important. There were so many unknowns for me going into it, and having them there with me just made that infinitely easier emotionally. Also, mom brought me an awesome lox and cream cheese bagel sandwich and a smoothie from Einsteins! They say I'll begin losing my hair in a couple of weeks, so my next plan is to go get a short haircut to ease the transition to baldness, and to start acquiring a repertoire of hats. For now, it's time to begin grading a bunch of papers, comforted by the fact that Taxol, Pertuzemab, and Herceptin are beginning their important work!


  1. I Love Nate's drawings of the drugs! He's made them look very powerful, which is a great thing for cancer-fighting substances. By the way, I think I remember some sweater it took you 10 years or something like that to knit. Seems that if you want to knit yourself a stylish hat, you better get started now or it won't be done until you're all better with your hair grown out. How about something like this (nobody would guess it's not your real hair:-) Cathrine :

  2. This comment has been removed by the author.

  3. It feels good for treatment to be underway, and I am optimistic both about anticipated effectiveness and not-so-bad side effects. You can’t avoid the hair loss, but the rest of it shouldn’t be too bad. Most side effects will come from the paclitaxel (Taxol®).

    The generic versus brands names of drugs can be confusing, as we have chatted about. In fact, there was an op-ed piece in NY Times recently on the same topic:

    For any particular pharmaceutical compound, medical and popular culture tend to favor either the generic or trade name, usually for obscure reasons. I've almost never heard any physician refer to the antibiotic gentamicin by its trade name Garamycin®, and everybody uses clindamycin, not Cleocin®, and ceftriaxone, not Rocephin®. But the reverse is true for other drugs. Who remembers that Lipitor® is really atorvastatin or that warfarin and Coumadin® are the same anticoagulant? In your current chemotherapy, the same difference appears to be emerging. Oncologists and patients refer to paclitaxel and trastuzumab by their trade names, Taxol® and Herceptin®, to the glee of their manufacturers. But as best I can tell, everybody uses pertuzumab and not its trade name, Perjeta®. It's a newer drug, and maybe the brand name will come into common usage, but for now I imagine the company's marketing department is not happy.

    Pertuzumab and trastuzumab indeed are biologic compounds and not chemotherapeutic drugs in the usual sense. That is, they are not direct cellular poisons but work indirectly, as antibodies that target particular proteins on the cancer cells' membranes. The suffix "umab" denotes "hUman Monocloncal AntiBody", a class of drugs that collectively are the biggest moneymakers in the pharmaceutical industry today. (The drug Patricia takes for her psoriatic arthritis is in the same class: adalimumab or Humira®, widely advertized for rheumatoid arthritis and psoriasis. I’ve been told it is currently the biggest selling pharmaceutical worldwide.) In breast cancer, trastuzumab and pertuzumab both target the HER2* receptor protein on your cancer cells. And now a bulb lights for an aha! moment: trastuzumab = Herceptin®. As you correctly state, paclitaxel/Taxol® targets your cancer cells' estrogen/progesterone receptor. Hence the importance of your tumor's "triple positive" receptor analysis: ER+, PR+, HER2+, allowing this targeted therapy, which doesn't work (or not as well) on tumors without these receptor proteins.

    Well, enough science. Doctor hat comes off, Dad hat on. Hang in, Babe. I’m always here. See you at Christmas!

    Es tuya el alba de oro.

    Love-- Dr. Dad

  4. The "removed" comment was just to correct a typo, reposted above.

    Dr. Dad

  5. * HER = human epithlial [cell] receptor

  6. Dad, thanks so much for the additional details. This is really helpful not just for me, but (I'm assuming) for others who read this.


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