chemotherapy

Reading this blog, one might get the impression that chemotherapy was responsible for my cure. It wasn’t and it almost killed me. If anything, I got better despite the chemo and not because of it. Still, I want to make it clear that when I write about cancer, I’m writing strictly about my own Cancer and my own experience. (the terms chemotherapy, cytotoxic (cell-killing) chemotherapy, and platinum-based chemotherapy are relatively interchangeable in this article, I am not referring to immunotherapy or more targeted oncological techniques).

the cytotoxicity symbol is haunting

Everyone has cancer at some point in their lives and everyone’s cancer is entirely individual. As I’ve written, I believe that cancer is an important part of the immune system: insulating vital organs from damage due to infection or repeated injury, as in skin (eg. from the sun) and lung cancer (eg. from smoking) or, in Lance Armstrong’s case, testicular cancer (from riding a bike for most of his life). What Lance fails to mention in It’s Not About the Bike, is the fact that IT’S ALL ABOUT THE BIKE. He very likely got his cancer from riding a bike. It doesn’t take a rocket scientist or an oncologist to make that connection – repeated bike-to-ball injury. 

Lance goes on to credit platinum-based chemotherapy (Cisplatin – which I also had) for saving his life, which it probably did. Testicular cancer patients respond very well to Cisplatin (see below). The track record for stage IV melanoma using current cytotoxic chemotherapies (and Cisplatin isn’t even approved for melanoma treatment in the US) is, however, very poor and even successive modifications to my own protocol have shown little to no improvement (link to a review of my combined treatment) and are not recommended, but very often prescribed. 

He even credits chemo for winning the Tour de France, which I can actually understand – having lost a lot of weight and gained a lot of muscle since the end of my own chemo hell. I may ride it yet, but chemo is not a fitness routine I could ever recommend to anyone.

This from the good folks over at Wikipedia:

“Chemotherapy is highly effective in some cancers, useless in others, and unnecessary in still others. Taking all forms of cancer together, people who receive chemotherapy increase their odds of living five years after diagnosis by about two percentage points (e.g., from about 61% being alive after five years to about 63% of them being alive after five years).  However, this overall rate obscures the wide variation. Cytotoxic chemotherapy produces much larger gains for some forms of cancer, including testicular cancer (about 40% of the men who live five years after diagnosis are alive because of chemotherapy), lymphomas (about 13%), and cervical cancer (12%). By contrast, chemotherapy is essentially useless in other cancers, including prostate cancer, melanoma of the skin, multiple myeloma, bladder cancer, kidney cancer, and pancreatic cancer: people who receive chemotherapy for these conditions are just as likely to die within five years as people who do not. Chemotherapy only slightly improves survival for some of the most common forms of cancer, including breast cancers (1.5%) and lung cancers (1.5%).”

This from the NIH regarding its effectiveness: "The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required."

Cytotoxic chemotherapy is just that, it kills cells - the healthy along with the ostensibly ‘sick’. Different cancers have different responses to chemotherapy and it generally works best on the faster-growing varieties, as they are ‘hungrier’ and take in more of the poison. But other rapidly-dividing cells, like red and white blood cells, platelets, the entire digestive tract, and hair are also early victims. This is why chemo patients throw up a lot, lose their hair and have weakened immune systems.

This is the only empirical evidence of my response to chemo:

During treatment, which consisted of five three-day cycles over four months, using Cisplatin, Dacarbazine (DTIC) and Carmustine (BCNU), I felt sick, tired, weak, nauseous, was puking constantly, had arms full of holes, a completely wrecked immune system, no platelets, was covered in bruises, and generally very miserable – an athlete’s foot infection could have killed me at this point.

Following treatment: severe muscle atrophy, busted and completely calcified gall bladder, shingles, enlarged prostate, peripheral neuropathy and allegedly progressive disease (all since cured). Another session probably would have resulted in permanent damage or simply killed me - the cancer and not the chemo taking the blame as it always does in these cases. As it is, I am considered a very rare melanoma chemo success story (duly reflected in the statistics); the chemo taking the credit for my recovery.

Chemotherapy is barbaric and amounts to torture. We’ll look back on it someday with the same disgust and disbelief as we regard trepanning and witch burning. The history of this highly-carcinogenic and counter-intuitive therapy is also not surprising if you’ve been through it - this (very plausible, but unsubstantiated story) also from Wikipedia:

“Mustard gas was used as a chemical warfare agent during World War I and was studied further during World War II. During a military operation in World War II, following a German air raid on the Italian harbour of Bari, a group of people were accidentally exposed to mustard gas (there stockpiled by the allied forces) and were later found to have very low white blood cell counts. It was reasoned that an agent that damaged the rapidly growing white blood cells might have a similar effect on cancer. Therefore, in the 1940s, several patients with advanced lymphomas (cancers of certain white blood cells) were given the drug by vein, rather than by breathing the irritating gas.”

Mustard gas was prohibited under the Geneva Convention (since 1925, mind you), yet it is somehow legal and desirable to give it to people intravenously who are dying anyway. Considering all of the advances in medicine since the ‘40s, cytotoxic chemotherapy remains largely unchanged. Carmustine (BCNU) – by far the worst of my chemo drugs is derived from mustard gas. The first chemotherapies for melanoma used phenylalanine mustard – the connection with phenylalanine somehow known, but not carried over into a product label warning for phenylalanine or NutraSweet, as reported earlier.

I read somewhere that 96% of cancer patients don’t actually die from cancer. I don’t know if that’s true, but I wouldn’t be surprised. I also read that 80% of oncologists would not choose platinum-based chemotherapy if they themselves had cancer – again, no real surprise there. The 'response' statistics from clinical trials and their eventual highly-paid rubber-stamped regimens are misleading and fraught with inaccuracy, misdirection and misinformation. 'Response' to a therapy is in no way associated with 'survival'. Patients who are termed 'unevaluable' are often those who died during the treatment and are removed from the statistics - or worse, counted as having 'responded' to it. If you had enough Carmustine, you could destroy every cell in your brain (they've actually done this with rats) including the cancer. You would have 'responded' to the treatment, but at the obvious cost of your life. Article here.

When making the decision of whether to go the chemo route or not, it is important to educate yourself as much as possible. Research the drugs to be used, understand the potential side effects (temporary and permanent) and the survival statistics - but take those statistics with some skepticism. Weigh carefully the risks and benefits and realize that the doctors may be offering you chemo simply because they have nothing else in their arsenal. Or for worse reasons. Look for alternatives – they exist and I’ll list what I believe helped me in the next post. Your health is your survival and the choices are always yours.

The only therapy that will ever work for you is the one(s) that you actually believe in. Lance is alive and I’m alive – the difference is that he’s alive because of chemo and I’m alive despite (or even to spite) it. Either way, I’m happy for both of us.