Why Some Survivors Still Need More Chemo

These last few weeks have been a bit confusing so I wanted to break down my understanding of what it means when you are told you may need more chemotheraphy.

The path was pretty clear since my diagnosis: I was going to receive neoadjuvant chemotheraphy (i.e., chemo prior to surgery), undergo surgery, have 6 weeks of radiation, and end with hormonal therapy. However, my path changed based on the biopsy results from my surgery. We have now added adjuvant chemo (i.e., chemo after surgery) to my treatment plan. I want to take a moment to breakdown what this means and my experience with round 1 of Xeloda (Capecitabine).

When you undergo neoadjuvant chemo, you and your doctors are not only aiming for the possibility of the size of the tumor to shrink, but also, for there to be no active cancer cells remaining in the breast tissue, or lymph nodes (if the cancer has spread there). One of the ways your care team is able to evaluate how well you respond to neoadjuvant therapies is by looking at the tissue that was removed during surgery to see if there are any actively growing cancer cells present. If there are no active cancer cells present, this is referred to as a “pathologic complete response” (pCR). It is important to note that the definition of pCR is still debated; some studies conclude that a pCR is achieved when only looking at the breast tissue while other scholars look at the breast tissue and auxiliary nodes combined. As such, it all depends on how your care team is defining and measuring the successful of neoadjuvant chemotherapy.

While I am disease-free post surgery (yea! Cancer is removed and all scans came back clear!) doctors did find that there was “residual disease” remaining in the tissue that was removed. While there was success in my neoadjuvant treatment, it was not 100%, and therefore, we want to continue our aggressive treatment plan and proceed with adjuvant chemo, Capecitabine (Xeloda). Luckily, patients with incomplete response to neoadjuvant chemotherapy benefited from Capecitabine!

Capecitabine are pills I take twice a day and follow a “cycle” of two weeks on, one week off. After two week on the new chemo, I am happy to report that I am feeling ok. I can confirm that the rumors of this being an “easier” chemo are true. Easier in the sense that you can take the pills in the comfort of your own home. However, I don’t want to undermine the power of this chemo. Overall, I am feeling well but a few noticeable side effects include:

• Tiredness and fatigue

• Upset stomach / cramps

• Overall sense of not feeling well but cannot place your finger on what exactly is wrong

• Upset GI track

• Wrist Pain (this could be because of the Aromatase Inhibitors I am on like Anastrozle/Arimidex)

• The only time I felt nauseous was when I took the pills without food! Remember to take Capecitabine with food!

Honestly, these symptoms are manageable. I am still working full-time and able to continue with my health and fitness exercise routine which is my sanity. One of the side effects I continuously monitor for is Hand and Foot Syndrome. This is the most common side effect, but so far, after completing round 1, I am in the clear!