Two questions on lung cancer treatment
Q1: Last day of week two. Starting to feel a little more fatigued, but all in all I think it is going well. Anyway, the two drugs I am on are Cisplatin and Etoposide [as well as radiotherapy].
Cisplatin attacks rapidly dividing DNA by stitching the two strands together so they can't come apart. It's a well-known chemo mainstay. Wikipedia has a good article on it here
Over a period of chemotherapy it can cause neurological effects like peripheral numbness which you need to keep an eye on as well as hair loss etc chemo side effects. One friend who had it for bowel cancer had to stop to avoid nerve damage towards the end of her therapy but is fine now.
Etopside does something similar, but a little bit different. Wikipedia has a good article on it here
DNA strands are wound together into a spiral, so to divide they need topoisomerases, which briefly cut the strands, so one can pivot around the other. Etopside stitches the protein topoisomerase to the DNA causing the whole process to get stuck.
Both these agents are aiming to cause cancer cells to self-destruct in programmed cell death (epoptosis) by attacking the DNA replication of dividing cells. This will make you feel tired and lose hair and maybe feel a bit sick in the stomach while you are having chemo because rapidly dividing cells such as in hair follicles and some gut lining ones are naturally dividing all the time, whereas others like nearly all your brain cells and muscle cells don't divide at all or hardly at all.
Are there any other conventional treatments that might help? Here are three conventional additional drugs used in [non-small cell] lung cancer that would combine with the drugs you are taking.
1. The article on Drugs boost lung cancer survival suggests taking Taxotere with your current cocktail of cisplatin, etopside and radiation to stop the cancer recurring. Wikipedia has a good article on it here
Its another one that attacks rapidly dividing cells, this time by stopping them pulling their chromosomes apart so it has similar side effects. The treatment combines cisplatin and etoposide, with radiotherapy and Taxotere, to prevent the cancer re-occurring. It could boost the survival rate of some lung cancer patients by a third.
2. A second Lung cancer drug erlotinib or Tarceva 'extends life'. Wikipedia has a good article on it here
Erlotinib (Tarceva) added to chemotherapy improved overall survival by 19%. It acts by inhibiting epidermal growth factor, so it probably has fewer side effects than the ones that attack dividing cells.
3. Another article in the list Anti-estrogen Drug (Tamoxifen) reduces lung cancer deaths:
Wikipedia has a good article on it here
Tamoxifen is an anti-estrogen drug normally used in hormone sensitive breast cancer, but the article says any lung cancers have estrogen receptors and women on the drug had better survival. It would inhibit your estrogen but wont make your hair fall out.
Q2: In discussion with some of the nurses at the chemo day stay they said that some drugs react badly to some foods eg grapefruit, etc. Have you come across this?
Grapefruit interacts in rather unpredictable ways with a number of drugs including etopside mentioned above. Grapefruit is also known to stop estrogen breaking down by blocking the enzyme that metabolizes it. This had been suspected to cause women who eat lots of grapefruit to have something like 20% higher rates of breast cancer, but this may have been confounded by additional hrt.
A good wikipedia article explaining how grapefruit affects drugs and steroid metabolism is here
The fact that they warned you about grapefruit is good but grapefruit is an exceptional case, so it doesn't mean that other things like epicatechin gallate in green tea which actually helps to stop cancers gaining a blood supply and resveratrol in red wine and grape juice which is toxic to cancer cells but not normal cells are harmful during chemo unless they say so specifically.