Thursday, December 1, 2011

Taxing taxol

Recently I learned that my neighbor was taking oral Taxol for the treatment of metastatic prostate cancer. Prostate cancer has much in common with breast cancer: about the same number of men are diagnosed each year as women with breast cancer; BRAC1 mutations increase incidence of both prostate and breast cancer; it is usually sex hormone driven; and if it spreads, it goes to similar places: bones, liver, lungs, brain...
How it differs is that it is half as deadly as BC but  a pain to biopsy and surgically deal with. In general, it is much slower growing than BC.

But ORAL Taxol? It is very hard for a drug to survive the digestive system. Assuming the drug survives the highly acidic stomach, it has to be absorbed in the gut and survive all the liver enzymes. Having the drug injected directly into the bloodstream avoids all those problems. In the past, it was found that the cytochromes in the liver deactivated Taxol. They had a formulation with cyclosporin which would neutralize the cytochromes but the cyclosporin would also deactivate the immune system. Not good. I am assuming they found something relatively harmless to deal with the cytochromes. I know grapefruit juice interferes with some of the liver enzymes leading to spikes in blood levels of certain drugs (statins for example).

But taking the Taxol daily would eliminate the very long infusions that are necessary. I had 4 doses spread out over 8 weeks. After I complained about the severe muscle and nerve pain, it was suggested that maybe I should have 12 weekly doses instead.
Nein danke.
This would extend my stay in chemoland 4 weeks and involve 12 painful infusions versus 4. From then on out, if I were asked how I felt on Taxol, I would just say, Fine.

On various boards, there is a debate on which is worse: the side effects of Taxol or those of Adriamycin. In general, people vote for the Red Devil. Aside from the nausea, fatigue and mucus membrane sores, it can cause some long term though rare side effects down the road: heart failure and leukemia. Taxol rarely causes nausea but the numbness and pain due to nerve damage is really no fun.

I had to wait until late afternoon yesterday for the sun to burn a path in the snow for me to run. Today was Maya's enrichment class, which she enjoys.

No comments:


Blog Archive