Chemo II - waiting for Cycle 4 - 28 October 2020

Monday's Covid swab was negative, Ca 125 was down a little bit more to 11, CT scan shows everything nasty has got smaller.  So I'm back at the Macmillan Centre again. Still have a bit of a sore mouth, watery eyes, a doxorubicin rash and the bottoms of my feet feel like I've got gravel in my shoes, but I'm fit for another round of poison. The last month was a bit gruelling - I felt  a bit gruelled for quite a while. A bit worse than usual due to the gut-onslaught after the scan and then just as WBCs became competent again, I had a flu jab which certainly made me feel like I'd had a flu jab for a day and a half or two. Return of decent energy only came on Sunday just gone when I was attacked by a housework demon.

It seems quiet in the Centre today and I've actually been able to sneak a quick pic of one corner of the chemotherapy suite without risking upsetting anyone - partly because everything has been spaced out for Covid-prevention purposes and there's been an even stiffer crack down on non-patients. It looks very concretey bleak but somehow it isn't. In the diagonally opposite corner which you can't see is a cordoned off area with buckets to catch the leaks from the glass roof - I think this imparts a homely feel. In the foregound is the drip stand forest. I'm sitting on a chair similar to the red ones but it's black. I've cadged an adjustable table from an empty bed and set out my things to do and flask of hot chocolate.

There's been a potential development, leavening the tedium of these chemo cycles and providing me with more reading matter. Very busy clinic yesterday meant my consultation phone call was with a visiting doctor from Israel rather than Dr M. Very nice, happy to answer questions, and keen to ask me one too. 

My main queries were about poly-ADP ribose polymerase inhibitors (PARP inhibitors, 'rib' drugs), which I'm expected to go on when the poison chemo ends - oral medicine taken every day with the aim of preventing ovarian cancer regrowth.  Olaparib is the one on offer. Left to itself, the PARP molecule helps damaged cells to repair themselves, so inhibiting it prevents cancer cells from repairing themselves. I guess it stops all your other cells from repairing themselves too, though. It used to be licensed only for cancers with a BRCA fault: such cancers were already down with cell repair problems and were therefore ripe for a further kicking from an outside  agent . Now it's known that olaparib has some effect on platinum-sensitive cancers too, which mine is, so I'm in the frame. It's a  maintenance treatment which you take until the cancer comes back while hoping it doesn't.

The doctor's question was about going on a trial to find out whether adding a 'nib' drug (cediranib) to the 'rib' drug gives better, synergistic results. Cediranib seems to operate in a similar arena to the bevacizumab (Avastin) that I had after the first lot of chemo - not entirely happily wrt side-effects... As you will recall (!) bevacizumab binds vascular endothelial growth factor (VEGF) thus reducing the ability of cancers to regrow their blood supplies and thus slowing their growth. Cediranib is also classed as a 'targetted therapy' and seems to go for the same result by inhibiting VEGF tyrosine kinase inhibitor. In order to make this a good thing, and now I am guessing, I think we have to grope for a triple negative where tyrosine kinase is an enzyme that does away with VEGF i.e. VEGF in the cancer context is bad; VEGF tyrosine kinase eats VEGF up, so is good; VEGF t k inhibitor is therefore bad; so cediranib which inhibits VEGF t k inhibitor is good...???

An international trial called ICON6 showed that cediranib with and after chemotherapy is better than chemo alone. The trial now in question is an international Phase III, randomised trial called ICON9 where half the participants get just olaparib and half get olaparib plus cediranib. It doesn't use the term but I'd expect it to be double-blind where hardly anyone knows who is getting what to prevent the introduction of biases - I think only the computer knows and it isn't telling. I said I was open to the idea, so in rather indecent haste, I was sent the patient information - 27 pages! I have to read that then say if I'm still open to the idea, and then I would have to be tested to see if I'm eligible.

Well, today's chemo is over, I've had a shifty through the 27 pages and have generated 2 A4-sides of questions, but in big writing. I'm sitting in the Macmillan Living Room waiting for Christopher to ring me from Mornington Crescent at which point I will decamp to a street corner north of Euston Road to be picked up.