EP0057-201 Phase 2A Trial - Cycle 2, Day 1, third infusion day - 11 November 2021

Back in for third treatment. The attendance pattern, thankfully, reduces now. No longer Monday Covid swab, Tuesday blood and clinic, Wednesday treatment, Friday bloods, Tuesday bloods then starting all over again the next week. It's now Tuesday Covid swab, bloods and clinic then Thursday treatment followed by a week off, which should be much less all-consuming and hopefully less tiring. 

Still don't have the measure of this regime. On the (very) basic metric of loo visits I think the chemo bit is working. But it's not such an emphatic reduction as experienced after the previous  carboplatin treatments and it's unreliable. And there are other gut issues which seem to be associated - either as an after/ongoing effect of the EP0057 or as a side effect of the olaparib. Am going through a process of elimination on this but I now lean to the former:

• the unwanted effects are similar to what followed after previous chemos. After the previous chemos, however, I was putting them down to side effects or rebound effects of the anti-nausea meds, which I was taking for five days after chemo day.  There is now more data available - after EP0057 I don't need the anti-nausea meds for so long  - after the first infusion I only took them for three days and after the second only for two days (and with the dexamethasone at half-dose)  but the gut effects still started at around the same time post-infusion. TMI risk... we are talking Day Five Diarrhoea Episode followed by maybe a week of what feels like an internal industrial ferment, now known at home as Farmyard Syndrome;
• I didn't have them when on olaparib every day for eight months on the ICON9 trial;
• When bending the doctor's ear at Tuesday clinic on the idea of the EP0057 upsetting my gut bugs and/or possibly causing some lactose intolerance, he was (I thought) a bit irritated by the microbiome suggestion, perhaps especially when I mentioned a British Journal of Cancer article I'd found - one of the authors is Tim Spector (Professor Microbiome and the friendly face of the Kings College London/Zoe Covid symptom reporting app) - "The gut microbiome: what the oncologist ought to know". While a lot of this article went way over my head, it did seem to conclude that chemo upsets your gut bugs. Clinic doctor seemed a bit more lenient on the lactose intolerance idea; he said that chemo affects the gut epithelium - and later interweb study says that the lactase enzyme is located in the gut epithelium

Immediate plan of action: reduce lactose intake by shifting milk intake to Lacto Free over the next month and see what happens. Hard cheese, butter and fermented milk things contain less lactose, so they're going to stay in for the time being.

Life has been  very unvarying, living in a self-imposed state of great carefulness and exile from old stimulations - cinema, art galleries, theatre. Now the allotment is less busy and the nights are drawing in the absence is more marked. They may all be 'opened up' but Covid numbers are plateaued at badbadbad. Even if less likely to lead to serious illness for the thrice jabbed, I really don't want it!  If cases start to go down significantly, it will be very freeing. And in the meantime, we are getting a mid-November session in Devon - first time since July - yippee.