Post Surgery Treatment Plan

Life has been very busy with a lot of appointments. Along with the weekly visits to plastic surgery, I had a follow up appointment with my oncologist on March 30 to go over the next steps now that surgery is behind me. The plan has changed a little based on the pathology results post surgery.

Since there were still some active cancer cells, the new treatment plan includes eleven cycles of immunotherapy, Keytruda, every three weeks. I will also be taking a chemo pill called Xeloda, or capecitabine. Before starting the chemo pill, they needed to run a lab test to check my enzymes and see how my body metabolizes the medication. I received a call and went back to the cancer center on April 1 to get that completed.

I will begin both the immunotherapy and the chemo pill on April 9. The immunotherapy is still given through an IV and takes about an hour. I’ll be taking the chemo pill twice a day for two full weeks, or fourteen days, of treatment followed by one week, or seven days, of rest. That three‑week pattern makes up one cycle, and I’ll move through eight of those cycles in total. The chemo pill will continue into September and the immunotherapy will continue into November.

My oncologist explained that this treatment is recommended because there were still remaining cancer cells. The concern is that if even a microscopic cell breaks off and is somewhere in my body, this treatment gives me a better chance of preventing it from growing. He explained that if breast cancer comes back after a double mastectomy, it would return somewhere else in the body such as the chest wall or the bones, which would make it stage four.

He also explained that there are three groups of people. There are people whose cancer will come back no matter what they do. There are people who benefit from the additional treatment and it truly makes a difference. And there are people who would have been fine without the extra treatment. The challenge is that they do not know who falls into which group. When it comes to cancer, even a small percentage of improvement becomes the standard of care.

They also consider how well a patient tolerates treatment. If someone handles it well and it does not cause additional problems, then the extra treatment is worth it. If someone does not tolerate it well and it causes more harm than good, then they would not continue it. Since I’ve tolerated IV chemo well, he feels that I will be able to tolerate the chemo pill as well. 

Right now I have about a seventy percent chance that my cancer will not recur. The additional treatment increases that by about eight to ten percent. So while it will be a long road, things are going as well as they can.

Thank you for all the prayers and support. It means more than you will ever know.