Taxotere&
Carboplatin&
Herceptin&
Pertuzumab.
Does this shirt exist? I would wear it.
Commonly known as TCPH, this is the chemotherapy regimen I’m on. It’s actually a combination of chemo drugs – the T and the C – and monoclonal antibodies, H and P. They’re also not actually administered in that order; the cycle starts with the H, then the P, the T and the C, but the acronym persists. And for an editor, it is deeply annoying that the T and the H are brand names while the C and P are generics. Still, When people ask me what I’m taking, I say “TCHP,” and they nod, oh yes.
Taxotere, or docetaxel, is made from the needles of the European yew tree, not to be confused with paclitaxel, which is made from the bark of the Pacific yew. Yew is highly toxic! Which makes it good at killing cancer; so good that the Pacific yew has been harvested for medicinal use to the brink of extinction, thus prompting the turn to the European yew and the more sustainable harvest of needles. Taxotere is also the subject of ongoing lawsuits claiming it causes irreversible hair loss and eye damage in a minority of patients. In a majority of patients, including me it would seem, it causes peripheral neuropathy of the fingers and toes. Despite putting on ice mittens diligently during the hourlong taxotere infusion as instructed, the tips of three of the fingers of my left hand have gone numb. We’ll see when the feeling comes back.
Carboplatin is a platinum-based chemotherapy drug infused for half an hour, always after the taxotere. If you swap them around it doesn’t work, apparently. Both carboplatin and taxotere cause your hair to fall out. I find it darkly funny that the metal busily killing my cancer is more precious than the sterling silver ring on my finger.
H = The kind of cancer I have is HER2-positive, which means that the cancer is “overexpressing” copies of a gene called HER2. Herceptin is an HER2 inhibitor that blocks the gene’s protein receptors (of which there are way too many!) from receiving growth signals. I don’t totally understand the chemistry here, but essentially, the same thing that makes HER2-positive breast cancer grow quickly, this abundance of receptors, is also its Achilles heel. So that’s a good thing, I guess. Also my friend Diana was in a clinical trial for Herceptin twenty years ago so I like thinking that in some small way she has saved my life.
P = Pertuzumab is another HER2 inhibitor used in combination with Herceptin and Taxotere and that’s about all I know about that.
Pre-treatment they also infuse you with two kinds of antinausea meds, and at the end affix a little oval plastic robot to your upper arm that releases a booster shot of something called Neulasta twenty-four hours after the infusion therapy has ended. It blinks at you, green, for the next day, and then when it’s time to activate does a bunch of excited beeping. When it’s over, you just rip it off your arm and throw it away.
All of this medical technology is truly amazing; I have respect for and awe of its power. But I was dreading round two of chemo. I think I’m still a little traumatized from the first round’s chemo-covid double punch, truly, a dreadful experience that left me flattened, sleeping all day, barely able to make a scrambled egg or masticate a graham cracker. I was instantly prescribed paxlovid – more drugs for the cancer patient! – which quickly dispatched the fever at least. But the nausea was intense and the impact of the whole thing on my mouth defies language. It was as though someone had rammed a wad of steel wool into my mouth cavity and scrubbed it around vigorously. I couldn’t eat anything too hot, too cold, too hard, too pointy. Just eggs and tapioca pudding and those graham crackers. It lasted a good week, long after I was up and walking around and trying to eat more reasonable food like lukewarm chicken soup.
When it came time to get prepped for this week’s return to the hospital, the pre-chemo steroids made me testy and edgy. I woke up at 5:30 day of, unable to calm my mind. When it came time to get dressed I went to put on the lucky charm bracelet that E had given me last month – it’s beautiful, silver, loaded with meaningful totems: a soup ladle, a canoe, a nest with three little eggs, a ferry boat (because I love ferries), and an acrobat swinging on a trapeze. But, wait, the acrobat was missing! She must have fallen off somewhere the last time I wore it, which was the last time I had chemo. I searched the floor of the bedroom, but nothing. I sat on the bed and cried.
It seemed like a bad omen, here I was going off to this thing that was going to pump poison into my veins and make me sick and unable to do the thing I’ve worked so hard at, which I so dearly want to get better at, in any consistent form for months and months on end. In November I will have surgery on my chest (probably) and I will be grounded for who knows how long, unable to use my arms, unable to fly. I had lost the symbol of that possibility. I was so sad. But Paul came and put his arms around me and talked me down. He affixed an old charm from my keychain, a in-joke gifted from a circus friend, to the bracelet in the acrobat’s place, and we packed up the lunchbox cooler with the stupid ice mittens and (less stupid) booties and a snack, and off we went to the hospital.
And all was well. Treatment was fine. We chatted with the chemo nurse about the origins of chemotherapy in wartime, when it was first discovered that mustard gas could be an effective treatment for cancer, and Paul pointed out that the yew tree was once the preferred wood for long bows. Chemotherapy and warfare, inextricably linked.
When it was over we met Zoe for smoothies. I hadn’t seen her since the wedding, as she flew the coop for a well-deserved vacation in Italy the following week. “I can’t believe I went to Italy and I came back and you shaved your head and are having chemotherapy!”
I know. It’s nuts. But I do like my new haircut. It’s hitting all sorts of latent GenX triggers; I want to go get a skateboard and fuck some shit up.
But instead, on Monday night, with my Neulasta robot blinking on my arm and the nausea yet to kick in, I went to class and, very gently, flew.
I appreciate your writing this so very much. For all the scary and painful parts, it helps make cancer a decipherable experience instead of a black box, like the bars hiding the identity of people in photographs. And your writing in particular, opens it up like tender flower petals. Thank you, and in all the ways this can be expressed, may you continue to fly.