so long red devil

My weekly dates with the red devil (adriamycin) have become fairly uneventful.  Every few weeks, Dr C examines my belly and he too seems impressed with the progress.  I am no longer in excrutiating pain when he pokes and prods around my belly and he can no longer "feel" my liver (it was so swollen back in August/September that he could feel the "fullness" and would use his measuring tape to note where the tumors were). 

Adriamycin is part of a class of drugs callend anthracylcines (Adriamycin/doxirubicin & Ellence/ebirubicin are two common anthracylines used to treat breast cancer).  While these drugs are considered quite effective, they carry with them a risk of cardiotoxicity that increases with each subsequent dose. 

Cumulative risk of chronic heart failure
Source: http://annonc.oxfordjournals.org/content/early/2009/01/19/annonc.mdn728.full

Here's where we dork out a bit... you can see in the figure above that the risk of CHF (chronic heart failure) is quite minimal at cumulative doses below 400-500 mg/m2.  At these lower cumulative doses, the benefits of the drug greatly outweigh the risks.  However, above 500 mg/m2, the risk of CHF begins to increase significantly... and the effects are irreversible and, potentially, deadly.  If you really want to get into the details, check out the link below the graph above.

As of this December, I have received 425 mg/m2 of adriamycin (including the 4 doses I had in 2005 + the weekly adriamycin I have been receiving since September).  Even though the adriamycin seems to be working, we are at the point where the risks of further treatment will likely outweight the benefits.  Given that I am still feeling relatively healthy and there are a number of other chemotherapy regimens out there still to try, we will be shelving the adriamycin and moving on to another drug (TBD). 

There may come a day when the benefits do outweigh the risks of adriamycin (if we do not find another drug that controls my tumor burden)... so we may see the red devil again someday... but for now, I thank her for the work that she has done for me and I look forward to the next stage of this battle.