So I get questions about my chemo all the time, so I thought I would put this together drug by drug for you. This is my process…
First, I am on a therapy called R-CHOP, named after the initials of the drugs of the therapy.
- Rituximab – is a monoclonal antibody
- Cyclophosphamide – a chemotherapy drug
- doxorubicin – a chemotherapy drug that has the chemical name Hydroxydaunorubicin
- vincristine – a chemotherapy drug that was originally known as Oncovin®
- Prednisolone – a steroid.
I come into the infusion room and the nurse gets my port ready (places an IV site into my port in my chest). They take my vitals, order my chemo and meds from pharmacy, and double checks what my doctor wants.
Once my drugs come in, all the fun begins! My first drugs are oral doses of Benadryl (to help stop any possible reactions), Zofran (for nausea and vomiting), and Prednisone (I will explain this later). About a half hour later, I start my Rituxan IV. It takes about 4 hours to infuse then the rest of my drugs take about an hour to finish.
Rituxumab (Rituxan)
How it works
Rituxan circulates in the lymphatic system and tissue. It binds specifically to the CD20 antigen, a molecule present on the surface of the normal and malignant pre-B and mature B cells. This binding can be imagined as a lock fitting a key. More than 90 percent of B-cell NHL express CD20. Once bound to B-cells, Rituxan induces lysis (destruction of the cell) through several possible mechanisms: apoptosis (cell suicide), initiating a lytic (killing) signal to natural killer cells (a type of immune cell), initiates an attack on the cell membrane, punching holes in target cells causing lysis, sends cells signals to stop dividing and replicating, causes recognition of tumor initiating NK cells to attack tumor, and also has a synergistic effect with other chemotherapy drugs.
The side effects that I feel
My blood pressure has lowered
Nausea
Weakness
Low blood cell counts – decreased immune system!
I had to take Allopurinol for 10 days after my first chemo because this drug causes so much cell death. The first round of chemo causes the most cell death, which is hard for the body to process. The kidneys take the biggest hit, so this drug was taken to help protect my kidneys and help them process all the different cell parts and electrolytes that are released from the cells as they die. It made me have to pee within 20 minutes of drinking anything and I had to drink 3000 mL of water a day. That would be 1 ½ 2 liter bottles. It was a serious pain in my bottom!
Cyclophosphamide (Cytoxan)
How it works
Cytoxan is part of a group of medications called alkylating agents. The medication itself is not active against cancer, but it is metabolized by the liver into its active form. The active form causes "cross-linking" of DNA cells. When DNA is cross-linked, it can no longer function properly. Since DNA is essential for cells to grow and multiply, alkylating medications prevent cell growth and multiplication, and may cause cell death.
While Cytoxan can kill both healthy and cancerous cells, it has a greater effect on cells that are multiplying rapidly. Generally, cancer cells multiply more rapidly than healthy cells and are, therefore, more affected by the drug. Healthy cells that maybe affected are cells that are in need of constant replacing such as; lining of the GI tract (mouth to anus), skin, and blood cells/bone marrow.
Cytoxan also suppresses the immune system!
The side effects I feel
Nausea and vomiting
Loss of appetite
Partial hair loss
Low blood cell counts – decreased immune system
Feeling tired or weak
I hate this drug! Within a couple of minutes of taking it, I get the feeling of having the flu and my sinuses feel like someone is squeezing them between two metal slabs. My head hurts and I feel just plain awful. It is also the drug that makes me very nauseous and sometimes vomit the night of chemo.
Doxorubicin/ Hydroxydaunorubicin (Adriamycin)
How it works
Doxorubicin is part of a group of medications called anthracyclines. Anthracyclines kill cells (including cancer cells and normal cells like cytoxan) by working in several ways. Doxorubicin binds to DNA in cells, changing the shape of the DNA and causing other problems with the DNA. Doxorubicin can damage the membranes (outer coating) of cells and may damage other parts of cells as well.
The side effects I feel
Nausea and vomiting
Hair loss – I am supposed to have complete hair loss, but my hair is putting up a fight! I still have
arm hair, some leg hair, a little pubic hair, all my eye lashes, and most of my eyebrows (they are starting to thin out), and very small amount growing on my head (which forces me to shave my hair because it is thin and sporadically growing). I have no armpit hair!
Pink urine for about 8 hours
Vincristine (Oncovin)
How it works
Dividing cells go through two primary cycles. There is a relatively long resting phase (interphase), during which the cell matures and prepares for cell division. Then, it enters the stage of mitosis (metaphase) where it actually divides, first with synthesis of microtubules that form the spindles on which the DNA align and divide. These steps happen at highly increased rates in cancer cells. Vincristine binds to the microtubules, preventing the formation of spindles and freezing the cell in metaphase (metaphase arrest). The result is an inability of the cells to divide and actual death of the cells.
The side effects I feel
Hair loss
Numbness and tingling in fingers (neuropathy)
Constipation
Prednisone (Sterapred)
How it works
Prednisone is part of a group of medications called glucocorticoids. These medicines are a type of corticosteroid, or "steroid" for short. Prednisone is similar to glucocorticoids that occur naturally in the body.
Although glucocorticoids have numerous affects in the body, they are used mostly for their anti-inflammatory or immune-suppressing properties. This drug works for most conditions by decreasing inflammation or suppressing an overactive immune system.
The side effects I feel
Stomach upset
Increase risk of infection or inability to heal wounds
Inability to sleep
Frequent urination
If you haven’t realized it yet from Facebook or this blog, Prednisone is the devil! I feel horrible when I take it and I hate that I have to. I have to take it for 4 more days after chemo, but I have side effects from it for 3-5 days after taking it. I get a feeling of being disconnected from my body and very weak on top of the other effects I feel.
On top of the side effects from the drugs above I have had mouth sores, small weight loss, fatigue, weakness, hot flashes, night sweats, and issues with smell (especially cooking meat). These can come from many of these drugs and some (like the smelling issue) I have no idea which drug that comes from. I begin to feel better 8-10 days after chemo. I have also had a much stronger hit on my immune system than most people. I now also have to take a growth hormone shot for 7 days after chemo. I also get a shot in my butt every 4 weeks of Lupron to help protect my ovaries so I won’t become sterile. Isn’t this all so very fun???
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