Unfortunately a weakened immune system delayed the start of Round 2 and has led to a change in my treatment plan

Weakened Immune System

One of the side effects of chemotherapy is a significantly weakened immune system.  While I’ve been feeling pretty good, the chemo apparently has hit my immune system pretty hard.  Towards the end of Week 3 it became clear that my white blood cell counts were down pretty significantly.  While I was hoping they would rebound for the start of Week 4 they did not and I was forced to delay a week.  My oncologist put me on antibiotics and the start of my second round was pushed to Week 5.

Change in Treatment Plan

My original treatment plan was three rounds of Bleomycin, Etoposide, and Cisplatin (3xBEP).  Due to my immune system’s response and the dangers of lung toxicity associated with Bleomycin this has been changed to one round of Bleomycin, Etoposide, and Cisplatin and three rounds of Etoposide and Cisplatin with Neulasta shots to boost my immune system between rounds (1xBEP, 3xEP).  While I’m disappointed to have an additional week of Etoposide and Cisplatin, which is really exhausting and uncomfortable for me, I’m glad to hear that I may avoid some of the longer term lung toxicity side effects.

Week 4

I did not receive any treatment Week 4 due to a weakened immune system.

Week 5

Week 5 began with some confusion about how best to respond to my reduced white blood cell counts.  Initially, my oncologist reduced my Etoposide concentrations my 25%.  Since this was a deviation from the original plan, I contacted my IU oncologist asking if this was common.  He responded that while he might delay treatment a week he would likely not reduce the Etoposide dosage and would be more likely to recommend Neulasta to boost white blood cell counts and prevent an additional week delay.

Since there appeared to be a difference of opinions, I requested a meeting of the minds with Dr. McGuire, my VCU oncologist, and Dr. Hanna, my IU oncologist.  They ultimately agreed that it would be an appropriate course of action to bump my Etoposide concentration back up to 100, eliminate the bleomycin, and begin Neulasta shots.  While Bleomycin has some lung toxicity side effects, they are exacerbated by Neulasta.  Dr. McGuire has had patients require a lung transplant after Bleomycin/Neulasta induced lung toxicity.  Because of this, he’s uncomfortable recommending the two together.  Neulasta alone does not contribute to lung toxicity without the presence of Bleomycin.  Their ultimate recommendation was to cease the Bleomycin, add Neulasta, and add an additional round of EP.

As I said before, I’m very much not looking forward to an additional round of EP.  It’s very uncomfortable (bloating, stomach aches, acid reflux, neuropathy, tinnitis, etc.) and exhausting.  That said, I’m glad that my oncologists have reached a consensus.  Ultimately, I want whatever will produce the best long term results for me in terms of survival rate and side effects.  Anything temporary I’m very much willing to tolerate.