#22 BRING IN THE BIGGER GUNS

Back at the Day Hospital this week for the first of the Pembrolizumab (aka: Keytruda) immunotherapy treatments. Hello chemo-ward my old friend. Same staff, fluorescent lighting, beeping sounds, and palpable smell. I can pretty much taste this room whenever I think of it.

Anyway Chair number 13 for my first visit. One bonus is the session lasts just 40 minutes so feet up and enough time to catch up on some messages and read my book. No sneaky naps nowadays.

Also had my consultation with Dr Kildare this week. He only wants to see me for blood analysis and consults every other visit (ie: every 6 weeks) so next immunotherapy appointment I will be in and out (shake it all about).

So what is immunotherapy?

Well, having listened to a dozen podcasts it’s quite an interesting and fairly new development for cancer. Basically, it activates your own immune system to seek out and destroy cancer cells.

Bit like sending in the Jackal for an undercover assassination mission armed with a fake nose, binoculars,  and a long-range sniper rifle.

The immune system usually relies on its standard regiment of T-cell soldiers to fight off bacteria, viruses or parasites. If they find any enemy cells they will mercilessly take them down with a round of gunfire. They’ll swoop in, clean up the mess and send out thousands of antibodies to keep the invaders away whilst also leaving a little reminder for future reference and military intelligence.

It’s a super-efficient assault team and for the most part does its job with great success.

Message to my immune system – YOU HAD ONE JOB!

But cancer cells are devious little fuckers and can use something ‘cutely’ called the Programmed Cell Death Protein-1 (PD-1) to hide themselves from T-cells. This camouflage prevents the T-cell infantry from advancing on the cancer cells therefore enabling the cancer cells to radio in for reinforcement and multiply and spread.

So the basis behind immunotherapy is to send in backup for the immune system by dispatching the SAS. With their additional tactical training and skillset they are deployed to find and block the PD-1 via a search and destroy mission and nuke any cancer cells they come across.

Immunotherapy is a standard treatment for some organ cancers and head and neck, esophageal, and renal cell cancers. Apparently, it works significantly well for Melanoma cancers. Before immunotherapy was available only five per cent of those with advanced Melanoma (which had spread) survived five years or longer. With Immunotherapy that figure is now 50 per cent.

It is also used specifically for Triple Negative Breast Cancer because although hormone-led cancers are treated with hormone blocker tablets post-surgery/treatment, TNBC is not fed by hormones so Pembrolizumab is the ammunition of choice.

Meanwhile, I asked Kildare about a scan to prove the cancer was no longer hiding in a bunker somewhere.

“How do we know it’s gone?” I said.

“We don’t.” was the answer.

Thankfully I don’t just like him because of his reassuring bedside manner.

Basically, if TNBC returns, it will often resurface elsewhere in the body (not the breast) and so the blood tests they’ll do and continue doing regularly after treatment will be an indicator if it’s reared its ugly head whilst I have to ‘be aware’ of any changes myself. Will I turn into a hypochondriac? Probably.

I’ll get a mammogram after treatment ends and then annually. I asked about other scans but they are not advised due to radiation levels. So I looked it up.

A mammogram gives off a 0.4mSv dose of radiation (equivalent to 2 months’ worth of ‘natural’ radiation we are usually exposed to) which to be fair isn’t too bad considering the benefits of early detection. However, a chest CAT scan gives off 7mSv (equivalent to 2 years’ worth of radiation).

We absorb between 2 to 3mSv annually from natural background radiation and it takes a dose of around 1,000 mSv absorbed over a short period of time to induce acute radiation sickness.

If nothing else, every day is a school day at the moment.