At a glance
- Ask how long each of the treatments will take, assuming no delays.
- How will it be administered?
- How often will it need to be administered?
- Ask what side effects are expected.
- Ask if there are any side effects that you should be particularly aware of – such as life threatening.
- Ask what to do if you experience side effects.
- Ask what you can do to improve outcome.
- Ask how you can aid recovery/healing.
- Ask if your partner should stop or start anything, such as medicines or food.
Jen’s targeted therapies consisted of Trastuzumab (Herceptin®) and Pertuzumab (Perjeta®). At the time, I had no idea what they were and because they were partially administered in conjunction with chemotherapy drugs, I assumed they were chemotherapy drugs too. It wasn’t until I carried out research much later that I understood the distinction.
Also known as biological therapy, targeted therapy consists of a range of medicines which all pretty much seek to do the same thing: prevent the growth and spread of cancer.
The deciding factors as to whether they are used are quite complex but, as a general rule, they revolve around whether the cancer cells are human epidermal growth (HER2) and/or oestrogen receptor (ER) positive or negative. Thus, you may see or hear HER2+/HER2- and ER+/ER- written or mentioned at some point.
For example, if a tumour is found to be human epidermal growth positive (HER2+), then a drug such as Trastuzumab (Herceptin®) can be used to prevent cell division and thus growth and spread of the tumour. Used in conjunction with chemotherapy, which kills cancer cells, and hormone therapy, which prevents cancer cells from forming, you have a combined effect of stopping growth of existing cancer, killing the existing cancer and preventing the cancer from coming back. I’m grossly oversimplifying things here but I hope it helps you grasp the general principal.
It’s beyond the scope of this book and, frankly, my ability, to fully illustrate or understand every facet of targeted therapy. As far as I’m concerned, you and I don’t need to grasp the exact cellular mechanisms by which these things work, just as long as they do and that your partner gets the ones she needs.
The methods used to administer these drugs are very varied too, ranging from tablets, through to injections and infusions (IV drips). Targeted therapy can also be administered before, during and after the other treatments your partner may be given.
At time of writing, the following targeted therapies are in use in the UK:
Abemaciclib (Verzenios®)
Afinitor® (Everolimus)*
Everolimus (Afinitor®)*
Herceptin® (Trastuzumab)
Ibrance® (Palbociclib)*
Kadcyla® (Trastuzumab emtansine)
Kisqali® (Ribociclib)*
Lapatinib (Tyverb®)*
Palbociclib (Ibrance®)*
Perjeta® (Pertuzumab)
Pertuzumab (Perjeta®)
Ribociclib (Kisqali®)*
Trastuzumab (Herceptin®)
Trastuzumab emtansine (Kadcyla®)
Tyverb® (Lapatinib)*
Verzenios® (Abemaciclib)
*Limited NHS access at time of writing. Sadly, NICE, the governing body which decides what drugs are available as standard on the NHS, has a tendency to restrict drugs based on cost.
Dealing with side effects
There is a broad range of side effects with targeted therapies. The following non-exhaustive list gives you an idea of some of the listed side effects.
IMPORTANT! Before you read this list, keep in mind that these are some of the common AND uncommon side effects of ALL targeted therapies. Not ALL targeted therapies have ALL of the below side effects and there’s nothing to say your partner will encounter ANY of them. Jen has regular Herceptin injections with no side effects whatsoever. The list below is to demonstrate how important it is to be aware of your partner’s medication and the potential side effects she MAY encounter so you can be ready to support her.
Diarrhoea and/or constipation
Change in taste
Bruising
Abdominal pain
Headaches
Blood clots
Shortness of breath and coughing
Raised blood glucose levels (hyperglycemia)
High cholesterol
High blood pressure (hypertension)
Bowel perforation
Fistula
Indigestion and heartburn
Finding it difficult to sleep
Headaches
Back pain
Muscle and joint aches and pains
Menopausal symptoms (such as hot flushes and night sweats)
Nose bleeds
Osteonecrosis of the jaw (when bone in the jaw dies)
Slow wound healing
Numbness and tingling in hands or feet (peripheral neuropathy)
Low levels of potassium in the blood
This is all pretty scary shit, right? But, remember, there’s NOTHING that says your partner will experience any of them. If she does, the chances are it will be the common, less severe ones.
Administration of these drugs is closely monitored by the oncology team. The regular blood tests, for example, will be aimed at picking up any irregular readings and they WILL be looking for issues that are pertinent to the specific drug regimen your partner is being given. So you don’t need to be looking out for, say, low potassium, because they’ll be looking out for it. The more common side effects will need to be reported by you or your partner at either your regular oncology sessions or via your key medical team members, depending on the severity of the symptoms. A good example of this is if your partner vomits once after treatment then settles back to normal, this should be noted on the list of side effects you or your partner keeps so it can be reported at your next oncology meeting. This way they can take appropriate steps to prevent it from happening after future sessions. If the vomiting is uncontrolled, however, it needs to be reported to your partner’s primary care providers as a matter of urgency as your partner could become far more seriously ill as time goes on.
If you have ANY doubts or concerns, call the number(s) for your primary care provider(s) and ASK. They’re trained for this. You’re not. It’s ALWAYS better to ask and be wrong (worst case, you feel foolish temporarily) than to not ask and be right (worst case, your partner dies and you blame yourself for the rest of your days).
I’m not trying to scare you…well I am trying to scare you (a little bit), but in this case it’s justified I feel.