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Developing Drug Resistance

I love those who can smile in trouble.

Restrating Chemotherapy

In August 2013, we returned to my husband's oncologist, Dr AA. He wanted Arun to restart chemotherapy while continuing with Zytiga. He also felt Zytiga alone would not contain the disease. He prescribed Docetaxel for the next three months, in three weekly cycles as before. The doctors found evidence of disease progression in October, and a change in chemotherapy was warranted. Fortunately for Arun, the medication was oral this time round. He only had to get blood tests every three weeks and a bone scan at the end of three months, the reports of which were to be sent to the oncologist. So far, all oral medication had always worked well. It was painless to administer and easy to transport while travelling.

Arun continued to work, walk, and travel as before. His appetite remained good, maintaining a healthy Indian diet. We managed to do a family trip to Coonoor for Christmas that year. Flying to Coimbatore and driving up to Coonoor the next morning, it was as close to nature as you could get. There were rolling tea gardens on either side of the road and the Nilgiris were lush and green-soothing to the tired eyes of the plain-dwellers of north India. Arun was content to have uninterrupted quality time with his grandchildren.

Later, we went on a road trip to Bharatpur in February 2014 so that the grandchildren could see the large migratory birds that come to India every year. The three-day trip proved very fruitful for the adults, although the children found it difficult to focus on the birds either nesting or  hiding in the bushes-from long distances. The children were fascinated by the snakes at the bird sanctuary and the peacocks that woke us up every morning at our hotel, The Bagh. They were regulars at the Delhi Zoo, going there almost once every three months, and remained fascinated by the large caged animals, but observing birds from long distances was a different story.

Rising PSA and Repeated Drug Resistance

After we returned, we discovered that Arun's PSA was rising, It was becoming apparent that while some chemotherapy had worked for three-four months, the rest only manifested in toxicity and no benefit. Why was drug resistance occurring repeatedly with so many of the treatments that Arun had received? To begin with, he developed resistance to Casodex and the other hormone-blocking drugs. This was followed by resistance to Ra-223, and then to Zytiga and Docetaxel. Drug resistance was proving to be the cause of therapeutic failure at regular intervals and relapse of the disease. Was the cancer outsmarting his body's ability to curtail it while still on a particular anti-cancer drug (See p. 38-40 in 'Drug Resistance")?

In view of Arun's rising PSA, his oncologist suggested we start Xtandi, a new drug, which was recently approved by the FDA and had become available internationallyalthough it had yet not arrived in India. In March 2014, it was prescribed to Arun and we had to get special permission from the Ministry of Health to import this medicine. Though the drug was orally administered, Arun had a great deal of toxicity with this therapy, including nausea and fatigue. Besides, it did little to control his disease and the oncologist decided to stop this treatment within two months. It was Ineffective. The PSA had continued to rise during the two months of the new medication.