All good questions! My views below, others will no doubt have more
1) There are normally 3 potential dose-limiting factors for oxaliplatin:
- cumulative toxicity - usually neuropathy. My oncologist got concerned when it was neuropathy that affected quality of life (eg balance, pain, etc) that didn’t largely resolve by the next treatment cycle.
- acute toxicity. Some folk (myself included) will have a sensitivity/allergy-type reaction somewhere along the line, which will warrant changing treatments
- treatment failure (ie progression while on treatment). This seems less common on oxaliplatin as the neuropathy is usually dose-limiting first, but can happen.
The main thing is to make sure you’re updating your onc on all side effects before each treatment, so they can factor this into your treatment plan accordingly.
2) Maintaining muscle mass is tough. I was also relatively strong before chemo, but I’ve lost a lot. I tried to double my protein intake during the “good” week between treatments (esp through shakes and lean chicken), and keep up resistance training where I could. It’s damn hard though and I think most people will experience some decline in body composition.
3) As always I’d say check with your doc, but I’ve been known to have a drink or two toward the end of my “good” week when I feel like my liver is not going to murder me for it. They say one drink on chemo is like 3 or 4 normally though, so just take it slow and definitely watch out if you’re driving or on other medications too.
Best of luck,
Male 38; Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2, May-20=1.9.
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic VMAT radiation; complete metabolic response
07/19 ULAR (robot), temp ileo, 1/27 LN
08/19 Missed a liver spot
08-11/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resection #2
02/20 Ileostomy reversed
03/20 PET & MRI = NED!