Platinum-Level Treatment

Tomorrow is my second round of treatment, and boy do I ever have mixed feelings about it! I don't want to voluntarily show up for something that will make me weak and miserable. The alternative is even worse, though, so needs must.

I'm getting a combination of chemotherapy and immunotherapy, for which I have coined the term "chemunotherapy." Along with some medications to prevent the worst of the immediate nausea and inflammation, they'll be giving me three infusions:

1. Carboplatin. As the name suggests, this chemotherapy drug is actually made with platinum. So I am, literally, getting platinum-level treatment. In fact, many cancer patients get one of the family of platinum-based chemo drugs, which reduce DNA repair and synthesis, keeping the cancer from growing. This particular platin is less toxic to the patient than its predecessor, cisplatin, though cisplatin is still used depending on the particular cancer and/or patient profile. Carboplatin does still cause nausea, and it can cause a dangerous drop in white blood cell count. I am unlikely to lose my hair, though it may well thin. No sign of that so far, though.
2. Pemetrexed. This is a more specific chemotherapy drug which is used for pleural mesothelioma and non-small cell lung cancer. It is a folate antimetabolite, which prevents DNA and RNA synthesis, slowing cell division. I take vitamin B12 and folic acid to reduce negative consequences to me, as opposed to to my cancer.
3. Keytruda (pembrolizumab). This is the immunotherapy part of the cocktail. It is a "checkpoint inhibitor," which means that it turns off the cancer's protective messaging that tells the immune system that the cancer cells are me and not an invader. One of the most common side effects—which I have been experiencing—is fatigue. Keytruda has been approved for some kinds of cancer, such as advanced melanoma, starting in 2014 but was only approved by the FDA for mesothelioma in September of 2024. I am therefore getting the very latest treatment while also knowing that oncologists have ten years of experience with it.

Medical side effects to these medications range from the unpleasant to the fatal. A further side effect is a very large medical bill, particularly for the Keytruda (see photo). I have already hit my out-of-pocket maximum for the year and have surely endeared myself to my insurance company.

The eye-popping figures for a single treatment. The $1.20 is almost funny in the context.

The treatments are every three weeks. The general pattern is that week 1 is the infusions and worst of the side effects. During week 2 I can expect to recover from the side effects, feeling a bit stronger with each day. Week 3 comes with further improvement and is not so bad except for the growing dread of the next cycle. I'll get 4 to 6 cycles, depending on how my blood counts hold up.