Almost immediately after recovering from the serious infection that I incurred in my surgical wound post dissection of the lymph nodes in my left groin, I started interferon therapy. Since about 1995, high dose interferon alpha-2b has been the recommended adjuvant treatment of patients with melanoma who have undergone a complete surgical resection but who are considered to be at a high risk of relapse. Evidence has shown that this therapy produces a statistically significantly better relapse free survival rate than those who do not undergo the treatment. There has been no evidence that this therapy has any statistically significant impact on overall survival.
The treatment consists of a regimen of 20 million units of interferon alpha-2b per square meter of body surface per day given intravenously for 5 days a week every week for 4 weeks. My treatment started on the first Monday of July 2008. It was recommended that I come to the infusion center in the early to mid-afternoon so that “most of the side effects would be felt after I had gone to bed”.
The side effects of Interferon Therapy are described as fatigue and flu-like symptoms which include fever, chills, headache, and general body aches. Another common side effect is loss of appetite which can sometimes be attributed to feelings of nausea or the development of a metallic taste in the mouth. Less common side effects include hair thinning, dry skin, heart palpitations, and lightheadedness. The side effects are said to be reversible when therapy is stopped.
The First Week
So, after having received patient education about the therapy and a dietary consult, I arrived at the Infusion Center that first Monday afternoon. I settled into the chair, which was actually quite comfortable. My wife sat beside me. There was a television to watch on the wall right in front of us which happened to be turned to the channel she usually watched in the afternoon. I think that I remember thunderstorm warnings on the TV that first day. Probably a warning of things to come. There were thunderstorms on many weekday afternoons during July 2008 in east Tennessee.
My nurse introduces herself and briefly repeats much of what we have already been told to expect. I remember that she made the comment: “Interferon wasn’t so bad. Many more chemo treatments have much worse side effects.” She was an attractive young lady with reddish hair and fair skin – could have been one of my own children. I would have her on about 80% of the days through the course of treatment.
The treatment sessions were divided into three steps. First I was given an infusion of fluids with an anti-nausea medication also delivered intravenously. I thought to myself that nausea must not be a sometimes thing with this drug! The first step would usually take about 45 minutes given a little wait time thrown in for good measure. Next came the infusion of Interferon. This step would take about one and one half to two hours. The third step was to wait a few minutes after all of the other steps to make sure all was OK before leaving to go home. So, treatment would start between 1 and 2 pm and would finish between 4 and 5 pm. This routine would be the same pretty much the entire four weeks of the treatment.
It would take about 30 to 40 minutes to get to our parked car and then travel home after treatment. At about 20 minutes I would start the feel the first symptoms of the side effects. The first day it was only a headache in the car but by the time we got home, I had severe chills and body aches. I just got in my recliner and covered up with blankets. I didn’t have much nausea yet so I was able to eat a little dinner and then went to bed. By this time, it was all I could do to walk upstairs and with the help of my wife, fall into bed. I shivered mightily. My fever shot up past 102 degrees. The body aches were more like cramps and charley horses than anything I had felt with the flu. I finally went to sleep. By morning, I was feeling better but, of course, the very next afternoon I was back in the infusion center for my second dose.
This process went on for the next four days. I would go to the infusion center, receive treatment and go home. By the third day, I was tasting the metallic flavor that I had been warned about. It would not go away until about a month after the last treatment four weeks later. By the fourth day, the nausea had come into play. I really didn’t throw up but did I want to! All of the symptoms were worse each day than the day before. But each day, I would wake up and be well enough to go back for more.
Finally, the weekend came. By Sunday afternoon, most of the effects of the drug were gone and that night I had the best rest that I had all week. Then Monday came and back to the infusion center to start week two.
The Rest of Treatment
For the next three weeks, my wife would get me up and we would try to have lunch together before going to the infusion center for treatment. Every day I would come home sick and essentially go to bed very early, take nausea medication and try to sleep it off. Each day the side effects were worse than the day before. I learned that Interferon has a long half-life in your body. That means that most of the previous dose is still there when you get the next dose. So every day for four weeks you are just building up the amount of interferon working in your body and the amount of drug causing the side effects you feel.
I thought that after the first week that it was bad but I could make it through the entire regimen with no problem. But after the second week, I knew that it would be all I could do to make it the rest of the way.
To be perfectly honest, I really don’t remember much of the last two weeks of treatment. I was sick all the time. My wife tells stories of the neurological impact that the treatment had on me. Not only was I sick with fever, chills, aches, and pains; I was also “out of it” and “not acting normally at all”.
Finally, the four weeks were up. I had made it through the treatment. About four or five days with no further treatment, I was beginning to function more normally. I knew that there was a recommended second part to this treatment – more interferon at lower doses for the next year. I managed to do some research so that I would go to the doctor informed about what I wanted to do next. Because of the severe side effects that I had experienced, I was not sure that I wanted to continue with more Interferon. I wanted to work and get back to as normal a life as possible as soon as I could.
In my research, I found the following results from a research study:
As can be seen in this chart, the relapse free survival period for both groups was essentially the same until about year 7 when it improved slightly for those who had gone though the additional 48 weeks of treatment.
As a result of reviewing this information and discussing it with my doctor, I decided not to continue with the maintenance portion of the interferon therapy. It took me almost three months to really get back to normal. While I went to work, I was not as effective as I was before treatment. But by October 2008, I was back to normal, working hard and being productive.
I would continue to improve for the next six months. Beginning in February 2009, my son and I undertook a renovation of one of our bedrooms into a nursery. My oldest daughter and her husband were expecting a child which would be my first grandchild. I couldn’t feel better. My leg was still numb at the surgical sites but otherwise I was feeling great. I thought at this point that all was well and that I had likely beaten Melanoma – at the very least I had won the first major battle. Little did I realize that there would be more battles yet to come.