[MUSIC PLAYING]
JANE MEISEL: Hello!
How are you?
CHRISTEN CHANDLER: Good?
How are you?
JANE MEISEL: I haven't seen you
in a while.
CHRISTEN CHANDLER: I know.
It's been a while.
JANE MEISEL: Yeah.
How are things going?
CHRISTEN CHANDLER: Really good.
JANE MEISEL: Yeah?
CHRISTEN CHANDLER: I can't
complain.
JANE MEISEL: Awesome.
Still taking the pills,
and everything's going well
with that?
CHRISTEN CHANDLER: I mentioned
last time I sometimes get some
sores on my nose, and I've been
noticing a little bit of hair
loss, but that's--
I mean, I really can't complain
if that's all I've got going on.
JANE MEISEL: I mean, the hair
looks good, but--
CHRISTEN CHANDLER: Thanks.
JANE MEISEL: Yeah.
CHRISTEN CHANDLER: It's a lot
of powder.
JANE MEISEL: Some people use--
well, some people use thickening
shampoos that are biotin
supplements I think we may have
talked about that before,
which helps with hair and nail
growth
because sometimes the medicines
can actually cause a little bit
of hair thinning.
So that could be what you're
noticing.
And then with the sores,
are you using anything
like Vaseline?
Or how are you--
CHRISTEN CHANDLER: So if they
get really bad,
I'll use a pain relief,
Neosporin, on a Q tip,
and that will help.
But, I mean, they usually
are just more
annoying than anything else.
JANE MEISEL: OK.
CHRISTEN CHANDLER: Quick
question.
JANE MEISEL: Yes.
CHRISTEN CHANDLER: Since April
will be four years, so moving
into five years,
what does that survival rate
kind of look
like if once I hit five years?
JANE MEISEL: It's such
a hard question,
and I think such a moving
target.
And we talked
about this a little bit
at the beginning
when you started
that the average patient will
stay on those two drugs
for about two years
before progressing.
And then some people, of course,
progress earlier than that.
Some people, and you are falling
into this category,
do really, really well
beyond that.
And I think what we don't know
enough about yet is
these patients who do really,
really well for a long time,
what does that mean?
If the scans show no evidence
of any progression,
is there some point
in the future where we can back
off on treatment
and do less and watch you
carefully?
Or do we just continue you on it
since you're tolerating it
really well?
CHRISTEN CHANDLER: Right.
JANE MEISEL: And I think
at this point
since we know not that much
about what
would happen if we backed off,
and because when you did present
initially with your cancer
having come back,
it was pretty dramatic
with the pleural infusions,
and you were feeling pretty sick
and had the liver involvement
all this stuff,
my preference would be probably
to keep you on it even
at the five-year mark.
CHRISTEN CHANDLER: Mine, too.
JANE MEISEL: Yeah.
But I think we can--
I think we can continue to talk
about that as we get there.
And the other thing that's nice
is that having--
if you get
to that five-year mark,
or even where you are right now,
the fact you've been so
sensitive to these drugs
and they've worked so well
for so long also bodes well
for you doing really,
really well on the next thing,
if at any point
you progressively need
a next thing.
CHRISTEN CHANDLER: I know
that it can suppress
my immune system a little bit.
Are there things that I should
avoid while I'm on that?
Or can I just live life
like normal?
JANE MEISEL: It suppresses
your white blood cell count
a bit.
And that's one of the very, very
common side effects.
What we don't see
with this class of drugs,
in contrast to chemotherapy,
is that we really don't see
a lot of infections related
to that.
And so your immune system
is very mildly suppressed.
But I wouldn't say that there
are things you should actively
avoid.
CHRISTEN CHANDLER: My mom will
constantly say, oh, you're
immunocompromised.
You've got to really be careful.
Can you explain to me
the difference?
Because when I ask you that,
you'll say,
when I look at my labs,
my white blood cell count
will be critically low.
But my total ANC is on the lower
end of normal, but it's still
in normal.
JANE MEISEL: Well, I think
because the neutropenia
that you have,
the low white blood cell count
that you have
and that slightly low
neutrophil count, is really
a direct byproduct and side
effect.
CHRISTEN CHANDLER: OK.
JANE MEISEL: And we now have
studies in so many patients
on these CDK4/6 inhibitors
showing that even though people
have routinely
low white blood cell counts
and live like that,
they don't tend to be--
they don't tend to get
infections, and especially
life-threatening infections
at a higher rate.
CHRISTEN CHANDLER: OK.
JANE MEISEL: And so that leads
us to think that it's
a different kind of suppression,
that those neutrophils,
those white cells that you have
are probably still functioning
just as well,
whereas with chemo, they
probably don't function as well.
That's why people are more
likely to get infections.
CHRISTEN CHANDLER: And what
is the future of my treatment
look like?
I was
on every three-month scans, now
I'm on every four months.
What does that look
like scan-wise?
JANE MEISEL: There's
no absolute, we must scan you
every three months or every four
months.
I think some of that--
CHRISTEN CHANDLER: I like it.
JANE MEISEL: I know.
Well, I was going to say, some
of it, I think,
is also based on patient
and physician comfort,
like, how comfortable do you
feel?
Some people hate scans,
some people prefer to just get
that little check a little more
often.
I think it's arbitrary,
but I would suggest to you, just
to plant the seed,
that potentially when you get
to five years, we could space
it out to every six months
and see how things are going.
And, of course, they'll see you
probably every three months just
because we want to make sure
that you're still feeling well
and there's not anything we're
missing.
But yeah, I mean,
I think at some point
if the cancer progresses on what
you're on, I would suspect that
at that point
we would switch you
to an estrogen receptor
down regulator regimen or trials
that are open,
if you're amenable to that.
And then I think after that,
there's still so many options.
And those options probably will
look different, too, at the time
that you need them because I
suspect that will still
be several years from now,
if not longer.
So I think in the future
to me looks very, very bright
in terms of both you having lots
of options and options
that are going to allow you
to live your life really, really
fully.
CHRISTEN CHANDLER: Thank you so
much.
JANE MEISEL: Oh, of course.
I'm so glad you're able to come
in today.
It's great to see you.
CHRISTEN CHANDLER: Awesome.
You, too, as always.