Wait, what? Why chemo?
I know that I’ve written about chemo before, but I still get asked about it on a regular basis. And I realize that it’s even more confusing now that I’ve actually been diagnosed with malignant cancer. So, to lay it out clearly: surgery was enough to treat my cancer, and the chemo that I’m on has absolutely nothing to do with cancer. Instead I, and many others, take low-dose chemotherapy to treat my lupus.
As a side note, I’m using “chemo” or “chemotherapy” as it is used in the vernacular; the terms refer to medications that are traditionally given to cancer patients. (As opposed to the scientific use, in which any chemical used to treat a disease can be called a chemotherapeutic agent).
But lupus isn’t cancer, right?
No, lupus is not cancer. Lupus can predispose a person to develop certain cancers, but it is not itself any form of cancer. So why do we take chemo? The answer is that we basically take it for the side-effects. When a cancer patient takes chemo, one of the side-effects of the treatment is that (s)he becomes very immunocompromised. The chemo “accidentally” kills cells in the immune system while killing cancer cells; it’s a form of chemical friendly fire. This is why cancer patients tend to be very careful about crowds, and will wear face-masks if necessary to avoid infections. Lupus patients, on the other hand, need our immune systems to be shut down, since the immune system is responsible for our disease.
How does chemo help treat lupus symptoms?
What many people don’t realize is that chemo drugs generally don’t target any specific kind of cell. There are certainly exceptions, but most of the time the chemo is a wide-spectrum poison that kills any rapidly dividing/growing cells. Since many cancers grow much more quickly than most healthy tissue in the body, this strategy can be highly successful in treating cancer. Unfortunately, cancerous cells aren’t the only quick-growing cells in the body, and other quickly growing cells will also be killed by chemo. The idea is to give a patient enough chemo to kill cancerous cells, but not so much that it kills the patient. As it turns out, the cells in the immune system are some of the most quickly growing cells in the body, so they are hit hard by chemo drugs. So for those of us whose immune systems are overactive, chemo can help kill off enough immune cells to help improve our symptoms.
Do lupus patients on chemo have the same side-effects?
This really varies from person to person. In general, lupus patients take a lower dose of a chemo drug than a cancer patient would, so the side-effects tend to be less severe. That being said, yes, most of us experience some degree of nausea, headaches, mouth sores and often hair loss. The symptoms are there, but they aren’t (again, generally) as severe. Side-effects from chemo occur because other rapidly-dividing cells, such as the cells that line the mouth and GI tract, are killed. Chemo is not a very specific tool, which is why the approval of new, more targeted, lupus drugs is so exciting.
How long are lupus patients on chemo?
Cancer patients are often given a defined schedule of chemo treatments. They may, for example, have to receive an infusion of chemo once every other week for two months. Lupus patients, on the other hand, very rarely have a defined schedule. We don’t get told to come in for two months. It is not uncommon for a patient to stay on a particular chemo drug until the body builds up resistance to it. So we don’t know how long we will be on chemo, but it’s likely to be months or even years. This is only possible because the dose given to lupus patients is significantly less than that given to cancer patients.