Avastin hypertension

I am now off of Avastin in preparation for surgery in December. Since Avastin prevents blood vessel growth, it needs to be removed so that the surgical wounds can heal properly.


Another side effect is hypertension. My blood pressure lately is around 155/90 and that's even with 10 mg per day of Norvasc. I haven't noticed any problems with the high blood pressure, but I know that long term it should be lower. I was curious how long it takes to return to normal after stopping Avastin, so I did a little Googling.

There's a good amount of information now about how to identify and manage Avastin-induced hypertension, but I haven't yet found any data about how patients respond after stopping it. Then it occurred to me – Avastin is usually given to patients with late stage cancer, so there's probably not much chance to track patients for years after stopping therapy.

It's just another little reminder that I'm sailing in uncharted waters and heading further from shore every year. Fortunately I deal well with uncertainty so it doesn't bother me emotionally, but as a scientist it's striking to me how difficult it is in medicine to get enough data to make informed decisions.

10% chance of survival

What does my cancer diagnosis mean? Will it be fatal? How long do I have to live? How will I feel as the cancer progresses? How, exactly, does cancer kill?

When I entered chemotherapy in September 2004 I learned that I would be receiving a relatively new anti-cancer drug, Avastin. It had been shown to improve the survival of patients with metastatic colorectal cancer. I looked up the drug information to find out exactly what to expect:


In studies, progression-free survival improved from 4.5 months to 7.5 months. Um, that doesn't sound so good. This new drug would add only 3 months to my life, and half of the patients were dead after 12 months. There's less than a 10% chance of surviving for 36 months. Chemotherapy wasn't likely to cure me, it would only slightly slow down the cancer.

However, these studies covered hundreds of patients. What condition were they in when they started? Most people with colorectal cancer were diagnosed in their 50's or older -- I was only 31. Many of them were probably elderly and not in great health overall. Would my youth buy me a better outcome? Is my cancer the same as theirs, or is mine genetically different and might it react better to treatment?

Maybe I can be in that 10% that outlive the studies. Maybe my youth will let me endure stronger chemotherapy and surgery. I don't feel like I'm dying -- maybe I'll live 2 years, 5 years, 10 years. Of course, even if I beat the odds and hold off the cancer for 5 years, that still means that I'll be dead decades younger than those people who develop cancer later in life.

My strategy is to act like I have 2 years to live. I'm not going to quit my job since I still need to pay for rent and food. I'm not going to be sad on every holiday, imagining that it's the last time I'll ever celebrate Thanksgiving, Christmas, or my birthday. I'm not going to stop dating -- I can still do fun things and get enjoyment out of life. Why should I quit trying to live while I still have things to do? What a waste it would be to act depressed and not make the most of whatever time I have left.

However, I should be realistic and deal with the fact that it's very unlikely that I'll reach old age. There's not much sense in overworking now in pursuit of early retirement. My career path might need to change. I have a PhD in chemical engineering and I want to be a professor. But that takes years of devotion, and the early years as an assistant professor can be rough. Can I live up to expectations while going through treatment? Would it be fair to take on graduate students when I might not be able to support them though to graduation?

Today I've been living 2-1/2 years with cancer. I've outlived my initial assumption of 2 years. In fact, I've kept that idea of 2 years as a sliding expectation. It's not just 2 years, but 2 more years. I'm in my third round of chemotherapy, after a period of remission tumors have reappeared in my pelvis and caused some suffering, but they seem to be responding to these drugs and (aside from the side effects of chemotherapy and radiation) I still feel pretty good and functional. I will continue to act as though I have 2 more years. I'm enjoying the annual National Cherry Blossom Festival this week, not with the sadness that it might be my last but with the knowledge that I've seen it twice before as a colon cancer patient and I'm still here, living my life as well as possible.