People have been asking: “How many rounds of chemo do you have to do?” or “When will you be done with chemo?”  There is no solid answer to that question because we don’t know what is going to happen.  But here is my understanding of how it sometimes goes:

• The standard strategy is to use a chemotherapy as long as it works to either hold the cancer in check or reduce it.
• The standard understanding of chemotherapy in metastatic disease is that eventually, the cancer becomes resistant to any chemotherapy, so it eventually stops working.  Basically the cancer cells figure out a way around the specific mechanism of damage that the specific chemotherapy creates–different chemo drugs have different methods of action.
• Sometimes people quit a chemotherapy that is still working because the side effects get too bad.
• If (or when eventually) a chemotherapy and it is not working (the disease progresses, shown in follow-up scans or tests), then you try a different one.
• Repeat, repeat, repeat.  Standard understanding is that you get the best/longest responses to the first one or two therapies tried; the further along you are in the chain of chemotherapy treatments, the shorter the time it will work.  This is not 100% true because some chemo drugs are just the right thing for a person’s cancer situation; and experimental drugs may be used later in treatment and be better than standard drugs; etc.  So you never know.
• The current evidence shows that trying even seven or eight different chemos may be worthwhile.
• Eventually, in standard medical care, patients decide that more chemo is not worth the side effects, because it will most likely not extend survival time; then the focus shifts to palliative care (treating pain and other symptoms of the cancer) rather than trying to stop the cancer.  Palliative care is an important specialty in medicine that apparently cancer patients do not access soon enough.  Palliative care is not just pain medication–it can include things like radiation of bone metastases that are causing pain or limiting function.

So my answer to “When will you be done with chemo?” is sometimes “Never, I hope!” Because if something’s working, without bad side effects, why would I stop?

I think in cases where people’s cancer just goes away, and they are “NED” (no evidence of disease), they sometimes stop chemo.  Also, people take breaks from chemo (for holidays, or trips, or just to recover from side effects).

But there are also people who ditch standard medical treatment–often when it stops working well for them–and try alternative or complementary treatments or integrative treatment strategies (standard plus complementary treatments).  Which I have been looking into, for sure, because standard chemotherapy in the end doesn’t have that much to offer.