Risk of Nuelasta(sp)?

[smokey 234]

I am undergoing dose dense AC + T.  I have finished 2 doses of AC. I am wondering about the side affects of the Nuelasta shot. Somebody told me that a woman died from it in a phase 2 study due to lack of oxygen to the brain.  I didn't realize that anything this risky could happen.
Also, my oncologist implied that since my counts were good after the first AC that I might not need Nuelasta shots when I do Taxol. Have you everheard of that?
And, last but not least, I know it is wrong to second guess but am I doing overkill.  I have a 2.3 cm invasive lobular cancer, est, prog both 90%+  her2 - o out of 3. Sentinel biopsy 4 removed all clean. My margins were clean except there is some LCIS in the breast. I hope I am not overtreating this thing.
Sorry for so many questions, but this site is very helpful.

[CCF-RN,MSN-rf]

Dear Smokey234:  Most of the data using dose dense therapy has been on women with high risk disease.  Based on your nodal status and HER2 status, your risk may not be considered "high" from the point of view of systemic disease.  From our perspective, neulasta is a safe medication.  We have not had any serious problems using it.  In the setting of a clinical trial, anything bad that happens to a person must be reported, regardless of whether it is thought to be due to the medication or not.  If, in fact, this story is true, it may be that the person suffered some type of event and coincidentally was taking neulasta.  Growth factors (neupogen or neulasta) are given during dose dense therapy for prophylaxis as part of the protocol.  The theory is that part of dose dense therapy means keeping on schedule.  If we wait to see if the counts drop before using growth factors, we may delay therapy such that the benefit of dose dense therapy is not obtained.  Of course, in lower risk women, we do not know whether there is an advantage to using dose dense therapy at this time.  

Finally, you mention that LCIS remains in the breast.  This does not mean clean margins.  If there is LCIS in the breast, most would recommend additional intervention for local control; either reexcision of the lump, mastectomy, or, in some cases, radiation therapy may be acceptable.  Radiation would be recommended in any case if a lumpectomy were performed.

[smokey 234]

In regards to the LCIS the quote was on the new posterior margin ot ink right breast, Lobular carcinoma in situ involving ducts.  No evidence of carcinoma at inked margin. The path report was read by someone at Sloan who said that they do not go back for the LCIS but it will be treated with radiation.  Do you think that I should have had a re-excision?

[surgeon]

Actually, LCIS does not have the same significance as, say, DCIS: it's considered a marker but there's always been controversy about its actual significance. When found, in many cases it's felt adequate simply to follow serially. So having it at margins is not really considered (by many, anyway) to be "unclean" margins. The official answer you got above might have been thinking of DCIS.

[smokey 234]

Thank you. That is what they told me at corenell weill and Sloan Kettering. They said LCIS signifies a greater risk of developing cancer, but not necessarily from those cells.  I was clearly told I had clean margins, by those two institutions, and that in 2004 pathologists donot go back for LCIS just for DCIS. I pray my information is correct.  I will be having radiation after chemo.