Taxotere or taxol after AC?

[Jaybers]

Hello,

I had DCIS 5-1/2 years ago with a left mastectomy and reconstruction.  I recently had surgery to remove 3 lumps on the same left breast (outter margins), 1 that was DCIS and 2 that were invasive ductal carncinoma with moderate differentiation, progesterone and estrogen positive.  1 lymph node was positive with 1 mm of cancerous cells.

My oncologist was initially quite comfortable recommending 4 cycles of taxotere + cytoxin.  Then, after discussing it with a colleague decided that due to my age, 46, it would be safest for me to go the full course and undergo 4 cycles of adriamyacin + cytoxin and 4 cycles of taxol.  Based on what I have read, I feel more comfortable with taxotere (from a risk perspective and effectiveness too) and asked if I could substitute taxotere for taxol, but was told that the studies are just a year old.  Is taxotere becoming a more common/favorable way to go in combination with AC?  My body is quite sensitive to medication in general so I am trying to do my research to make this as comfortable as possible....

Thank you for your opinion and information

[Irishgal2]

Hi

I had 4 cycles of AC regmine and I was given a new anti nausea drug called EMEND.  It is manufactured by Merck Sharpe and Dohme.  I took the first tablet 1 hour before each chemo session and then 1 tablet with breakfast for the next two days.  This is now the recommended anti nausea drug in Ireland for chemo nausea as it has less side effects such as constipation.  However on the day of each chemo I was give an injection of Zofron and Dextamed (anti nausea steriod, excuse the spelling).  I also took 4 tablets with breakfast of Dextamed for the 3 subsequent days after each chemo.  My nausea was not too bad and never got sick.  So maybe ask your Oncologist about this combination also.  

[riley180]

Hi.
There is enough safety information about Abraxane to allow its use. However, as you have hinted, the use of this drug in your setting (which is chemotherapy as an adjunct to curative surgery) has not been established. In such cases it may not be reimbursed.
Inquire from your doctor if there is an ongoing clinical trial of Abraxane if you are interested.
lhughes69 is right about the red pee, but it is the Adriamycin that produces this.
My best to you.

[lhughes69]

Yes, all my symptoms decreased and disappeared approximately the same time as the return of my hair (3 months to completely go away).  I have no known adverse reactions to any of my chemo (I did 4 A/C and 4 Abraxane).  My premeds for A/C were decadron (a steriod) and zofran.  Decadron causes some antlike feeling on your main body or on your legs, but goes away as soon as they finish administering it.

I'm fairly sensitive to drugs also, so I know how wiggy you might feel about putting all these toxins in your body.  If it makes you feel better, A/C is allowed while you are pregnant (I did it!).  I don't remember any reactions to those drugs with the exception of eventual tiredness around the 4th treatment.

Just a few suggestions, stay away from Tylenol and Tylenol products (they can affect your liver enzymes and hence your bloodwork), and don't drink during treatment (same reason).  Drink a lot of water with A/C especially.  The red one (cytoxan?) will make you pee red, don't freak.  Drink a lot of water to flush this out.  Your nurse should tell you this anyway.  And try to walk as much as you can each day.  Take a good multi-vitamin and B complex vitamin (approved by your onc) to help with the fatigue.  I took the OneSource multi from Walmart and B-50 generic from Walmart.  Helped bunches.

Best of luck to you!

[Jaybers]

Thank you for your information.  I have not heard of abraxane and will be certain to ask about it since it seems less harsh. Since we are in the Kaiser system, they tend to wait for the newer drug studies to be fully published, but I will asked.  As a matter of fact, I asked about substituting taxotere for taxol and was told that the study time for taxotere was only a year, however, I have known people to do A/C with taxotere.  

I have also heard great things about Zofran and will definitely request that because I am so sensitive to medications.  Did your tingling to the fingers and toes go away after the treatment ended?

I thank you, sincerely, for your response and for taking the time to help me.

[Jaybers]

I was Her2Neu negative and I understand that to be a positive indicator.  I hear that taxotere is easier to tolerate than taxol (although they are from the same family).  I tend to agree with you about the 4 cycles so I should probably repose the question to my oncologist about having 4 cycles of AC, then following it up with taxotere.  Thank you so much for posting your information--I really appreciate it.

[lhughes69]

There is a newer drug called Abraxane which is the chemical equivalent to Taxol, but is delivered in a different method.  It's not been as thoroughly tested, because it is newer.  Your insurance may not cover the newer drug b/c of this.  It does not have some of the stronger side-effects of Taxol, takes only 30 minutes to deliver (versus 3 hours) and has no pre-meds to prevent some of the side-effects.

Call this lucky or not, but I was allergic to the delivering goo of Taxol (it's a caster-oil derivative).  Talk about your answered prayers (I didn't want to spend ALL day in an oncologist office and worrying about all those lovely side effects).  The only side-effects of the Abraxane that I had were tingling in the fingers and toes, hair loss, tiredness.

I wish you luck through all this.  If they do not offer, please ask for Zofran for nausea with the A/C.  It doesn't make you sleepy, you take it twice a day at the beginning of your treatments for about 3 days.  It kept me from getting sick.  It's a bit more expensive than Phenergan, but so worth the extra co-pay.

[riley180]

Hi.
Unfortunately, there is no clear answer to your query. I hope this helps:
If your have a positive lymph node for cancer, 4 cycles of taxotere and cytoxan seems too short.
Taxotere is a better drug in advanced and metastatic breast cancer. There is no direct comparison in the curative setting as an adjunct to surgery. Translating the benefit merely from experience in the metastatic setting cannot be done, since the risk profile of those patients are higher compared to you.
At most, it may be better to go for more than 4 cycles, and include either Taxol or Taxotere.
You should also explore your HER2 status. If this is positive, then you are a candidate for another drug which is Herceptin. Experience with combinations of Herceptin and Taxol are longer and have produced good results (the Taxotere combinations are still preliminary), so the decision may favor Taxol in this setting.