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Did anyone get by without Neulasta shot?

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arabella View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote arabella Quote  Post ReplyReply Direct Link To This Post Topic: Did anyone get by without Neulasta shot?
    Posted: Mar 01 2013 at 10:58am
I will soon begin TC chemo....6 rounds....this Tuesday..... and my doctor has said that he will probably not give me a Neulasta shot after first treatment....he will see how I do.  

Can anyone give me any advice on this?  Everybody seems to get the Neulasta shot.  Has anyone gotten by without having to have the shot???  I live about an hour and half away from the cancer center.

TIA
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debB View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote debB Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 11:08am
I had Neulasta with A/C but not Taxol.

Deb
Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote krisa Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 11:22am
I had neulasta shot after A/C and TAXOL. Everyone is different :)
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 11:44am
I had Neulasta shot after every TC chemo.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Annie Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 11:48am
   Hi Arabella,     I would say that if your insurance covers it get it.

                    If not and it is under the Dr's jurisdiction I would push for it.

                   You seem to be doing so well with getting ready for your chemo from reading your posts.   I am just thinking that if possible why not have the protection in place. I do not know how the medical works there in the U.S.   Here in Ontario if a person lands in the hospital due to low WBC the government with sanction giving the injection but only once a problem occurs. Fortunately at the time I had insurance but it covered Neupogen which is given I believe 6 days in a row. Not many plans in Canada cover Neulasta for some reason probably because it is more expensive.

                  I wish you all the best and keep us posted with how you are doing because we are all cheering for you!   Love, Annie
Annie TNBC Stage IIA Gr 3 1cm lesion 2/5 lymph nodes+ lumpectomy,FEC & D 30Rads finished(08/2009) BRCA- Chronic Cellulitis due to Radiation-- L.Mastectomy Jan 2012
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cheeks Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 11:48am
I did not receive the Neulasta at all. It may have made a difference that my chemo was not given dose dense??
 
Blair
Lump found 11/08
DX: 2/09 @52 TNBC
L. Mast. 3/26/09, SN-, BRCA-,
4.5 cm (post surgical)T2NOMO
Chemo: 4/09-10/09 Taxol x 12,
A/C x 4, No rad.No recon. NED 1/17. New Primary right breast TN, 2/2018.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Natalie Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 12:09pm
I also had the Nuelasta injection the day after each treatment.
Natalie
TNBC stage1 size 1.8, grade3 no nodes 4/11 Lumpectomy 5/11 4cycles DD A/C 4cycles DD Taxol. Double Mastectomy 12/11 BRCA all neg
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sabinecalifornia Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 12:17pm
Had the neulasta shot the day after my AC. Made me very sick.
DX TNBC 7/11 @ age 50, Stage 2A Grade 3, 1/19, LE/AD 8/11, BRCA1/2 neg.,
4 A/C, 10 Taxol, 2 Abraxane due to allerg. react. to Taxol, fin 3/12. 33 Rads 6/12. NED CT 8/12, 10/13, 10/14
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lee21 Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 12:34pm
This is what I have been able to find regarding the use of growth factors (Neulasta and Neupogen are formulations of G-CSF, granulocyte colony stimulating factor) in prevention of febrile neutropenia (fever due to low neutrophil count) (ASCO 2012):
http://jco.ascopubs.org/content/30/14/1715.long
Pg 3 Table 1 item #5
Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20% risk for this complication.
● ASCO guidelines recommend using white cell stimulating factors when the risk of febrile neutropenia, secondary to a recommended chemotherapy regimen, is approximately 20% and equally effective treatment programs that do not require white cell stimulating factors are unavailable.
● Exceptions should be made when using regimens that have a lower chance of causing febrile neutropenia if it is determined that the patient is at high risk for this complication (as a result of age, medical history, or disease characteristics).

Generally, this recommendation translates to growth factor support in the setting of dose dense chemotherapy regimen (chemo given every 2 weeks); G-CSF also seems to be provided regularly when a patient is getting TAC even though it is on a 3 week regimen. The oncologist has discretion determining who needs it based on age, co-morbidities, and other factors.

G-CSF usage is not without risk:
http://jnci.oxfordjournals.org/content/99/3/196.long

Acute myeloid leukemia or myelodysplastic syndrome following use of granulocyte colony-stimulating factors during breast cancer adjuvant chemotherapy

I've asked this of two prominent oncologists and they think the jury is still out.

Kaye, in my opinion, your doctor is taking a prudent approach.  You may be able to get by without the need for Neulasta which would be really great.  On the other hand, if your neutrophil count drops below a certain threshold (generally 1000/mm3)  or looks like it is heading that way, he can always give you Neulasta or Neupogen which act very quickly.

Also Neulasta and Neupogen can be self-administered: it's just a subcutaneous injection, no big deal.  You might not be able to get hold of the drug ahead of time for the first cycle while they are still figuring out the best way to go forward but if it is determined you need it, for subsequent cycles you can buy it, store it in your refrigerator and self-administer.  Be sure to administer Neulasta 24 hours AFTER chemo, so as not to have chemo whack out newly mobilized neutrophils. Just a cautionary note, you may have to insist on self-administering and for your oncologist to write you a prescription.  The doctor/hospital makes a lot of money out of administering Neulasta themselves so they have an incentive to have you drive to the clinic/hospital to get injected. On the other hand, be sure to check with your insurance company how much will be covered if you get Neulasta from the drug store or get it from MedCo.  Under my insurance, it's $5.00 for 4 doses if I buy it through Medco (mail order) and $100.0 from the pharmacy.
12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant
1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30
11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm
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Charlene View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Charlene Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 12:35pm
On the issue of side effects from the Neulasta shot--I was never convinced exactly why I started feeling bad on day 3.  Was it the chemo on day 1 catching up with me or the shot on day 2?  I'll never know.  I do tend to agree that if your insurance pays for it, why not, other than the hassle of having to return the next day.
Charlene
DX 3/10 @59 ILC/TNBC
Stage 1, Grade 2, Multifocal; Lumpectomy/re-excision
SNB 0/4 nodes, BRCA-; Taxotere/Cytoxan X4, 30 rads
3/14:NED
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TriplePositiveGirl Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 1:12pm
I never had a neulasta shot during chemo (i heard the side effects were not pleasant). But I also had the gemzar/carbo chemo regimen. I seem to remember that my oncologist said she would only recommend this if my counts dipped really low. Fortunately, I did not experience low white cell count and was able to receive the chemo as scheduled (oh lucky me).  Maybe this neulasta is not recommended for carboplatin/gemzar chemo?? 

Lisa
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 1:17pm
I had carbo/gemzar with my recurrence and did not have the neulasta shot either.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote kirby Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 1:25pm
I had AC . Nuelasta was not even offered or suggested during my time. But that was years ago, before dose dense and I only had 4 tx's. my energy was fine, I worked thru tx and didnt have any problems getting chemo on time.
kirby

dx Feb. 2001. Age 44
Lumpectomy

2cm. no nodes stage 1 grade 3

4 rnds AC, 35 rads
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Post Options Post Options   Thanks (0) Thanks(0)   Quote beck Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 2:40pm
i didnt need the nuelasta shot in 2007 with the er postive chemo, which was a harder chemo. they said my counts didnt stay low, but with the cmf chemo which they said was a much milder chemo for my tn last year , i needed the shot every time , and it still didnt bring counts up , it took a long time   shot made me achy in the hips beck
ER postive in 2007 10 nodes in underarm,primary unknown, right side, did chemo and rad. Dec. 2011 TN left side 1.5 CM no nodes stage 1 did cmf chemo and rads.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote debB Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 3:16pm
I should also add that they shipped it to my house and I administered it myself.

Deb
Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote susanb Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 4:19pm
I didn't automatically get Nuelasta with my first round of AC and as a result I had to wait 5 weeks instead of 4 for the next round. My counts were really low so after that I got the shot the day after chemo for the other 3 rounds. I think the reason I didn't get it with the first round was an insurance issue.
Dx June 06 stage 1 at age 46, no nodes, clean margins, Ki-67 at 54, Bilateral Mastectomy, 4 rounds AC, complete hysterectomy Aug O7. Mother and Grandmother both died of breast cancer dx in their 30's.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Loafer Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2013 at 8:16pm
Nuelasta after T&C seems to be standard care. I had chemo in the hospital and the nuelasta shot at a clinic closer to my home. Your hospital may be affiliated with other locations which you may want to look into. The shot takes 5 minutes, which isn't worth a 1 1/2 drive. Some people also self administer the neupogen shot. ( not for me!). My white count stayed up and i never got sick - so it must have worked. There are side effects so you will want to take Claritin. Good luck!
DX 8/14/12, age 51, right lumpectomy, 1 8cm, tnb, stage 1, grade 3, 0/7 lymph nodes, BRCA -    11/2/12 4 rounds T&C
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Post Options Post Options   Thanks (0) Thanks(0)   Quote arabella Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2013 at 8:37am
Thanks to everybody for taking the time to post your thoughts and personal experiences.  I feel so much better informed now. You ladies are the best!  Heart   .....    Kaye


Lee,
When it was said that Robin Roberts got msd from her chemo treatment, I just thought it was the chemo....guess it was/could've been the Neulasta shot.    I see now why my doctor said that the SEs of Neulasta shot could be worse than actual chemo.  Thanks for posting all the info.   .......  Kaye
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MLindaG Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2013 at 8:53am
I did not have any Neulasta shots.  I did not have any problems with my white blood cells counts.  I did not receive my A/C dose dense.  I had A/C every three weeks for 4 treatments.  Then went to taxol weekly for 12 treatments.  I had a 3.5 cm lump in breast and a lump in my lymph.  After all my Chemo all the lumps were gone.  I had very good response to the Chemo.  I finished my Chemo 12/20/12 and was operated on 2/13/13, will be starting radiation 3/12/13.  Good luck! Knowledge is power!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lillie Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2013 at 5:06pm
Dear Kaye,
 
Speaking of Robin Roberts having MSD from the chemo treatments.  I did hear her doctor say, on a program I watched, that the cause most likely was the cytoxin she had as breast cancer treatment.   I don't believe the Neulasta would cause MSD??
 
I had neulasta the day after all my 8 treatments.  4 a/c and 4 t/gemzar.  I did not miss a treatment, but my counts did get low the week between treatments.  Seems as though it could depend upon the individual person, or insurance or doctor preference. 
 
I was told that the third day after chemo was when the body begins feeling the SE of chemo.  I'm sure I had effects from neulasta too, but they all blended together.  I will say that the last 4 treatments (Taxol and gemzar) was when I had the bone pain, ugh! 
 
Good luck Sweetie!!
 
God Bless,
Lillie
Dx 6/06 age 65,IDC-TNBC
Stage IIb,Gr3,2cm,BRCA-
6/06 L/Mast/w/SNB,1of3 Nodes+
6/06 Axl. 9 nodes-
8/8 thru 11/15 Chemo (Clin-Trial) DD A/Cx4 -- DD taxol+gemzar x4
No Rads.
No RECON - 11/2015-9 yrs NED
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