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Taxol - Dose Dense question

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    Posted: Feb 05 2009 at 11:44pm

Hello everyone.

My wife is nearing the end of her AC treatment.  Then she moves onto 4 rounds of Taxol.

We all know that dose densing reduces the risk of recurrence with Triple Negative.  And so I was really happy when Andrea's Oncologist said she'd be taking the Taxol over 2 week spells - as opposed to the standard 3.

My question/concern is this...........

How come we're reading about so many Triple Negs who have their Taxol WEEKLY - not 2 WEEKLY?

Do the weekly patients take a lesser dosage, but have more than 4 rounds?

Would be so grateful for your opinions/experiences. Smile

James


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Post Options Post Options   Thanks (0) Thanks(0)   Quote pinetree Quote  Post ReplyReply Direct Link To This Post Posted: Feb 06 2009 at 2:23am
Dear James,

I'm glad you posted this question, as I have the same one.  I only have one more A/C and then I will be getting 12 weekly doses of Taxol. 

So - sorry that I don't have the answer, but glad you posed the question. 

My hats are off to you husbands who are information gatherer's like you.  

Take Care

Melissa
Lumpect. 10/28/08,
DX 11/3/08,
Meddulary Invasive TNBC
BRCA1/BRCA2 Neg, 0 nodes
12/8/08 Bilat Mastect
w/reconstruction
Jan 09 will begin
AC every 2wks x 4
T every week x 12
ST 2/Gr 3
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: Feb 06 2009 at 5:59am
Oncologists differ, but my understanding is that the standard of care for dose dense AC&T is for 12 weekly fractionated doses of Taxol in the second phase.  Altogether, it ends up being a somewhat higher total dose than the amount that used to be given in 4 tri-weekly shots.  Taxotere, on the other hand, is not usually fractionated this way.  It also is not generally given dose-dense, because of toxicity, I think.  So I'm not sure where the 4 doses of Taxol given every two weeks are coming from.  It must be an older, or alternative version of the dose dense protocol.
Best,
Denise
DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote krisa Quote  Post ReplyReply Direct Link To This Post Posted: Feb 06 2009 at 6:18am
i had dose dense AC and Taxol.  i have no idea why oncologists prescribe different chemos and doses.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote phoenix Quote  Post ReplyReply Direct Link To This Post Posted: Feb 06 2009 at 7:23am
Frenchie,
 
I have read that in studies done with Taxol. 12 weekly rounds with a lesser dose is better. The study said the women that had 12 doses over 12 weeks, did much better all around plus their reoccurence rate was less than the other group. I think more doctors are doing it that way now. 
 
I am in a clinical trail taking avastin an (immunology drug) with the taxol
and thats how they do it. (12 doses)
phoenix
phoenix
DX 7/08
Lumpectomy 8.22,08
Stage II Triple Neg.
No node
Clear Margins started to go into blood vessals.
IDC
4 A/C Dose Dense
12 Taxol
rads in March
Albany,N.Y
Capitol Region
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Nancy Quote  Post ReplyReply Direct Link To This Post Posted: Feb 06 2009 at 7:49am
James,
 
Here are 2 links which we have on the News forum. This was discussed many months ago. My friend Sandra Jean was only to receive 4 treatments, and then they changed it to 12. Hope this helps.
Nancy
 
 
 


Edited by Nancy - Feb 06 2009 at 9:25am
Nancy
DD Lori dx TNBC June 13,2007
Lumpectomy due to incorrect dx of a cyst
mastectomy July 6 2007
chemo ACT all 3 every 3 weeks 6 tx Aug-Nov
28 rads ended Jan 2008
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Post Options Post Options   Thanks (0) Thanks(0)   Quote peach Quote  Post ReplyReply Direct Link To This Post Posted: Feb 06 2009 at 9:24am
I also had dose dense AC&T, but noticed others on the board were getting it every 12 weeks.  I talked to my oncologist about every week but they wouldn't budge.  Sure wish I'd had the above info back then to show my Doc.  I couldn't find anything in writing at that time I really needed our researchers Nancy and Trip back then.
 
I personally will take any edge I can get fighting this disease.  Check back in and let us know what you find out.
 
Pat
Dx 5/07 TNBC
IDC Stg.2, Gr.2,
Sentinel node 0/1 BRCA-
Lumpectomy,Chemo(AC-T DD)Rads
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Nancy Quote  Post ReplyReply Direct Link To This Post Posted: Feb 06 2009 at 9:34am
Hey Pat,
 
I wish I woud have known this for Lori also. That was August 2007 when she started chemo. However, I don't think these articles came out until last year. Lori had 6 treatments of AC and T combined. I would think that was the same dosage, spread over a longer time period. They said hers was dose dense...or do I have that flipped? The understanding is that the little c beasts do not have time to regroup if the T is given every week.
 
The women on the site who are 15, 20 years out from dx had their chemo every week for a year. Same concept as the T.
Hugs,
Nancy
Nancy
DD Lori dx TNBC June 13,2007
Lumpectomy due to incorrect dx of a cyst
mastectomy July 6 2007
chemo ACT all 3 every 3 weeks 6 tx Aug-Nov
28 rads ended Jan 2008
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Frenchie Quote  Post ReplyReply Direct Link To This Post Posted: Feb 07 2009 at 3:38am

Thanks so much for this guys.

Andrea is being given the highest dose AC/Taxol - but over 2 not 3 weeks.  But upon reading this evidence, I will definately taking the matter up with her Oncologist about the weekly option.

From my heart, again, I can't thank you all enough for your invaluable opinions/experiences.

James
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Netterz Quote  Post ReplyReply Direct Link To This Post Posted: Feb 07 2009 at 9:45am
I was supposed to do dose dense Taxol, after the standard AC bi-weekly, which I had no reaction to at all, not even so much as a queasy tummy. I was apparently highly allergic and could not complete the 4 taxol x 2 weeks. I had been so sick,  I was told by the nurses in the infusion room, I had turned purple and almost stopped breathing a few minutes into infusion, that they wheeled me down to the ER both times for emergency toxicity treatment, but my Onc refused to change the Taxol and I refused to take it again. My breast had started swelling, was hot, and an angry red color, pitted, nipple retracted inside, and terribly painful, so I was more worried about why that was happening, instead of arguing with the Onc about going back for more Taxol,  l fell out of the regime, I decided that I was not going to risk going back and attempting another try more Taxol by doubling up on the pre-meds, I almost died, so it was not going to happen. 
 
I have heard from other women, and then asked my new Oncologist, that due to certain allergies, as well as each persons organs ability to flush the toxins, they have to go with different regimes, and at times, lower doses more often, and adjustments to the premeds, as well as what goes in along with the chemo, and how slow they infuse it.
 
In the blood work that they use to monitor each persons ability to handle the different types of chemo, is usually how the Oncologist determines what the best possible way, type, duration, and speed of the infusion to administer the chemo treatments, for each person.
 
The working condition of the organs that work to flush toxins from the body, kidneys, liver, heart, etc. as well as known allergies, all plays into how the Oncologist determines for each individual, the safest most effective way to treat each person.
 
That is how it was explained to me. Hope this helps
 
Hug
 
 
T-Neg diag.5/07-40yo
Stage IIIa
Grade III
7/26 +nodes ax.
4-A/C pre-lumpectomy 2 Taxol post
+Tissue involvement
Finished Rad 4/08
DX of Advanced CTCL 2/09
Lansing,MI
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Post Options Post Options   Thanks (0) Thanks(0)   Quote kskitn Quote  Post ReplyReply Direct Link To This Post Posted: Feb 07 2009 at 10:54am
I hope your wife is doing well and I just finished my 1st dose of my 12 week regimen.  I have been doing some reading and from what I can understand Taxol is more successful for TNBC patients.  I would ask the onc and see why they are doing biweekly instead of weekly.  I may wish I was biweekly when I get into the middle of this but so far so good.
 
I kept hearing how much better T was than AC and so far it is like day after weeks of nights.  Much better and easier on my system.  I know that 1 out of ever 10 people have severe allergic reations but I think that the pre-med help the other 9 make it through.
 
Good-Luck and let us know if you get an answer.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Krys Quote  Post ReplyReply Direct Link To This Post Posted: Feb 07 2009 at 12:24pm
HI htere,
I am doing Taxol every two weeks. When I asked about the weekly reigime my onc said that the research was done on the difference between 3 weekly and weekly. This showed a about a 3% improvemet in survival rate I think. However she thought that a dense dose at 2 weeks would offer the best for me, but said if I really wanted weekly at a lower dose she would do it. I have to say I have found the side effects from Taxol to be much more hard to deal with than the AC. However only 2 cycles to go!!!!!
Mastectomy 20th Oct 08
4 tumours 1x2, 2x3 + 1x4 cm
Grade 3, stage 3
Clear margins
2/26 nodes +ve
Scans clear
20 Nov start 4x2 weekly AC then 4x2 weekly Taxol
30 Rads starting Mid march 09
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Post Options Post Options   Thanks (0) Thanks(0)   Quote yjennings Quote  Post ReplyReply Direct Link To This Post Posted: Feb 07 2009 at 6:03pm
I did the dose dense for A/C then Taxol.  My oncologist said that he thought I would be able to handle it based on my labs, my age, and my health.  He did however give me the option to do ACT all together every 3 weeks but I chose the other.  I was able to do 3 of the 4 Taxol, had itching about 5 days after each treatment and got progressively worse.  Turns out it was neuropathy and he prescribed gabapentin and metanx and it has helped tremendously.  I go see the radiologist on Tuesday.
38 yrs old dx 10/08
1.2 cm, Stage 1, Grade 3, IDC
neg node, lumpectomy
AC x 4
Taxol X 4 did 3 of 4 (canx last treatment due to neuropathy)
Radiation: 35
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Post Options Post Options   Thanks (0) Thanks(0)   Quote trip2 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 09 2009 at 6:25am
Net,
 
Possibly because of the way I read your post regarding your reaction to Taxol a question immediately jumped into my mind re what you are going thru right now.
It may be the way I read it and no connection whatsoever but is there any possibility that the Taxol could have caused what has happened to you?
I know some are allergic to these different meds they throw our way and have various reactions.
I guess in the way you phrased it I just thought I would ask.
 
All my best,
 
Stage 2 2003
Stage 1 2007
BRCA 1+
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Netterz Quote  Post ReplyReply Direct Link To This Post Posted: Feb 09 2009 at 9:00pm
Nope.... the verdict is in... I am going to post the email I sent you and Nancy, so  I dont have to type it all out again, my poor brain is about fried after today.... lol
T-Neg diag.5/07-40yo
Stage IIIa
Grade III
7/26 +nodes ax.
4-A/C pre-lumpectomy 2 Taxol post
+Tissue involvement
Finished Rad 4/08
DX of Advanced CTCL 2/09
Lansing,MI
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Post Options Post Options   Thanks (0) Thanks(0)   Quote AC and JC Quote  Post ReplyReply Direct Link To This Post Posted: May 21 2009 at 2:38pm
Hey all:

I know this is an older thread but it came up as my wife and are considering bi-weekly vs. weekly Taxol (she just finished her second AC today). So, I figured I'd stick a link here to help the next folks looking for guidance in this area.

This quote is in the context of Avastin & Taxol, but Dr. Robert Livingston from the Arizona Cancer Center in Tucson states that weekly paclitaxel is "the best way to administer the drug". The full article can be found here.

Thanks,
Jason
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Sunris Quote  Post ReplyReply Direct Link To This Post Posted: May 21 2009 at 3:21pm
I have always wondered the same question regarding why some get different doses / time frames for Taxol. I am doing neoadjuvant chemo with 12 ( 1 x weekly ) doses of Taxol THEN I will be doing FAC for 12 weeks ( 1 treatment every 3 weeks, I believe) ... Then it will be surgery time ( still not sure as to what route it will be) .... I have spoken with many women here at M.D.Anderson and it seems to me that their standard of care is this particular action plan ( unless of course you are stage IIIB ? or stage 4 ? ) Or in a more rare circumstance) When I read many posts here on this site it seems to me that more women have AC then Taxol ...hmmm...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg--- Quote  Post ReplyReply Direct Link To This Post Posted: May 21 2009 at 5:26pm
Dear All,
 
Dr. Livingston is called the Father of Metronomic dosing (weekly). Weekly chemotherapy seems to be more effective with fewer side effects. I tried hard to get weekly Taxol 2 years ago in Canada to no avail.
 
Maybe it is a coincidence but long-term survivors have had weekly chemotherapy have had it for longer than 6 months (1 year seems to be common).
 
Just a bit of trivia but the dose-dense (found to be 28% more effective for triple negative than the once every 3 week regimen) is called the Simon-Norton Model (Dr. Larry Norton).
 
Those minds that think outside the box will be the ones that find the cure without all the side effects for us! If only we could channel the pink river  of money into research!!
 
The weekly chemotherapy makes sense for us since our tumors are high-grade, usually high Ki-67 and weekly would kill the tumor cells in every phase of the cycles life.
 
One of our sisters from Japan had dose-dense AC + T followed by one year of Xeloda.  I bet we may find the TNBC having neoadjuvant to test for efficacy followed by weekly chemotherapy longer, with less toxic effect. I would trade a year for chemotherapy for old age any time.
 
Connie
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Roxanne Quote  Post ReplyReply Direct Link To This Post Posted: May 21 2009 at 8:35pm
Hi,
   I was wondering what they did differently for Stage IIIB or 4?
 
Blessings, Roxanne
DX 1/09 Metast. Adenocarcinoma
Stage IIIb Grade 3 TNBC
BRCA 1/2 Neg.
Lumpectomy & Ax. Node Dissect.
4 Tx A/C finished 5/09
12 Tx Taxol finished 8/09
35 rads finished 9/09
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Post Options Post Options   Thanks (0) Thanks(0)   Quote trip2 Quote  Post ReplyReply Direct Link To This Post Posted: May 23 2009 at 3:38pm
Hi Roxanne,
 
What you might do is post your question in the Recurrence/Metastasis & Tips section of the forum.  Many ladies there are Stage IV and would definitely give you some help.
 
Best wishes
Stage 2 2003
Stage 1 2007
BRCA 1+
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