New Posts New Posts RSS Feed - Attention Newbies:  Important New Chemo Study
  FAQ FAQ  Forum Search   Events   Register Register  Login Login

Attention Newbies: Important New Chemo Study

 Post Reply Post Reply Page  <1 6789>
Author
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 13328
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 18 2011 at 3:27pm
Originally posted by dmwolf dmwolf wrote:

Newbies: you might want to discuss this study with your doctor as you work together to come up with a treatment plan.


Chemotherapy Sequence Affects Early Breast Cancer Outcomes

Elsevier Global Medical News. 2011 Jan 7, B Jancin

SAN ANTONIO (EGMN) The sequence in which paclitaxel and anthracyclines are given for treatment of early breast cancer makes a big difference in long-term outcomes.

That's the conclusion reached in what is believed to be the largest-ever retrospective study of the clinical impact of the sequencing of taxanes and anthracyclines. The study involved 3,010 early breast cancer patients who were treated during 1994-2009 and entered into the prospective online database at the University of Texas M.D. Anderson Cancer Center, Houston.

The clear winner was paclitaxel, followed by anthracycline-based therapy with 5-fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide or 5-fluorouracil, epirubicin, and cyclophosphamide, Dr. Ricardo H. Alvarez reported at the San Antonio Breast Cancer Symposium.

Starting with paclitaxel rather than an anthracycline-first regimen led to better long-term results in the settings of adjuvant chemotherapy and primary systemic (or neoadjuvant) therapy.

The adjuvant chemotherapy analysis included 1,596 women, three-quarters of whom received paclitaxel followed by anthracyclines. The 5-year relapse-free survival rate with this regimen was 88.8%, compared with 79.5% when anthracyclines were followed by paclitaxel. The 10-year relapse-free survival rates were 81.8% and 73.5%, respectively.

Five-year overall survival was 93.1% with paclitaxel followed by anthracyclines, compared with 83.2% for the reverse. The 10-year overall survival rates were 83.9% and 65.6%, respectively.

In a multivariate analysis that was stratified for potential confounders, including age, clinical stage, hormone receptor status, tumor grade, and era of diagnosis, the anthracyclines-first sequence was associated with a 67% increased risk of relapse (P less than .0001) and a 2.5-fold greater risk of mortality (P = .001), according to Dr. Alvarez, a medical oncologist at M.D. Anderson.

Among 1,414 patients who underwent neoadjuvant therapy, the 5-year relapse-free survival rate was 79.0% with the paclitaxel-first regimen vs. 61.2% with the anthracyclines-first regimen. Ten-year relapse-free survival occurred in 61.7% and 50.5%, respectively, of these patients.

Overall survival was 84.2% and 66.2% at 5 and 10 years, respectively, in patients who received paclitaxel followed by anthracyclines, compared with 71.3% and 53.4% in those who got anthracyclines first.

In a multivariate analysis, the anthracyclines-followed-by-paclitaxel sequence of neoadjuvant chemotherapy was associated with an adjusted 49% higher risk of relapse (P = .01) and a nonsignificant 28% increase in risk of all-cause mortality (P = .17), compared with the paclitaxel-first strategy.

The mechanism that accounts for the increased efficacy of taxane-first regimens for treatment of breast cancer is unclear, according to Dr. Alvarez.




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

Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 13328
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jul 15 2011 at 8:43am
bump for the newbies
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

Back to Top
shelwee View Drop Down
Newbie
Newbie


Joined: Aug 09 2011
Location: Spokane, WA
Status: Offline
Points: 3
Post Options Post Options   Thanks (0) Thanks(0)   Quote shelwee Quote  Post ReplyReply Direct Link To This Post Posted: Aug 17 2011 at 4:10pm
Thanks Donna for reposting this. I'm meeting with my oncologist today (after all of those endless tests) and am getting a treatment plan in place. I will bring this study with me in case she hasn't seen it. Good news today: My PET scan showed no other cancer. I was TERRIFIED it was all through my body. Looking forward to finally doing something about it rather than taking endless tests!
45 years old, TNBC 8/2/11, Grade 3, 1.5 cm, don't know nodes yet, working on treatment options right now.
Back to Top
shelwee View Drop Down
Newbie
Newbie


Joined: Aug 09 2011
Location: Spokane, WA
Status: Offline
Points: 3
Post Options Post Options   Thanks (0) Thanks(0)   Quote shelwee Quote  Post ReplyReply Direct Link To This Post Posted: Aug 17 2011 at 4:11pm
My post should read "grade" 3  - just noticed that. ...
45 years old, TNBC 8/2/11, Grade 3, 1.5 cm, don't know nodes yet, working on treatment options right now.
Back to Top
Lillie View Drop Down
Senior Member
Senior Member
Avatar

Joined: Jul 10 2009
Location: Eastern NC
Status: Offline
Points: 3611
Post Options Post Options   Thanks (0) Thanks(0)   Quote Lillie Quote  Post ReplyReply Direct Link To This Post Posted: Aug 18 2011 at 9:49am
Dear Shelwee,

Clear Pet scan "Whoo Hooo!   I am glad your treatment plans are beginning to fall in place. It is sooooo frightening when testing is going on and no plan is in place with which to fight, and we fear the very worst.

You are in a good place here for support of all kinds.

God Bless,
Lillie

I
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 - 11/2018-12 yrs NED
Back to Top
mags20487 View Drop Down
Senior Member
Senior Member


Joined: Aug 18 2011
Location: Florida
Status: Offline
Points: 151
Post Options Post Options   Thanks (0) Thanks(0)   Quote mags20487 Quote  Post ReplyReply Direct Link To This Post Posted: Aug 20 2011 at 3:13pm
I too will print this off and take it with me!  Thanks for this great info!
Back to Top
cheeks View Drop Down
Senior Member
Senior Member
Avatar

Joined: Jan 14 2011
Location: North Carolina
Status: Offline
Points: 667
Post Options Post Options   Thanks (0) Thanks(0)   Quote cheeks Quote  Post ReplyReply Direct Link To This Post Posted: Sep 22 2011 at 4:29am
I received my first chemo in 2009 and my oncologist specifically mentioned this study and used the Taxol first !
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.
Back to Top
Lillie View Drop Down
Senior Member
Senior Member
Avatar

Joined: Jul 10 2009
Location: Eastern NC
Status: Offline
Points: 3611
Post Options Post Options   Thanks (0) Thanks(0)   Quote Lillie Quote  Post ReplyReply Direct Link To This Post Posted: Sep 22 2011 at 12:11pm
Dear Blair (cheeks)

Congratulation on your NED status. I had my chemo in 2006, but the reverse order from yours. The "taxol first" was not the standard of care back then. It sounds as though we both are doing well.

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 - 11/2018-12 yrs NED
Back to Top
cheeks View Drop Down
Senior Member
Senior Member
Avatar

Joined: Jan 14 2011
Location: North Carolina
Status: Offline
Points: 667
Post Options Post Options   Thanks (0) Thanks(0)   Quote cheeks Quote  Post ReplyReply Direct Link To This Post Posted: Sep 23 2011 at 12:36pm
Dear Lillie, 

Thank you for the reply. Yes, I am doing very well. I continue to take vitamin D3 as suggested by my oncologist. I have modified my diet greatly - not just for the cancer but also for my blood sugars, cholesterol and for the chronic cystitis called interstitial cystitis which I developed during my A/C therapy. I can get no one to answer my questions regarding whether or not the Cytoxan may have caused the IC but I am very suspicious that it did since it can cause Hemmoraghic (sp)Cystitis which have the exact same symptoms but are supposed to only occur with higher doses of Cytoxan. If I have some questions to ask people about things we might have in common do i post it on this forum or start a new topic or survey? I am also glad that you are doing fine. 

Blair (cheeks)


Wife for 33 years and mother of 2 grown sons
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.
Back to Top
Lillie View Drop Down
Senior Member
Senior Member
Avatar

Joined: Jul 10 2009
Location: Eastern NC
Status: Offline
Points: 3611
Post Options Post Options   Thanks (0) Thanks(0)   Quote Lillie Quote  Post ReplyReply Direct Link To This Post Posted: Sep 23 2011 at 2:19pm
Hi Blair,

If would be best to post using a new topic under the TNBC Talk forum. That way your question or thoughts would be seen much easier and quicker.

So sorry about the cystitis. I have had a few bladder infections since my chemo. I've always wondered if there was any connection.

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 - 11/2018-12 yrs NED
Back to Top
cheeks View Drop Down
Senior Member
Senior Member
Avatar

Joined: Jan 14 2011
Location: North Carolina
Status: Offline
Points: 667
Post Options Post Options   Thanks (0) Thanks(0)   Quote cheeks Quote  Post ReplyReply Direct Link To This Post Posted: Sep 23 2011 at 2:23pm
Thanks Lillie, I will do that.


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.
Back to Top
mindy555 View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 13 2011
Location: Oklahoma
Status: Offline
Points: 975
Post Options Post Options   Thanks (0) Thanks(0)   Quote mindy555 Quote  Post ReplyReply Direct Link To This Post Posted: Oct 11 2011 at 4:32pm
I think what's as remarkable as the sequencing of chemo is the difference percentages at 5 & 10 years between those who received adjuvant vs. neoadjuvant therapy. My oncologist's explanation for the discrepancy in numbers is that many of the neoadjuvant group's higher staging.  For me, since adjuvant therapy was my first choice but didn't happen it's a little disheartening, just as it may be for some of you that had the reverse order of chemo- especially in light of the fact this has been known for quite some time.

A little off topic..

I literally just returned from MDA after my first dose of Taxol (which will be carried out here).  My reason for going to MDA was to seek a certified oncology breast surgeon to do surgery first. During the process I learned their protocol is neoadjuvant first always unless you are stage I.  I was clinically stage I after ultrasounds, MRI, Pet and CT scans when first diagnosed.  I'm now a IIa.   I feel like I've been standing in quicksand for too long.  So, there is a bright side by finally  being treated, even though it turned out differently than what I truly wanted- based on other TN savvy oncologist's & surgeon's opinions.  With 6 subtypes, TN is a tricky one to begin with.  I'm learning we have to go forward with the initial treatment plan, no matter what it is, with faith.  They both have their pros and cons.
Back to Top
cheeks View Drop Down
Senior Member
Senior Member
Avatar

Joined: Jan 14 2011
Location: North Carolina
Status: Offline
Points: 667
Post Options Post Options   Thanks (0) Thanks(0)   Quote cheeks Quote  Post ReplyReply Direct Link To This Post Posted: Oct 11 2011 at 6:51pm
Mindy555,

I think you are right that at some point we just have to make a decision and do something even if it's not the perfect thing to do. I first found my lump (it was fairly small) about the first of November of 2008.  I had to wait for several weeks to have a mammo. I got those results 11-11-08, had to wait several weeks for an ultrasound which was only a slight recommendation. That appointment and further treatment were disrupted by an unexpected hospitalization for a different problem. I wasn't seen for that ultrasound until January of 2009. The biopsy, PET, bone scans took place after that - we ended up not liking that surgeon at all and sought the opinion of two others, debated about which one - chemo before or afterwards, decided on a surgeon and went for the tests he wanted...an MRI...met with the oncologist he recommended. She reviewed everything -It was finally decided that surgery first was my best option because of where the tumor was located there was no saving the nipple or surrounding tissue and it had grown so large during the months of delay. The surgeon then had a death in his family and my surgery was delayed  - in the meantime I got sick with a bad cold - sinus infection and the surgery was delayed again. Finally, in March of 2009 a mastectomy was done - by this point the tumor was 4.5 cm (post surgical path report) although original estimates were 5-6 cm. That's why I totally understand the "quicksand" you are talking about and you are right about going forward with faith - with something. Best of luck to you in your treatment plan.

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.
Back to Top
mindy555 View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 13 2011
Location: Oklahoma
Status: Offline
Points: 975
Post Options Post Options   Thanks (0) Thanks(0)   Quote mindy555 Quote  Post ReplyReply Direct Link To This Post Posted: Oct 11 2011 at 8:39pm
Thank you Blair.  I wish all the best for you, too.  Congratulations on NED for over 2 years.

I'll pray for your continued wellness.   xxxxxx  Mindy
Back to Top
Erin View Drop Down
Newbie
Newbie
Avatar

Joined: Sep 26 2011
Location: Oregon
Status: Offline
Points: 8
Post Options Post Options   Thanks (0) Thanks(0)   Quote Erin Quote  Post ReplyReply Direct Link To This Post Posted: Nov 02 2011 at 3:30pm
I just wanted to let you know what my oncologist said when I brought this to his attention.  He is going to look into it further but his initial impression, and forgive me for my inexpertise, was that the study reviewed stats for people who are not on the "dose dense" therapy.  In other words, Taxol first is significantly more effective, according to the study, for those who recieve chemo every three weeks.  I don't know if it's standard now but I am recieving chemo every two weeks ("dose dense").  Although you might predict the results would be the same, there really is not telling if Taxol first is more effective with this dose schedule.
Also, I think having the AC at the end might be very difficult for some.  I have recently switched from the AC to Taxol and the difference in how I feel is remarkable.  I know I would have stuck it out but I predict many people might quit the AC if they were already run down from the Taxol.
Anyway, just some thoughts.  I hope more attention is brought to this study and I really appreciate it being posted.  I will let you know what my oncologist has to say after he reviews the study with his colleagues.
Back to Top
Grateful for today View Drop Down
Senior Member
Senior Member
Avatar

Joined: Sep 21 2011
Location: U.S.A.
Status: Offline
Points: 1835
Post Options Post Options   Thanks (0) Thanks(0)   Quote Grateful for today Quote  Post ReplyReply Direct Link To This Post Posted: Nov 02 2011 at 11:47pm
Erin,

Thank you for posting.
Am very interested in what your oncologist has to say about the question of Taxol vs AC first.
It's great that he is going to look into this matter.
From the article, the study was retrospective. Some feel prospective studies are the best way to go.
I had AC then Taxol (then surgery, then radiation).   I was not aware of the above study while having
chemo. After the fact, when I asked about ACT vs T-AC, I was also told ACT (dose dense) was better
(but was not given a resource/reference for the statement).

I recently posted a forum topic: 5FU (fluorouracil).......asking if anyone knew why MD Anderson in
Texas sometimes uses 5 FU along with T- AC.   Still waiting to see if any info will get posted.
Maybe your oncologist might know why MD Anderson uses 5FU sometimes with T-AC ?????
When I asked, I was told......different centers follow different protocols.

It's great that you are more than half way thru your chemo.
With taxol, I was told that Vitamin B 6 100mg daily might help decrease or prevent any peripheral
neuropathy.   I did take the Vitamin B6.....did get some finger and feet numbness which is resolving and
very minimal now.

With caring and positive thoughts,

Grateful for today..........Judy    
Back to Top
PTE View Drop Down
Newbie
Newbie
Avatar

Joined: Jan 14 2011
Location: San Jose, CA.
Status: Offline
Points: 13
Post Options Post Options   Thanks (0) Thanks(0)   Quote PTE Quote  Post ReplyReply Direct Link To This Post Posted: Dec 25 2011 at 6:30pm
Here we are, a little over a year since diagnosis.  Last chemo was near end of April 2011.  Rads all done!  Wife had her first mammogram in November.  Was called back due to a "mass" that couldn't be determined (we were a tad bit scared to say the least).  Further testing confirmed that it was just a fluid build up!!  All normal, all clear!!!  Doctor termed her a survivor (albeit short term so far). 

Now more problems.

Wife is having recurring bone pain especially in the large bones (hips, legs, shoulder etc)  Doctor said that could be something unrelated to the cancer or treatment since she is so far out from last treatment.  I say B.S. (of course, I'm not a medical professional).

Question?  Has anyone else suffered longer term bone pain or joint pain associated with four rounds (28 shots) of Neupogen? The oncologist seems to think wife should have all that chemo/treatment junk out of her system by now.

Thank you for being here

Pete
Back to Top
123Donna View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 24 2009
Location: St. Louis, MO
Status: Offline
Points: 13328
Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Dec 25 2011 at 6:58pm
Pete,

I'm not sure what may be causing your wife's pain, but I can tell you that after finishing chemo the first time over two years ago that I still have joint pain.  It's worse when I get up in the morning or if I've been sitting for a while.  The feet and hips just take a while to get going and feeling good.  I contribute this to the lingering effects from chemo (Taxotere especially) and it's probably just something I'll have to live with.  Is this similar to what your wife is experiencing?

Donna
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

Back to Top
Charlene View Drop Down
Senior Member
Senior Member
Avatar

Joined: Aug 14 2010
Location: Atlanta, GA
Status: Offline
Points: 613
Post Options Post Options   Thanks (0) Thanks(0)   Quote Charlene Quote  Post ReplyReply Direct Link To This Post Posted: Dec 25 2011 at 7:24pm
Hi, Pete,
I also have lingering joint pain which I believe to be a long-term side effect of the chemo I had.  I did not have Neupogen, but I did have 4 shots of Neulasta.  Like your wife, I was told by my oncologist that it was rather late to still be having symptoms, but . . . .  I had a bone scan to rule out any current bone metastasis.
Best wishes,
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
Back to Top
kirby View Drop Down
Senior Member
Senior Member


Joined: Oct 09 2007
Location: bay area,california
Status: Offline
Points: 1036
Post Options Post Options   Thanks (0) Thanks(0)   Quote kirby Quote  Post ReplyReply Direct Link To This Post Posted: Dec 27 2011 at 12:34am
PETE,
 
 I had joint pains for at least a year, year and a half,  after tx and never had nuelasta or nuepogen. I was always told that it was the chemo that made one achy. I took glucosomine/chondroiten for quite some time, then finally just stopped and it seems it had disapated. It was especially bad getting up and getting started in the mornings. The joint pains seemed to get better as the day wore on. Many dr's at that time would not associate it with tx. I was even told "I was too sensitive" , a trait most never associate with me ! Interestingly many in my online groups experienced joint pain.
kirby

dx Feb. 2001. Age 44
Lumpectomy

2cm. no nodes stage 1 grade 3

4 rnds AC, 35 rads
Back to Top
 Post Reply Post Reply Page  <1 6789>
  Share Topic   

Forum Jump Forum Permissions View Drop Down

Forum Software by Web Wiz Forums® version 12.01
Copyright ©2001-2018 Web Wiz Ltd.