Did anyone get by without Neulasta shot?
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Topic: Did anyone get by without Neulasta shot?
Posted By: arabella
Subject: Did anyone get by without Neulasta shot?
Date Posted: Mar 01 2013 at 10:58am
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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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Replies:
Posted By: debB
Date Posted: Mar 01 2013 at 11:08am
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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 |
Posted By: krisa
Date Posted: Mar 01 2013 at 11:22am
| I had neulasta shot after A/C and TAXOL. Everyone is different :) |
Posted By: 123Donna
Date Posted: Mar 01 2013 at 11:44am
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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 |
Posted By: Annie
Date Posted: Mar 01 2013 at 11:48am
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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 |
Posted By: cheeks
Date Posted: Mar 01 2013 at 11:48am
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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. |
Posted By: Natalie
Date Posted: Mar 01 2013 at 12:09pm
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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 |
Posted By: sabinecalifornia
Date Posted: Mar 01 2013 at 12:17pm
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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 |
Posted By: Lee21
Date Posted: Mar 01 2013 at 12:34pm
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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" rel="nofollow - 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" rel="nofollow - 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 chemotherapyI'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 |
Posted By: Charlene
Date Posted: Mar 01 2013 at 12:35pm
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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 |
Posted By: TriplePositiveGirl
Date Posted: Mar 01 2013 at 1:12pm
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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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Posted By: 123Donna
Date Posted: Mar 01 2013 at 1:17pm
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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 |
Posted By: kirby
Date Posted: Mar 01 2013 at 1:25pm
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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 |
Posted By: beck
Date Posted: Mar 01 2013 at 2:40pm
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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. |
Posted By: debB
Date Posted: Mar 01 2013 at 3:16pm
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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 |
Posted By: susanb
Date Posted: Mar 01 2013 at 4:19pm
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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. |
Posted By: Loafer
Date Posted: Mar 01 2013 at 8:16pm
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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 |
Posted By: arabella
Date 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!  ..... KayeLee, 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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Posted By: MLindaG
Date 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! |
Posted By: Lillie
Date Posted: Mar 02 2013 at 5:06pm
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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 - 11/2018-12 yrs NED |
Posted By: Boo
Date Posted: Mar 02 2013 at 10:59pm
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I have used both nuelasta and neupogen. I give myself three shots a week of neupogen on treatment weeks currently, if my counts are low. It is easy once you get used to it. I usually do not have side effects. Once or twice, over two years, I did react and then I would head to bed for the day. I am grateful I can keep my counts up so that I can receive full treatment. All these meds effect us differently, so if you need a shot, don't anticipate a result, just see how it goes. Neutropenia (nuetrophil counts very low) is not comfortable either. Most of my shots have been just fine. The once or twice it has bothered me, it has not the next time. Thinking of you, Anne ------------- dx 12/2010 age 50 TNBC 12 X 9 cm tumor 1 node, 3 X FEC 9 X Doxitaxol with concurrent rads - 2X3 cm residual tumor 20/1/12 mets in lungs METMAB trial May 7 to Oct. 21, CHK1 /Gem trial 26/12/12 fails |
Posted By: Lee21
Date Posted: Mar 04 2013 at 5:21pm
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Kaye, Good luck w/ chemo tomorrow. Be sure to drink plenty of fluids today and tomorrow (I was told to drink about 2 liters of fluid) so that the IV will slide right in and the excess chemo will get eliminated (Cytoxan can also cause cystitis). If your onc is giving you Benadryl, it will make you quite drowsy. I also asked for Ativan to take the edge off (makes me drowsy in addition). I bring reading material (on iPAD), ear buds to plug into iPAD to listen to music, Gatorade/water as well as a variety of foods (trail mix, fruits, crackers). Those hours at chemo can be quite long. I'm not sure if Taxotere causes neuropathy as frequently as Taxol - when I was on Taxol initially and Cisplatin later, I took Vit B6 100 mg (from Walgreens) twice a day, acetyl L-carnitine 500 mg (from Whole Foods) twice a day and glutamine 5 gm (powder from Vitamin Shoppe) three times a day. I don't know if it helped or not - I developed low grade neuropathy in fingers and toes. I also took Miralax starting the day before chemo and through the week. Constipation is caused by the anti-emetics they give you. You might need to figure out what is optimal by trial and error. Also the Decadron (dexamethasone) they give you to take gave me insomnia for a week. Very importantly, I brushed my teeth and rinsed my mouth with baking soda/salt mouth wash after each meal. Oral hygiene is key to minimizing discomfort during chemo. I'm sure your care team has told you all of these things; there are other things I am forgetting. ------------- 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 |
Posted By: Lee21
Date Posted: Mar 04 2013 at 5:30pm
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Just won't let me edit the post. I wanted to add: Almost forgot, I took Prilosec (a proton pump inhibitor) starting the day before through 1 week-10 days after each cycle. Prilosec minimizes heart burn. Over the counter Prilosec is much more expensive than the generic form that your doc can prescribe. ------------- 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 |
Posted By: BamaRachel
Date Posted: Mar 04 2013 at 11:23pm
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Kaye, hope everything goes well with your treatment tomorrow. I had the Neulasta shots after each of my eight treatments (four EC and four Taxotere) on the day after treatment. If you do get the Neulasta shot, make sure you take the regular Claritin OTC pills once a day for five or six days beginning on the day of the shot. I did so, and never experienced any of the bad side effects of the shot. If no one has mentioned it, make sure you get some Biotene mouth products (toothpaste, mouthwash, and there's a gel for dry mouth). Do NOT use any mouth products that have alcohol in them. Biotene is expensive but well worth it. And ask for a prescription for something called Magic Mouth Wash. It will help with mouth sores if you get them. After my third treatment is when I had a hard time with my mouth. If you get a chance, message me and let me know how you're doing. You will be in my prayers tonight and tomorrow. ------------- DX 7/5/11, TN Invas; Lump w/clear marg., 7/21/11; Stage 2A. Grade 3, 2.6 c; 0/6 nodes; TX 8/22/11 4DD E/C; 4Taxotere; Chemo ended 1/3/12; 33 Radiation Treatments, ended 3/15/12. |
Posted By: *Nancy
Date Posted: Mar 11 2013 at 1:00pm
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I got the Neulasta shot the day after each of my 4 rounds of chemo (Taxotere and Cytoxan). It worked tremendously well and brought my blood counts back beautifully. My insurance did not cover it though and we spent many thousands for it. It was also painful for about 48 hours afterward, starting about 24 to 48 hours after I got it. Would I do it again? Yes. ------------- Dx March 2010, age 54, 5 mm tumor, Stage Ia, Grade 3, 0/3 Nodes, Ki-67 70%, Lumpectomy April 2010, TC x 4, Rads x 33, Treatment completed Sept 2010, NED 06/17 |