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Taxol bi-weekly x 4 or weekly x12?

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    Posted: Feb 27 2020 at 4:48pm
Hello all, 

I am newly diagnosed with the dreadful TNBC and have been reading a lot from this forum and getting a lot of information, strength, and encouragement here. This is my go-to place for wonders. Thank you all for contributing to this valuable resource so we are together in the hard fight. 

About my situation: 
Jan. 10, 2020: Diagnosed TNBC, 1.8cm, T1N0M0, grade 3. Genetic testing results not out yet. 
Treatment: dose-dense AC x 4 , then T. I have done 3 rounds of AC. 

I know have a question: for Taxol, what's the best regimen: bi-weekly x4 or weekly x12?   

My oncologist's idea is that weekly T x 12:
-has less side effects; 
-has similar disease free survival as weekly, 
-and is what his facility does as common practice
-if I choose bi-weekly, it will be 6 rounds to match the T x12 total length of time. 

My reasoning is that dose-dense T x 4: 
-is one of the recommendations (the first one) on NCCA guidance. So far the clinical comparison between bi-weekly x 6 and weekly x 12 may be adopted to eliminate variables for easier comparison, in my opinion. 
- no evidence of improving clinical outcomes to extend T from four to six cycles. 
-dose-dense T can improve DFS for TNBC. 
-Less people drop out or change regimen in x 4 than in x12. 
-less neuropathy events in T x 4 than in x 12. 
Where I got these ideas/information:
1.SWOG S0221: A Phase III Trial Comparing Chemotherapy Schedules in High-Risk Early-Stage Breast Cancer https://ascopubs.org/doi/10.1200/JCO.2014.56.3296 
2. Six cycles of doxorubicin and cyclophosphamide or Paclitaxel are not superior to four cycles as adjuvant chemotherapy for breast cancer in women with zero to three positive axillary nodes: Cancer and Leukemia Group B 40101. https://www.ncbi.nlm.nih.gov/pubmed/22826271 
3. Cost effectiveness and tolerability of dose dense versus weekly paclitaxel chemotherapy in patients with early breast cancer: A real-world comparison.https://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.e18264 

I heard the x12 is a common and safe way to go, but I am thinking of the BEST plan. Since my knowledge is so limited, please give your input: were you offered with both x 4 and x 12 options? What was your experience? 

Thank you in advance,

Vivian
 

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Lisa s View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lisa s Quote  Post ReplyReply Direct Link To This Post Posted: Feb 27 2020 at 9:09pm
I was diagnosed in May 2017.  I chose weekly Taxol.  My doctor let me decide but was aiming towards weekly times 12/  I am off work in the summers so going once a week was doable.  I had ZERO neuropathy from this.  Everyone is different and I totally get someone wanted to go every 2 weeks to not have to think about it weekly.  
Hope this helps!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Feb 27 2020 at 9:34pm
Thank you, Lisa, for sharing your experience! Good to know 12 weekly Taxol is tolerable. No neuropathy is a huge thing! 

I am doing AC now and feel each infusion is hard to get by, and imagine 12 of such when it comes to Taxol would feel endless.  

I still have time and need to think more...Thank you again, Lisa!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Marymom Quote  Post ReplyReply Direct Link To This Post Posted: Feb 27 2020 at 10:04pm
Hello...
I was diagnosed 12/17/17.  1.6 cm no nodes.  I did 4 ac biweekly and 12 taxol weekly, 16 rads and 4 power blasts. AC just made me very tired.  Taxol...was very tolerable.  I had no neuropathy and I felt like myself...minus hair!  I have no side effects from treatment.
So, I hope this helps. I went to Sloan in nyc and I will keep you in my prayers...as I keep you all in my prayers.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Feb 27 2020 at 10:34pm
Thank you, Marymom, for sharing! Sloan is a top hospital! I am from Seattle. My doctor has never mentioned power blasts (Hifu if my guess is correct). I was told to go with chemotherapy, surgery, and then radiation. 

I lost most of my hair after 2 rounds of AC. So I wash my head, not hair! Like you, AC also makes me so tired, with very bad appetite. 

Thank you for your kind thoughts. I hope I can look back at all these and feel I made the right decision. It seems 12 weekly Taxol is definitely the mainstream. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Marymom Quote  Post ReplyReply Direct Link To This Post Posted: Feb 28 2020 at 6:08am
Yes...bad appetite and my taste buds were gone...with AC.  I lost a lot of weight on AC and gained it back with taxol!  

The beginning is rough, you read a lot, you are nervous and scared..but one day I realized that during treatment I could relax...as I was being monitored and watched like a hawk.  So, I did.  All those months, I decided not to worry about cancer.  I was diligent about caring for me.  My counts always were good and I caught a cold..that lasted a long time but never turned into anything else.  I followed the rules of chemo and remained healthy throughout treatment.  I iced my hands and feet and avoided neuropathy and kept ice in my mouth and never had mouth sores, this was during infusions.  For my toe and finger nails...I would soak them each day in apple cider vinegar.  They discolored, but I never had them lift or fall off.  I guess what I am trying to say is during treatment...just stay on top of you and donít worry about cancer.  They are watching you carefully.  
Godspeed dear friend and I know your decision will be the best one for you.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Feb 28 2020 at 1:15pm
You did so well and thorough with your self-care. It takes a lot time to do all needed at home with so little energy left from chemo. I realize even a tiny issue can cause huge discomfort during chemotherapy. I will save your tips to handle the Taxol infusion. 

My doctor said the 1st Taxol has to be done during weekday (I am doing AC on weekend). He will prescribe ice gloves and booties during infusion. I can see why with the possible reactions. A lot of anxiety and uncertainties, but you are right that I should relax and focus on taking care of myself. 

Thank you for your time and kindness!


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Marymom Quote  Post ReplyReply Direct Link To This Post Posted: Feb 28 2020 at 4:24pm
Viv,
Yes, you are tired...but taking care of yourself in a gentle way and knowing that everything you do for you...will be for your betterment.  It does not take much time, I worked, cooked, cleaned...I just did it at a slow pace.  Please note, on ac I did not work...I was off.  But, cooked and cleaned...at a slow pace...very slow.  With taxol and radiation, I worked the entire time.  Took off to get my infusion...and went back to work the next day.
Best, marymom
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Feb 28 2020 at 6:57pm
You are strong in spirit, Mary! I can't imagine going to work the next day after infusion; you are amazing! I am taking time off during the entire chemotherapy. For AC, I feel it's so necessary. Not sure about Taxol; if I do bi-weekly T, it will be hard. I haven't decided what to do with work arrangement during radiation.  I also do small house chores, like you said, very slowly. I take it as a way of exercise. I try to start easy aerobics exercise at home after 5 days of infusion, sometimes with light weights if I can. It's my goal to have regular exercise after the whole treatment is over. Right now, I focus on putting off the stress and taking care of myself...


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Marymom Quote  Post ReplyReply Direct Link To This Post Posted: Feb 28 2020 at 7:42pm
Work ended up being therapy.  I have a desk job...so, it was not a lot of physical work.  That was why I did cleaning and what not...it was exercise.  I also enjoy my house chores...and refused to let cancer take away my joy of cooking and cleaning!  Yup!  I love cooking and cleaning! 👀 So, exercise...try Leslie sansone walking tapes. You put them on or you tube them and you do it in front of your tv!  Everyday...I would walk a mile, maybe two, in the comfort of my home!  I would hit pause a lot!  
So...more Mary tips!  Love you kid!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Feb 29 2020 at 12:22am
Mary tips are awesome!I googled Leslie Sansone: she is viberant! I usually use Jenny McClendon's videos and now I have the Walking videos to go to. I definitely need to pause every 10 or 15 minutes-try to be gentle with myself.  

I am a school teacher so it's not possible to work while getting chemotherapy. Being on the go for many years, I think now it's time for me to put away everything for several months. 

Thanks for the Mary tipsHeart
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Post Options Post Options   Thanks (0) Thanks(0)   Quote COZAZ Quote  Post ReplyReply Direct Link To This Post Posted: Feb 29 2020 at 1:10am
Is the AC what they call The Red Devil?  Just had lumpectomy yesterday and chemo consult March 9th. Recovery nurse mentioned i would probably have the Red Devil and from what i've read is very hard on you...

I am the Storm!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Feb 29 2020 at 1:41am
Red Devil is the A part in AC. It's given before C during my infusion. Here is a link for some information. 

I have some of the side effects and feel very tired after each infusion of AC. The worst part is losing appetite (I don't count hair loss as the worst). Eating is hard, drinking water is even harder because I want to force myself to drink enough water to prevent bladder cancer. Other than that, it's tolerable. 

Just a reminder: an accumulative effect may show after 2 rounds of infusion in terms of skin color change and overall level of discomfort. But how you feel about nausea and vomiting will generally about the same as the 1st time. This is what my doctor told me and it's true with me. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote COZAZ Quote  Post ReplyReply Direct Link To This Post Posted: Feb 29 2020 at 8:05pm
Thanks  The link you sent is very helpful...
  
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2020 at 8:03am
Adriamycin is commonly referred to as the red devil.  Here's a good link for information on chemo drugs:



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 TNBCWarriorJ Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2020 at 4:45pm
I just completed (2/24/20) 4 dose dense AC and 4 dose dense Taxol.  I can't imagine having to go every week for 12 weeks.  It might be a little tougher to do the dose dense, but I am so grateful that I had a week off between and only had to go in 4 times.  My Oncologist said that there is a slight advantage to dose dense over the regular weekly, so I went for it.  Any little advantage in fighting this nasty disease is an advantage I will take.

I pretty much skated through the AC - the nausea and side effects were easily managed and minimal for me.  The Taxol was definitely harder and I did get some mild neuropathy.  For the me, the worst part is that the side effects were not as predictable as they were for me on the AC, I could also time it down to the minute when I would start feeling bad and how I would feel following the AC.  The Taxol was different and varied every time, but I still managed o.k. once I figured out that Tylenol and a heating pad/blanket worked for the aches.

I've also learned that EVERY person experiences it differently, but I highly recommend doing the 4 and getting it over with - I ran into chemo the last day so excited to get it over!!!!!

Best wishes for you whatever you decide.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2020 at 7:47pm
Thank you for sharing your experience of Taxol! Congratulations on getting done with chemo! You are indeed a warrior! 

I also feel 12 times seems forever. I know more people did the weekly than bi-weekly, but I feel I've had enough from AC and can't imagine repeating the same 12 times with Taxol. 

Taxol may or may not be easier than AC. My doctor said patients normally suffer more from either AC or T; nearly no one can be as lucky to escape from both in terms side effects. If I run into severe reactions, I can still go back to the weekly. I've planned for 12 weeks off work for Taxol; if I can complete the bi-weekly successfully, I will have the last 4 weeks to rest and recover. 

The disease free survival for bi-weekly Taxol is a bit higher, which is one of the factors I am considering. I want to try it unless I fail. I need to let my doctor know this Thursday so he can arrange for the rest. 

Thank you and I hope to join you soon at the chemo finishing line. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2020 at 7:48pm
This link has a really comprehensive list of drugs. Thank you, Donna!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Neen Quote  Post ReplyReply Direct Link To This Post Posted: Mar 04 2020 at 3:02pm
I was diagnosed in October, 1.6cm with clear nodes. I completed 4 A/C treatments, after first treatment anti nausea meds were tweaked, added Emend to Zofran. Last 3 treatments went well, I had slight nausea but was manageable. Then onto weekly Taxol with Carbo, this is a breeze compared to A/C. I feel like my old self, get tired easily, but doing well.     Everyone reacts differently, but I also believe our attitude also determines how we react.  I have 5 more Taxol/Carbo left, then surgery. Don't be afraid....I kept thinking of all the women on this forum and how they walked through the storm before me. I was going to be okay. Also, words have power...I refused to refer to A/C as the "Red Devil". I called it the"Healing Blood of Jesus", going through my veins and killing the cancer. Praying all goes well for you...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: Mar 04 2020 at 10:54pm
Thank you, Neen! I am glad you are feeling easier on Taxol than AC. I hope it's the same with me later.

I was told everyone is different in their reaction to chemo, and weekly Taxol is generally easier than bi-weekly ones. So if I don't have smooth path on bi-weekly (I will try it first), I can always go to weekly. 

I learned the drugs by their brand names so I feel neutral toward them. I also try not to think of side effects during infusion; I turn my head away and don't look at the red. It helps!
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