AC then T+Herceptin then hold the T(axol)?

[chicagoetc]

AC (every three weeks) was finished in November. On December 7 2007 weekly Taxol plus Herceptin was started. My first exposure to Taxol was somewhat dramatic (a "hypensitive" reaction that occurs within the first few seconds of exposure). But we were able to continue with the Taxol and Herceptin that same day after some hydrocortisone and a half hour break (of coughing) with no additional problems.

On 1/4/08 I told my doctor about some peripheral neuropathy/hypersentivity/aches (mostly hands/feet). He said I could skip a dose of Taxol if it got worse. Last week (1/11/08) I told my nurse it was worse and the doctor told her I should skip the Taxol.

Today, I go in. I have a minor sore throat but my bloodwork came back fine. The neuropathy et al is better (not totally resolved but better, but I really didn't tell anyone at the clinic this). When my nurse checked in with the doctor she said all bloodwork came back fine but that he wanted me to not have Taxol this week either. He will meet with me next week and will talk with me then.

I don't get it. I wanted to get through the Taxol, not stop it or delay it (as much as I hate the side effects). Probably I will have to wait until next week to know. But my brain is thinking a dozen reasons (I have a poor response to Taxol...or they want me to get Radiation before Taxol...or my new insurance needs more information to cover the Taxol...or I need some other kind of test...or maybe more reconstructive surgery first...or maybe he learned something at the conference in San Antonio that will make a difference...and on it goes).

Do I just need to be patient or do one of you know why this might be? [I'm not feeling very patient though I'm halfway relieved for another week to recover from some of the Taxol.]

Melanie

[Lolly]

HI Melanie,
I don't think you should worry too much about getting another week off from Taxol; you are still receiving Herceptin, right?
I'm wondering if your onc has second thoughts on the Taxol given your sensitivity to it, and is considering Taxotere which is a reformulated version of Taxol that is less likely to cause a reaction.
There is evidence that taxanes are beneficial in reducing recurrence in HER2+, ER/PR- BC, so be sure and do your research before your next visit with your onc.
Beyond that I don't feel qualified to advise you, but here's a link to some earlier posts on the subject of Taxol use in HER2+, ER/PR-:

http://her2support.org/vbulletin/showthread.php?t=30490&highlight=herceptin+taxol

Hope this helps.

<3 Lolly

[chrisy]

Hi Melanie,

wow, that must have been scary. Perhaps your onc is just being extra cautious, but you don't have to be a patient patient. If you have questions, you can ask the doctor what the thought process is, or you can ask the nurse to find out. No reason you should have to worry and wonder about it - you've got enough on your plate.

Doubtful it is insurance related, in my opinion, because a taxane is pretty much standard of care, if they're paying for herceptin, the taxol is a no brainer.

Remember, you did have a pretty serious first round of Taxol...maybe they will consider Taxotere as Lolly suggested or perhaps Abraxane (now there might be an insurance challenge).

Good luck!

[chicagoetc]

Thanks, that helps. Sounds like I need to put a call in to my doctor's nurse so that I don't wait all week. Apparently too my reactions to Taxol may be more than average. (I forgot to mention one trip in December to the ER.) But I can't really know until I hear from someone at my clinic.

And yes, I'm still getting the Herceptin.

Melanie

[Sheila]

Melanie
What are you taking for pre meds before the Taxol? And is it oral or IV? I just know they load me up and I 've not had any problems....maybe they could switch you to a much easier Abraxane, as usually one is allergic to the Cremaphor that Taxol is mixed in....it is a nasty pine tree based solvent...it sounds bad, and I have seen some people have some very nasty reactions....at least Abraxane isn't mixed with this....

[chicagoetc]

Before the Taxol I always get Decadron (a steroid I think), Ativan, and Pepcid (an antihistamine as well as an antacid I think). Or at least that's what I wrote. I had written that I was to receive Bendryl, so maybe I get that instead of the Ativan or Pepcid. It is all IV (via port) right before the Taxol which had been weekly.

[Sheila]

Just to show you by comparison, I get 8 mg Decadron IV push, 10 mg Pepcid IV push and 50 mg Benedryl IV push right before the Taxol....I used to get it weekly, now its every other week....how does that compare with your doses?

[chicagoetc]

Assuming the Taxol is resumed this coming Friday, I will check the doses of the pre-meds.

[The more I think about it, the more I dislike Taxol...and probably would dislike Taxotere for the same reasons. This is different I know from how most people experience it. I end up measuring my days by how many bandaids I have to put on...primarily on fingers that are getting inflamed and get worse the more I use them. Then I tend to bang them into things I'm trying to pick up or find my skin/joints on the rest of my fingers/hands becoming hypersensitive and achy or painful. For similar reasons it's hard to sleep under a cover...I just can't get my feet in the right position so that it's not uncomfortable or painful. Will I take it because it is one of the best options for treatment? Absolutely.]

1/20/08: Partial answer: I had to call my doctor today because of a cold/high fever or something. He indicated he knew I had skipped two doses of Taxol and wanted to know how the neuropathy is doing. I said it was much better. It makes me think that this is at least part of the reason for skipping the Taxol twice. So, ok, maybe I don't hate the Taxol so much after all, especially if I have a doctor attuned to what is going on. I see him tomorrow briefly to followup on the fever and then Friday for a regular meeting followed by chemo and/or Herceptin.

[Lolly]

I have neuropathy from Taxol too; I've been taking B6 (100 mg daily) for that reason, with my oncs ok. I think some here take more than, but check with your onc to see if it's ok.
It seems to have helped, and I know from previous Taxol that most of the neuropathy eventually goes away.

<3 Lolly

[Joan M]

I had neuropathy from Taxol, as well. I couldn't easily button my shirts, and my hands would lose strength. I couldn't open jars or even the garage door without having to use two hands to turn the key. Taxol also affected my hand-writing, I felt like I had to concentrate on holding the pen, which made me self-conscious at work.

When I had early stage bc I took Taxol for 21 weeks, which was unusual because it is usually given concurrently with Herceptin for only 12 weeks. I was doing Herceptin and radiation simultaneously with Herceptin. I was supposed to do the Taxol for 24 weeks, but my feet were getting swollen from the steroid, Decadron, and since I had early bc at that time, I quit it at 21 weeks.

Taxol and Herceptin work very well together, if your onc thinks your allergic reaction is under control. As Lolly mentioned, ask him about Taxotere, which improved upon allergic reactions from Taxol.

[chicagoetc]

My doctor definitely has been holding back the Taxol due to the neuropathy. He was going to hold it today but we decided to try it again for a week. I appreciate that he is taking it so seriously. [After three weeks no Taxol I still have numbness/hypersensitivity but not some of the previous skin problems or muscle/joint aches/pains.]

So we'll try it for a week and see what happens.

Sheila: My pre-Taxol IV meds include: 20mg Pepcid, 4mg Decadron, and 25mg Benedryl...roughly half of what you receive. Though I'm not sure an increase would address the neuropathy (but maybe the tendency to respond to the Taxol in an allergic or systemic toxic sense). You would probably know better than me on this one.

All said there will only be twelve weeks of Taxol plus Herceptin (with or without the Taxol). Herceptin continues after the twelve weeks of course.

Melanie

[Joan M]

Melanie,

I'm glad to hear that your onc is really working with you to try to get you through the treatment.

That's always a good sign.

Joan

[chicagoetc]

Thanks Joan...I think he is. I don't know why he isn't suggesting Taxotere now...unless maybe I'm so close to the end (four weeks more and I'm done with the twelve weeks of Taxol plus Herceptin). My next steps in treatment will probably take me through the next three months. I suspect a lot depends on how this all turns out. Melanie