low dosage adriamyacin - side effects?

[eric]

Caryn went to Sloan yesterday expecting a trial suggestion and instead they suggested going back onto Adriamyacin but at a low dose given weekly. We like the idea since she has been doing well on the Doxil (same class of drug) but had to get off since it was buring her sking from the inside. Adriamyacin was the very first chemo she went on when first diagnosed and she did not tolerate it well at all. She was hospitalized as a result of constant nausea but the docs feel the lower dose given weekly should make a dramatic difference. Has anyone else done this? If so, what was your experience?

Eric

[lilyecuadorian]

I dont know ...about it ...but I know it will work for her ..I know that in my heart , so many blessing for her and for you ...love Lily

[Julie2]

Hi Eric,

Why Caryn was advised to go on AC?Can she use Navelbine with Herceptin? HAs her IHC came back positive for Her2?

Thinking about you and your family

Julie

[tousled1]

Hi Eric,

When I had Adrymiacin I was given EMEND for nauseau and never once got sick. The major problem I had was with mouth sores but the oncologist prescribed a special mouthwash for me and that took care of the problem. Other than being tired I tolerated the A/C very well -- better than the Taxatore.

[eric]

Lily - I love that feeling in your heart...thank you!!!

Julie - Caryn hasn't gone onto Navelbine and the onc felt that the adria made sense since it is specifically effective against her2.

Tousled1 - Caryn had a much harder time on the ac than taxotere but hopefully it will be much easier this time around with the dosage and timing change.

Thank you all.

Love,
Eric

[Lani]

the TOPO IIA test just became FDA approved. If Caryn is TOPOIIA negative, Adriamycin may not be the choice for treatment according to Dr. Slamon's talk at SABCS. His studies are not a slam-dunk (not reconfirmed in thousands of clinical trial patients, just in his BCIRG006 study) but many in attendance seemed to be changing their prescribing practices based on it (judging by how they answered many polls).

Any chance she could get the test?
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When you say her skin was burning from the inside out, was that in an area previously radiated?--there is a phenomenon called "radiation recall dermatitis " when anthracyclines(or other agents) are given after radiation therapy. I will try to look up if decreasing the dose was helpful or if it is more like an allergy to strawberries, where eating less strawberries makes no difference.

a bit more information--
Radiation recall dermatitis is a rare toxic effect induced by several chemotherapeutic agents in patients who have received prior treatment with radiation therapy. The recall phenomenon was initially described as redness, edema, peeling and blistering that occurred in a previously intact skin area corresponding to the field of irradiation after treatment with doxorubicin . It has been subsequently reported in association with gemcitabine , docetaxel, paclitaxel, oxaliplatin and methotrexate, among others.

Doxil or Pegylated liposomal doxorubicin has a markedly distinct toxicity profile from its parent compound, doxorubicin. Whereas cardiotoxicity appears to be reduced, mucosal damage is frequent, and cutaneous toxicity in the form of hand-foot syndrome is dose limiting. It is currently approved for its use as monotherapy in metastatic breast cancer patients who are at increased cardiac risk, in ovarian cancer patients after failure of platinum-based chemotherapy, and in AIDS-related Kaposi's sarcoma.
Recently radiation recall dermatitis was described as being induced by pegylated liposomal doxorubicin, it shows that the addition of a pegylated liposomal coat does not prevent doxorubicin cutaneous toxicity after radiotherapy. Luckily it was successfully managed with high-potency topical steroids.

The article discussing this case warned that the potential cutaneous toxicity must be taken into account considering the increasing use of pegylated liposomal doxorubicin in patients who frequently receive radiation therapy, such as stage IV breast cancer patients.
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Very low dose chemotherapies--much too little to kill the cancer cells given daily--is called metronomic chemotherapy and has been tried in trials because of its antiangiogenic effect.

Just throwing things out there as I am not sure I follow what is being suggested.

Hope some of this disjointed thinking proves useful.

[eric]

Lani, I don't know that the test makes sense only because we know she was responding well to Doxil as her lung tumors disappeared and the liver lesions shrunk. The burning was mostly on her arms and looked like blisters. Topical cremes did help but since the effects are cumulative and she only had 2 infusions, her Onc felt we needed to stop before it got even worse.