Neupogen verses Neulasta?

[Chelee]

The first yr I was dx with bc my onc had me on Neulasta injections when my wbc was low. But now since my recurrence she wants me on Neupogen for 3 days. That makes me living at the cancer center. I do wkly chemo so that makes me down there 4 days a week. I'd rather do Neulasta...one trip and your done. (I'm still using a walker after my femur surgery and I'm in pain and it hurts to run down there daily.)

Why do some onc use Neulasta...and others Neupogen? Does one work quicker then another...and is there a big cost difference in the two that anyone might know of? Is there less bone pain with Neupogen? How many of you get to give yourself injections at home?

Chelee

[Pam P]

I give myself neupogen shots at home. I'm on navelbine too and do 3 days of shots after each weekly chemo. Will your insurance allow you to give yourself shots at home? It took me a little while to get used to it, but it's really easy to do.

[Becky]

Chelee

Neulasta "lasts" 10 days and you cannot have it in your body over 24 hrs before or after chemo. Since you get Navelbine weekly, you cannot have Neulasta and need 3 days of Neupogen (same drug but doesn't have the "lasting" technology). Neupogen lasts about 20-24 hrs in the body (hence needing a shot a day)

[DarleneM]

My husband gave me the neupogen shots and I don't recall having bone pain. It was a matter of convenience for me. That way I didn't have to make another 50 min. drive.
Take care!
Darlene

[Colleen007]

I'm also on Navelbine (3 weeks on/1 week off) and get Neupogen for 3 days after treatment. I self-inject at home.

My insurance uses a "specialty pharmacy" for these expensive drugs, so the injections are sent to me in a cooler by the specialty pharmacy. I cannot just go down to my local pharmacy or they won't be covered. It started out that my next door neighbor (who is a nurse) gave me the shots. Then she taught my husband to give them to me and then she taught me to give them to myself.

Not sure if you have any nurse friends who can help you to learn to self-inject? It makes life so much easier for me. I then bring my used needles to the Cancer Center when I go for treatment and dump them in the sharps box there.

Good luck!

[Rich66]

Becky,
What are the time constraints with the GM-CSF (Leukine) (http://her2support.org/vbulletin/showthread.php?t=41781) that you angled for? Can you use that in a weekly setting?

Also, I had heard from a doc that the wbc support drugs like neupogen needed multiple weeks between administration to avoid calling out stem cells to rebuild and then having chemo hit them before they calmed back down. Pam's arrangement suggests otherwise. Thoughts?

Some info here: http://breastcancer.about.com/od/lifeduringtreatment/f/neulasta_cost.htm

[Becky]

Leukine is also a daily shot as the technology to make it last 10 days (as in Neulasta) is patented. Neulasta and Neupogen are the same drug but Neulasta lasts. Leukine, as you know, is different.

The thing that makes Neulasta last is that polyethylene glycol (Peg) chains are attached comb style to the active. Therefore, it takes the body longer to recognize the drug as "non self" and get rid of it. Therefore, it lasts in the body and keeps working to boost the neutrophils. Neupogen and Leukine do not have this unique feature so it has to be injected daily as the body rids itself of it as "non self". I am hoping I am making it clear.

In dense dose therapy, one really needs the full 10 day regime to get back to go. Three shots are obviously sufficient for Navelbine (a drug I am not personally familar with).

I am not sure 3 doses of Leukine would be enough to work as it takes longer (at least in the 10 day scheme of things) but usually the monocytes boost quick enough to get chemo after 10 days use and 3 down days then chemo.

[tricia keegan]

The neupogen is cheaper, I had neulasta but could'nt give myself the injections so had a nurse come to the house to give them. On one occasion she could'nt make it so I went to my GP for it.
If it meant going to the cancer centre four days Chelee I'd try to get the hang of giving it to myself.

[Rich66]

So..2 people in this thread are getting neupogen with weekly Navelbine? Either on medicare?

[Chelee]

At least now I understand "why" my onc is giving me the neupogen verses Neulasta thanks to Becky. :) I didn't know about the the Neulasta lasted the 10 days...I just figured as always my onc is trying to make my life as misrable as possible. Running to the cancer center 4 days a wk after this femur surgery is difficult for me due to the pain I'm in. But I'll live with it till I get my insurance company to ok me to do my own injections at home. I started on that process yesterday.

As Colleen mentioned I found out it does come from a speciality pharmacy so it takes a little time to set-up for home delievery. (Darn.) But my husband called his employers benefits office and they are trying to expedite it for me. I can have my husband give me the shots or learn to do them myself...anything is better then driving down there almost daily.

The only concern I have is I noticed last night around 2:30 AM I woke up to my heart beating fast and I could hear my heart beating in my head. It wasn't real loud but drove me nuts. My heart rate shouldn't be up like that at rest...makes me think It's a reaction from the Neupogen? I seem find so far today...but maybe that's because the drug is out of my system? I'll mention it to the chemo nurse and see what she says today when I'm down there.

Chelee

[Colleen007]

Hi Chelee,

Once you get set up with the specialty pharmacy, things should go smoothly for you. Giving yourself (or having your husband give) the shots isn't so bad. I've never had a fast heart beat from the Neupogen or Neulasta so I'm not sure what is causing that. Hopefully it will subside soon.

Rich, in answer to your question, I am not on Medicare. I have private insurance through my employer.

[Chelee]

Rich, I'm not on medicare either. I have Anthem Blue Cross of CA through Caltech. (HMO)

Chelee

[StephN]

Hi -
My actual last treatment with chemos was a while back now, but I ALWAYS had Neupogen support. They would adjust the dose according to how my white cell count was doing.

Last time I used it was when I had WEEKLY Navelbine and Taxol. The 2 drugs together were very effective against my cancer, but I needed the shots 5 days instead of 3.

Neulasta was just on the market then, but not useful in my case.

Not sure on Rich's question about "calling out stem cells." I am sure there is much more research since I had the drug and they know a lot more about what it does in our bodies. My understanding was that I was taking it mainly to be able to stay on my chemo regimen.
Amgen, the maker, was always a partner in my studies so I got it with just a reasonable co-pay. I self-injected.

I asked my oncologist yesterday about the latest articles on breast cancer stem cells. Her comment: "Right now things are as clear as mud."
In other words some mouse model with a particular cell line may look promising with a certain agent, but there is a LONG way to go before anything is certain.

[ElaineM]

I don't know anything about Neulasta and Neupogen. Maybe I shouldn't even offer my comments, but I decided to share some info about my experience during chemo. I never had any shots for white blood, red blood, and platelets. I never had blood transfusions. I never had to skip chemo because my blood counts were too low. My blood counts never became dangerously low during chemo.
No I am not an amazing woman !! I used supplements prescribed by my naturopathic physician and good nutrition to keep my blood counts healthy. I took liquid iron for the red blood/hemoglobin. I took a product called Echatin Plus made by Integrative Therapuetics Inc. for the white blood. It has Asian mushrooms, astragalus, echinecea and licorice. I ate lots of vegetables, fruits and various kinds of mushrooms, especially Asian mushrooms which help the immune sytem and the white blood counts. If the white blood counts are good the immune system will do its job. If the red blood/hemoglobin is good it will do its job to keep the rest of our bodies running smoothly. Liquid iron can be fount in most pharmacies. It may not be on the counter with iron pills, but going to the counter and asking a pharmacist for it usually brings success. Liquid iron should not require a prescription. If a person wants to try the herbs in the supplement they should be available without a prescription in most health food stores. The food is available in most supermarkets. Since these things may not be covered by insurance they do require good old fashioned money to purchase them. I never asked the oncologist for permission. I just made a joint decision with my naturopath. Once the oncologist saw my blood counts were healthy he had no problem with what I did. I gave him my naturopath's business card in case he wanted to ask him questions. Since then my oncologist has referred quite a few other patients who are interested in complementary or integrative medicine to my naturopath.
The chemo did its job and the supplements and food did its job. No problems with the combination.
Each person has a right to decide for herself or himself how to handle the blood count/chemo problem. Going the alternative route was the way I decided to handle the situation. I struggled to pay for the supplements and often went without other things to pay for them,but I made the right choice for me.

[Rich66]

Elaine,
What chemo regime were you on?
Of course, you may have been cured from the surgery and the rest may have been moot. In stage IV, nothing seems to be moot;) (cough)
The iron bit seems interesting since there seems to be research showing anemia to be normal in cancer and perhaps beneficial. boosting

Steph,
Despite the "clear as mud" perspective, SABC did report on some human trial info. Please pass to your onc the following threads:

Cancer stem cell articles (history, current):
http://her2support.org/vbulletin/showthread.php?t=38953

Cancer stem cell treatments (pathways, agents, combinations):
http://her2support.org/vbulletin/showthread.php?t=39323

Metformin:
http://her2support.org/vbulletin/showthread.php?t=39740

[ElaineM]

Don't start judging or assuming anything Rich. I was simply sharing my experience. Each person has a right to decide what is appropriate for her or him. Medicines and/or supplements and herbs may work differently in each person no matter what the results of clinical trials are or what experiences other people were. Each person's body and experience may be a little different and each person may respond differently to the same things.

[Rich66]

No judging. Just pointing out the medical reality/possibility. Surgery with clean margins is the still the most likely curative intervention. So with early stage treatment, the other interventions are down the list in terms of efficacy and if the surgery succeeds, "may have been moot". It's too bad there aren't any tools available for stage IV patients with the same likelihood of curative success. Makes every last shred of possibly advantageous seem important. That's all I meant.

Can't agree more about differences in response to anything injected or consumed. Even time of day of infusion (http://her2support.org/vbulletin/showthread.php?t=41606) can make a difference. At some point it comes down to informed guesswork based on whatever information is available.

Some info I was referencing regarding iron: LINK (http://her2support.org/vbulletin/showthread.php?t=32801&highlight=iron)

Obviously, the chemo regimen seems to make a difference too. What did you have?

[StephN]

Hi Rich -
Thanks for the links on cancer stem cells, but these are reports of PRE-clinical data.

I was at AACR and saw the report mentioned. I was on the hunt for info on breast cancer stem cells.

Also, at the recent San Antonio symposium, the presentation on stem cells was CANCELLED due to the presenter not showing up. Several of our group there had planned to hear that one. This was quite disappointing.

We will keep watching for further data coming out.

[Rich66]

Depends on if an oncologist does any off label treatments. The clinical data from years of cancer patients on Metformin and the indications that it affects cancer stem cells seems to suggest a move forward with an existing, low toxicity element.

The SABC anouncement with Gradishar and Chang reported on an early trial.

Some other trial based CSC info:
http://her2support.org/vbulletin/showthread.php?p=199408&highlight=Cancer+trials+excitement#post199408

Who was the presenter who didn't show up?

[ElaineM]

I am not going to discuss my medical decisions and treatment choices with you Rich.
There are many wonderful people trying to work with their doctors and make the choices that are best for them. I do not want this thread to be about you and me, so I am going to stop here and I hope you will too.

[Rich66]

It's not about you or I as much as it's about options for supporting immune function through treatment. Considering different treatments often put different demands on the immune system, seems relevant to include that context in the discussion.

[Chelee]

Since I ended up with neutropenia the first time and landed in the hospital for 12 days on a heart moniter, wide spectrum of anti-biotics & oxygen. (Counting my hospital stay along with my time recovering at home I missed a total of 21 days of chemo which I was not happy about.) Especially since that was only my first infusion of TCH...and the fact that my 1st onc told me at my 1st appt with him, "Whatever we do...once we start we do not want any interruption in your chemo under any circumstances". (Needless to say I wasn't happy about it when my onc admitted he just wasn't paying attn that day to my numbers (labs) and he should of caught it. (So that cost me big time!)

That's why my onc is being extra careful this time. The minute she mentioned my wbc was low...I told her after what happened my first go around with chemo...I better get my Neulasta on schedule this time! That's when she ordered the Neupogen that very day.

(Side note here...I was told it would take a good 2 wks or more to get an authorization to have the Neupogen sent to my house so I could self inject.) I called my husbands benefits office and pulled some strings and by day 3 of this wk I had the Neupogen and syringes so that I didn't have to run down to the cancer center.) So instead of 4 days at the cancer center...I only have to be there once. :)

Chelee

[StephN]

Way to GO, Chelee. Cut down those highway miles and stress.

Rich - the forum that was cancelled was called "Can we Measure Tumor Dormancy and Does It Matter?"
Moderator Tyler Curiel from UT.

Robert Schreiber, PhD, was to give a presentation titled Cancer Immunoediting: Immunologic Control and Sculpting of Cancer.

Have not had a chance to look up their work. I assume this all had something to do with cancer stem cells.

VERY few doctors are going to go the off-label route unless there is VERY good evidence that it is the right thing to do for the given patient. The cancer centers would not tolerate it as it leaves them open for all kinds of problems and possibly shutting down.

That is why some people go to Mexico or Germany, for example, to get some unproven treatments. Or drugs in very early stage of investigation.