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-   -   Administration Every 3 Weeks Instead of Weekly for First 18 Weeks (http://her2support.org/vbulletin/showthread.php?t=67850)

MC1 04-06-2019 03:58 AM

Administration Every 3 Weeks Instead of Weekly for First 18 Weeks
The administration guideline on the Herceptin website specifies that it should be injected weekly from weeks 2-18 for TCH treatment. However, the doctor at my public hospital administers Herceptin every 3 weeks starting from week 1, ignoring the weekly regimen, is this going to increase my recurrence rate?

Becky 04-06-2019 11:22 AM

Re: Administration Every 3 Weeks Instead of Weekly for First 18 Weeks
I think everything will be just fine. Discuss your concerns with your doctor and why the three week regime is being used straight upfront

Lucy 04-06-2019 01:10 PM

Re: Administration Every 3 Weeks Instead of Weekly for First 18 Weeks
I agree with Becky that it should be okay but that you should discuss your concerns with your doctor for your own peace of mind.

It's worth noting that the dosage is based on the frequency given, meaning that you should get a stronger dose if you're only getting it once every three weeks. Is three weeks the schedule for your other drugs? If so, that may be why getting herceptin every three weeks was set up - more of a convenience for the patient. That would be my guess anyway.

MC1 04-06-2019 10:01 PM

Re: Administration Every 3 Weeks Instead of Weekly for First 18 Weeks
Thank you Lucy and Becky, I will raise this concern with my doctor. Just to give some background information, I am receiving treatment from a public hospital which has a critical shortage of doctors (i.e. at any point in time, this public hospital system that provide free medical care for the entire city is short by 300 doctors) which is public knowledge and is in headline news.

After my first cycle of chemotherapy, consisting of IV administration of 3 drugs (Herceptin, Corboplatin, Docetaxel) every 3 weeks for 6 cycles with Herceptin continuing for one year after, I was scheduled for the second cycle injection in 4 weeks instead of 3. When I asked the doctor why there was a 1 week delay, their response was it's because they are short of doctors. I fought with the nurses to schedule me in earlier and luckily they conceded but told me it's a one-time exception. I had to fight again for the timing of my 3rd cycle to be on the 3 week schedule, and luckily they conceded.

I thought all was well until I read the administration guidelines on the Herceptin site: https://www.herceptin.com/hcp/treatment/adjuvant/dosing
The instructions specify that for the TCH adjuvent treatment, the drugs Corboplatin and Docetaxel are to be given every 3 weeks for 6 cycles starting week 1, however, Herceptin is to be given weekly for the first 18 weeks.

This worried me and I wonder if the public hospital doctor bypassed the weekly instructions because of their staff shortage (i.e. it's more labour intensive to give me Herceptin weekly). I did notice that my dosage for the Herceptin was higher than the weekly dosage, the dosage was in accordance with the 3 week regimen.

Given that HER2 is an aggressive form of cancer, I am worried that derailing from the regime will affect Herceptin's efficacy and increase the chance of recurrence. I don't really have any clout with the public hospital doctors and wonder if I can get help somewhere else, perhaps from pharmaceutical companies, holding doctors responsible for the risks associated with derailing from clinically proven regimens.

Meti 04-07-2019 03:45 AM

Re: Administration Every 3 Weeks Instead of Weekly for First 18 Weeks
You should check the Herceptin Package Leaflet online. I’m in Italy, and when I was a week late in therapy, I got my first dose back. Because the first time you do Herceptin they give you a higher dose and then you do it every three weeks. But if you are one week late, you should redo the first dose, the initial one and then resume every three weeks.

Lucy 04-07-2019 06:36 AM

Re: Administration Every 3 Weeks Instead of Weekly for First 18 Weeks
Now I'm wondering how old the report is you read. I was treated at MD Anderson where there is no shortage of doctors. It and Sloan Kettering are the top two cancer facilities in the country. I got herceptin weekly for 12 weeks and then went to every three weeks. I was on a different chemo regimen than you and I was getting the chemo every week, which is why I got the herceptin every week for those twelve weeks. When I stopped getting chemo, I moved to every three weeks for the herceptin. So I didn't get it weekly for 18 weeks as you're saying is the guideline.

As for the hospital's not prioritizing your treatment, that would be a concern for me. You don't say where you are so I'm wondering, Is there anywhere else you can go to get treatment?

MC1 04-08-2019 07:15 AM

Re: Administration Every 3 Weeks Instead of Weekly for First 18 Weeks
Thank you Meti, I'm in Hong Kong, I will definitely keep the first dose redo information in mind when I negotiate with the docs in case they schedule my injections late again. Many thanks!

Thanks for the information Lucy. I think the report I am using should be the most recent on the Herceptin website, the link I provided in my prior message is the section of the website "For Healthcare Professionals".The 18 weeks weekly regimen is only for the TCH Adjuvent treatment.

I am glad to know the information you shared for the 2 best cancer facilities in your country. Since my chemo regimen is every 3 weeks, maybe that's why I am also getting Herceptin on that schedule.

I agree about the concern over delay of the injection schedule. I basically have to negotiate the day before each cycle for the schedule of the next cycle. This Thursday April 11 is when I see the doctor before my 3rd cycle injection on April 12, and also when I will know if they are willing to schedule my fourth injection on May 3rd. I have to prepare to fight with the public hospital doctors and nurses again. The worst case scenario is I need to go private, but the cost of one injection for my regimen will be 4 times the cost of the public hospital and my insurance coverage has been maxed out already. In any case, I am ready to pay for it but one private doctor has already declined my case as he wouldn't take on a new patient who is halfway through treatment with another hospital/doctor, probably because of risks and liability.

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