Weekly Taxol and Herceptin vs. Dose Dense Taxol and Herceptin

MDW · 04-30-2007, 10:55 AM

Hi – My first post and I’d like to first say how grateful I am for the site and everyone on it. My sister was diagnosed in January and ever since finding our way to the site shortly thereafter, it’s a been a tremendous source of information and encouragement to us both. Thank you!<o></o>

<o></o>Some background for my question: after my sister’s mastectomy (age 48 pre-menopausal, stage IIA, 1 positive node, ER-/PR -, Her2+++), she had oncology consultations with Dr. Antonio Wolff at Johns Hopkins and Dr Nicholas Robert at Fairfax hospital and they both recommended the same regimen - 4xAC every 3 weeks and then 12 weekly Taxol/Herceptin followed by Herceptin every 3 weeks for the remainder of the year. <o></o>

At the time, we asked both docs about Dose Dense administration and they both said that while they would use DD for ER- patients, they do not use it for Her2+. I don’t think we got a totally clear answer as to exactly why, but one thing they both said was that the safety data was limited to a pilot study at Memorial/Sloan of 70 patients and to them (and Hopkins in general, in the case of Dr. Wolff) the cardiac toxicity risk was not worth the trade-off for the “potentially small incremental benefit” of DD for Her2+ patients and they felt comfortable with the fully studied regimen they were recommending. Dr. Wolff also said that weekly Taxol was a form of “densification” in that the total the Taxol administered is 240mg/m2 over 3 weeks vs the standard 175mg/m2 every 3 weeks. Feeling comfortable that both oncologists were recommending the same regimen, my sister started AC in February under the care of Dr. Robert, just completed her 4<sup>th</sup> round and is scheduled for her 1<sup>st</sup> weekly Taxol next week.<o>

</o><o></o>However, given the recent recommendations of the ASBD regarding DD, we brought u the subject again at her appt last week and Dr. Robert said that those recommendations did not apply to Her2+ patients. He also said that weekly Taxol had been shown to be better than every 3 weeks but that weekly Taxol had not been compared to DD Taxol so that he was “very comfortable” with the weekly Taxol. We, unfortunately, are not so comfortable especially with the couple of posts that have been on the board recently that have mentioned the tremendous benefit of dose dense (I think Becky may have indicated a 38% survival benefit – even better than Herceptin!?!). So our question is, should we be insisting on DD Taxol? Does anyone have specific studies we can bring to Dr. Robert to use as justification? If he continues to resist, is this important enough that she should look for another oncologist? Any information/advice/opinions would be greatly appreciated! Thanks so much in advance for your help.<o></o>

Bev · 04-30-2007, 08:24 PM

Hi MDW, I did the treatment that your sister is embarking on. I hope someone who has done dose dense can answer your question. Try going to search and enter dose dense on the purple tool bar. I know there have been a few discussions.

For any discussions you find, look carefully at ER/PR status.

Good luck, BB

Mary Jo · 05-01-2007, 04:06 AM

I was diagnosed June 24, 2005. I too was er/pr neg. and her2neu+++. I had a large tumor. They thought about 2.5 cm but it turned out to be 4.5 cm by 1.5 cm. An oblong tumor. Also, I had 1 microscopic cell in the 1st node and the second node was clean. That microscopic cell was not found initially at surgery. Initially, my husband was told after surgery that there was no lymph node involvement. But after closer inspection, the micromet was found. Thankfully it was found. I opted out of having any more lymph nodes removed as we were confident there were no more involved BUT finding that micromet made the difference in radiation treatment or not. I did have 28 radiation treatments as well. That being said........................my onc. recommended dose dense A/C followed by 4 dose dense taxol along with herceptin every 3 weeks. That was my regimin.

Good luck in your decision making.

Mary Jo

MDW · 05-02-2007, 08:41 PM

Thank you very much for sharing your experiences, Bev and Marejo.

Becky · 05-03-2007, 05:11 AM

I believe that the weekly Taxol/Herceptin is a better regime (its like spraying a weed with Round Up every week versus every other week). However, I believe the oncologist was totally wrong on dense dosing. The Sloan trial on using dense dose AC followed by 12 taxol/Herceptin did NOT show increased cardio toxicity. I saw this poster myself one year ago at ASCO when I attended with this group. Maryanne - our member who is not on the board much right now due to her daughter's health, participated in this Sloan study.

Dense dosing helps hormone negative and Her2+ women the most and ER+ women the least (but NOT if you are also Her2+).

I consulted with 4 oncologists before and all of them did not encourage me to try the Herceptin trial (even though I did end up with getting Herceptin due to good timing). This was because they felt that dense dosing (being brand new for 9 months at that time) gave a KNOWN 38% benefit whereas the Herceptin trial was not completed yet. One oncologist outright told me that if I were his wife, he would do the dense dosing.

However, AC is done and the 12 weeklies are probably better overall as it is better with Abraxane (the same active solubilized a different way)

mts · 05-03-2007, 05:34 AM

Hi-

I was given DD AC+T +H and I am ER+ 10% and PR-. I was also Stage I. 41 yrs old at time of Dx.
I consulted with 4 onc's.
Because Herceptin at that time (2004) was not provided to Stage I's, I believe the oncs felt that DD was better. Now a days, with Herceptin, onc's may feel that DD is not as necessary ???

I still feel that DD was good for me and that even if Herceptin were readily available then as it is today, I would still have done the DD.

Everyone is different- I tolerated DD quite well. Of course there were days where I could not get out of bed, but thankfully I got through it. I know that many onc's look at the age of the patient, family setting and add many "opinion" factors into the mix in order to come up with the best treatment plan. For example- the treatment for a 60 yr old woman vs a 40 yr old. Not that any group is allowed to feel that they have more to live for than any other... but I think that onc's take age of children, overall health etc in the mix. I would think that 48 is pretty young... and that it is up to the patient to pick and choose whatever tx she wants and that the onc is there to provide good science.

Keep in mind that AC+T every three weeks ain't "chemo light" either... the one thing you don't want to do is hunt around for someone else to give you an opinion on which you have already decided upon... tic toc.

Either way, you still have to sign a release form !!!

Best of luck to your sister-- keep us posted on her decision.

MTS