Taxol and Paraplatin

[sandywc]

Hi All,

My best friend has had a reoccurrence (the third) of her breast cancer. She is HR2 positive and this is her third year since diagnosed. She had some node involvement and it first came back in the same breast. That's when they tested her and found she has the HR2 gene expression. She has been on Navelbine and Herceptin since, and was doing fine until last April when suddenly she became ill and they found a pretty good sized brain tumor on her brain stem. She had surgery and radiation. Somewhere in between she got spinal meningitis from the brain surgery and was very ill. She really hasn't gotten back from all of that and she still has nausea and vomiting, yet the only treatment at the moment is Herceptin. Now she has another lymph node involved near her neck and has been told that she will have an 8 week course of Avastin, Taxol and Paraplatin. I worry so much because she has already been nauseous and lost 30 pounds.

Has anyone had this treatment who might be able to tell me if the side effects were really bad? I'm going to fly out and visit her soon.

Thanks for any information,
Sandy in California

[CPA]

Sandy,

Here is some good and bad about the treatment your friend will be receiving.

Good News: Taxanes in combination with platinum salt chemotherapy (paraplatin/carboplatin or cisplatin) are often effective against HER2 cancers according to several studies in conjunction with Herceptin. My wife received adjuvant chemo containing carboplatin and taxotere (six three week cycles) with herceptin weekly continuing every 3 weeks for 1 year.

Bad News: Your friend will probably be given pre-meds including decadron (a steroid) to limit swelling and other side effects and an antiemetic (anti-nausea) medication. She should expect to take these medications for several days after each chemo treatment. If her insurance will cover the cost, I would recommend Zofran as the best (according to my wife) antiemetic. Compezine is much cheaper and can be used if she is still somewhat nauseous several days after treatment or if she is able to tolerate the nausea fairly well. She will probably get benadryl and tylenol as well because of common allergic reactions. She may already be getting these with herceptin.

You can expect a drop in white and red cell counts which may have to be treated with medications (Neulasta and Procrit are two common).

The description above may sound ugly, but it is possible to beat this. Give her plenty of support and be ready for some tough days. You will probably see special diets discussed, but my personal experience is to give her anything she can tolerate just to get calories the first week after each treatment, especially if you are worried about weight loss.

Try to give her plenty of fluids and keep fiber in her diet. Constipation is very common with this chemo regimen because of (temporary) damage to the GI tract. Better to keep things moving than to re-start them.

[sandywc]

CPA, thanks for your informative post. I believe my friend will be receiving the Taxol, paraplatin and Avastin on a weekly basis, the first week giving her 1/3 of the dose, the second week and third week the other 2/3. Then she will be off a week, and then the process will start again for another 3 weeks. I think she is in for a total of 8 or 9 weeks.

I am going to be flying out to be with her in a week or two. I appreciate all advice on how to best help her, cheer her and support her.

Sandy

[chrisy]

Hi Sandy,

Sorry your friend is having such a rough ride. Hopefully things will get better for her soon. I'll be sending good thoughts.

I had 6 cycles of weekly Taxol/Carboplatin/Herceptin for 3 weeks, then 1 week of Herceptin alone. I did not have Avastin, so I am not familiar with any side effects related to that.

Your friend will get plenty of premeds - I got decadron, aloxi, and benedryl. I also had prescriptions for Ativan and Zofran for nausea. If you need those, use them at the first hint of trouble. HOWEVER...

Everyone reacts differently,. I never once experienced any nausea during the entire 6 months. My advice to people is to not claim those side effects until they actually happen! Plus, although some foods tasted a little funny, I had a (too) great appetite and gained weight during chemo, as do many. Blame it on the steroids! That was bad news for me, but may be good news for your friend if she has lost 30 lbs.

Just have her take it cautiously at first - eat lightly and what sounds good. She will want to stay well hydrated and drink LOTS of water as these drugs are processed through her system.

I also, as CPA commented, took a hit to the blood counts - red and white both dropped although, again, I was lucky they never dropped that far. Your friends doctors will watch this closely and add "boosters" if needed.

Your friend is lucky to have a friend such as you Sandy to stand by her. That gesture of love and caring will be a big source of healing and encouragement.

Sending good thoughts,

Chris

[sandywc]

Chrisy,

Thanks so much for your encouraging e-mail. The Taxol and carboplatin were the culprits I worry about, so your message was very helpful. She's a strong person and is "looking forward" to the chemo to kick the cancer's butt. I hope that it will kick the cancer's butt without kicking hers.

sandy

[Mary Anne in TX]

I too have had Taxol, Carboplatin, and herceptin. I just finished 8 rounds every other week. I did well after the first three days when I was a bit goofy. I did take about one zofran each time (I call them the little magic pill). the last time, I got thrown for a loop, but it was due to an infection. Was around way too many people the first three days. They gave me the taxol slowly each time and that really helped me tolerate it better. About 1 1/2 - 1 3/4 hours, I think. It has worked for me, but am glad to be done with that. I start Navelbine and herceptin this Friday.

I think it matters to me how I precieve I will do too. I try to be sure to have email contact with my favorite people those first few days to keep my mind clear and focused on other things than me.
Seems to me these drugs are wacky sometimes. But I surely do want to keep on trucking, so I'll take 'um!
Best wishes,
mary anne