TCH dosages?

[duga35]

Hi guys, I was just wondering how my doages compare to some of the othere here who have had TCH. I'm 6'5 and weigh @275 so I would imagine its a pretty good hit.

Taxotere-180mg
Carbo-700mg
Herceptin-80mg

[hutchibk]

Hi Doug,
hmmm - I guess that I never knew my dosages, so I can't be of much help. Are you getting infusion every week or every 3 weeks?

[SoCalGal]

Well I don't normally post this kind of info but I'm 5'7 and weigh 124. Just happened to have my flow chart handy. My Herceptin dose - every 3 weeks - is 340. It doesn't say mg or kg or cc's or kegs - just the number.

I looked up my old flow chart and last year the Carbo was 450 along with 1000 gemzar. Again no other measure noted. In the olden days I did Herceptin 360 with Taxotere 90 for about 3 cycles. That really kicked mah but.

Some of it goes by weight and also by regime (once a week verses every 3 weeks) and of course there are guidelines for effectiveness. Hope this helps.
Flori

[SoCalGal]

Just re-reading your signature & post. Why is your herceptin dose so low? I looked back at my chart since 2002 and have always had between 340 and 360 Herceptin - every 3 weeks. Even weekly at 80 seems low. What's up with that? Please ask you onc and report back -
"Dr Flori"

[DanaRT]

I watch my dosages as I double check my name and the drug. I always want to make sure everything is correct. Then I hope the pharmacist was paying attention as she mixed the chemicals....


At 170 lbs and 5 feet 5 inches I receive(d)


Taxotere 138 mg in one hour
Carboplatin 734 mg in 30 minutes
Herceptin 156 mg in 30 minutes


In two weeks I will begin the three week cycle of Herceptin. The RN said the dosage will be just under 468 mg's if I understood her correctly.


My dosages seems a bit higher in comparison.


Dana

[swimangel72]

I don't know my dosages - another question I should ask my onc then? I usually just go along trusting him, but recently, because the snippy nurse who gave me my infusion this week made an error I called my onc to double-check - turns out she was wrong about how often to check my liver enzymes. She said once every three months was the rule - but my onc said EVERY time I get an infusion he wants my liver enzymes checked until they are normal (I had liver enzymes problems in the hospital due to staph infection, gall stone, etc.)

ANYWAY - I need to learn to stop feeling intimidated by this nurse - and get used to asking my onc the questions. He's a doll - and I never feel weird talking to him. Unfortunately, I don't routinely see my onc when I get my infusions.....that's why I'll have to call him.

[GemmaG]

Well, I'm 5'6 and weighs 115 lbs.
I get weekly Herceptin @ 100 mg.
Gemzar i get 2 weeks on one week off @ 750 mg./week

Hi Flori, isn't it Gemzar a kick in the da rear?! :-)

[harrie]

When I was getting herceptin, based on 5 ft, 106#s:

100 mg herceptin weekly
295 mg / 3 wk intervals

[duga35]

I'm taking the TCH at 3 week intervals. I don't know what the dosage will be for the Herceptin when I'm done with chemo. I'm 3 times your size and I can't figure out why my dosage isn't really that different. My onc had told me before that it went by body mass. Geeze, I hope he passed basic math in grade school!

What is really strange is that I had my 5th tx on Friday, and today I actually feel pretty good. The last times by Sunday I was usually very sick. I had a new infusion nurse in Friday, that didn't do a very good job of sticking me. It took four tries and she really dug around in my veins before I told her to go away and get one of the regular nurses. They had no problem hooking me up. Now I wonder if this new nurse even mixed my chemo the right way? I wasn't impressed with her at all. Nice lady, but seemed to need a refill on the air in her head.

Oh, btw, my onc stopped me from taking Tamoxifin during chemo. He told me that I didn't really need to take it right now during treatment and that maybe it was causing the severe reactions that I had to TCH.
I wasn't too comfy doing that, but he's the doctor! LOL

[harrie]

Duga,

First of all, I was on Arimidex prior to my TCH. I was told by both my oncologists to stop the Arimidex during chemo. I resumed taking it after the taxotere and carboplatin was done.

Secondly....I was on TCH on 3 wk intervals like you. But inbetween each taxotere/carbo tx, I was getting herceptin only. Which meant during chemo, I was going in weekly at the dosage of 100 mg of herceptin per wk.
AFTER the 6 rounds of taxo & carbo was completed, my herceptin txs went from weekly to every 3 wks at triple the dosage which came to approx 295 mg per tx (every 3 wks). This of course was based on my wt. This went of for one yr to the date of when i started my TCH.

[swimangel72]

Duga - this is the problem as I perceive it. We have to TRUST the infusion nurses.......no matter how much we trust our oncologists, it's the nurses who give us our treatments, and some of them don't inspire great trust.

So the question remains - how do we question the treatment while it's being given, without causing offense? Sometimes my desire to question is only to gently prod the nurse to double-check herself. Too often in my life I've been in situations where the "experts" failed to notice something that was very important to me (doctors and lawyers included) so I have a strong desire to advocate for myself. Still I get the feeling that I cause offense even when I'm not sounding nasty or assertive.

Does anyone have any advice for how to best approach the nurses during treatment?

[Jackie07]

Hi,

It's been more than six months since my last Herceptin. But I think things have not changed that much, so I am sharing my experience here.

[Duga, I was told to stop my Tamoxifen when I was starting my TCH. I resumed it when I stopped getting Herceptin treatment.]

At Scott & White Memorial Hospital, my chemo medicine was mixed by the lab technician in another location. When I checked in for infusion, the receptionist notifies the infusion desk, the infusion desk notified the lab - I know this because there were a couple of times I was informed that my intended infusion time would be too late because the lab staff need to be notified (by 4:00pm) before I get to the place at 4:15 pm even though the infusion room opens till 6:30 pm when necessary.

There was at least one time my chemo medicine was wasted because they mixed it according to my schedule and we did not expect my doctor then informed me that my Muga score was too low to allow chemo.

The staff giving me the infusion always check the bags - two people varifying the name of the drug to each other - before they hook it up with my IV line. Often time, during the infusion, I would glance over to see if I am getting saline or the chemo, and if so, which chemo drug.

My point is that when they prepare the chemo medicine in the lab, they prepare it according to the doctor's instruction - if there's a weight factor, if there's a dosage factor... A couple of times, when I had 'reaction' to the 'cocktail', it is the infusion nurse who notified the head nurse, and the head nurse consult with the doctor to get certain medicine for me.

Hope this helps in some way. The doctor is the key person. But each step needs to have good safe guard procedure to prevent any mistakes.

[swimangel72]

Wow Jackie - your cancer treatment center sounds so much more modern and organized than mine. The nurses do it all at my location - prepare the drugs and give them to the patient. I never heard or saw any lab people - and I've never seen the nurses verify anything with each other. One nurse handles about 3 to 4 patients at a time.......I'm worried now after reading how your treatments were handled.

When I was in the hospital and needed a blood transfusion two nurses verified my name, the number on my bracelet, and the numbers on the bags of blood - that was the only time I saw any kind of security or verification since I started on this BC journey.

My treatment center is in my oncologist's office. He's usually there. But it is "bare-bones" - comfy recliners, but no tv sets; no privacy curtains; no food; we do have blankets and pillows if we want. I don't care about any frills - but I do worry if I'm consistently getting the correct treatment, even though my treatments aren't very complicated.

Sorry Duga if I've taken over your thread - but ultimately how does anyone know if they are really getting the right meds? I'm going to have to call my onc tomorrow and get some reassurances!

[harrie]

When I went for my infusions, I inquired about the dosages every time. In fact after each treatment I would request a copy of the "flow sheet" which is the paper that says what meds I received, dosages, etc. It is a running tally for each time I go in. Where I received my chemo was run by one oncologist, a general oncolgist. This was done in my hometown. I consider my "main" oncologist to be the one I saw in California for my surgery. He is from a facility called Breastlink and they specialize in breasts. When I started getting my treatments, I emailed my CA oncologist telling him of the dosages I was getting. For me it was a good double-ck. I gave him my wt/ht and I think it was the BUN score on my labs. My breast onco told me that my carbo dosages were too low. He said my chemo onco should use the formula based on the clinical trials which was AUC=6. My chemo was basing it on AUC5 and told me basically that maybe I should just go back to CA and have my chemo done there! To make a LONG story short, I had a talk with my chemo onco and I was able to convince him that I was willing to assume all risks of side effects, but I wanted to go with the higher dosage as the clinical trials indicated. I told him I meant him no disrespect but if I am going to do this, I wanted to go all the way. We ended up in a decent working relationship for the rest of the duration of the chemo tx, but it was H--- communicating with him at first and getting the tx that I wanted. Thank goodnes I had my CA breast oncol for me to talk to anytime. He did not want to micromange my case and my chemo onco refused to communicate with him directly so for a while it was a very stressful situation for me to be in. But, point is,....I pushed to find out what I needed, I was able to get what I was comfortable with, and it worked out without having to change drs. Thank goodnes....

[hutchibk]

Wow - I am surprised that the nurses would mix and or prepare the chemo. At my clinic, there is an infusion pharmacy attached to the infusion room, and we have a head pharmacist and trained chemo pharmacy technicians who handle all the orders. Then, the coordinating infusion desk nurse checks all of the orders and 'bags' before they are given to the floor nurse who then again checks the file and orders, shows it to the patient for verification of name and birthdate, then hooks you up and off you go...

Doug, have you or your doc considered implanting you with a port?

[kk1]

The theory behind not taking an AI during chemo is the following:

An AI does not actually kill cells, it just slows or prevents growth. This is why you don't see AI's used as a mono therapy with active disease. In contrast chemotherapy kills actively growing cells both cancerous and non-cancerous. Cancer cells grow faster than healthy cells and so take up more of the toxic chemo. Basically it's a race where you hope cancer cells die first. If you were to take an AI you would slow the growth of the cancer cells which exactly what you don't want to do during chemo. The faster the cancer cells grow during chemo the more they die.......or so the theory goes

[harrie]

kk1,
So THAT is why AI are not recommended during chemo. Thanks for the explanation. It makes a lot of sense.