QUESTION FOR JESSICA

Hi Jessica

I noticed that you mentioned that you have taken Abraxane/Herceptin combo. I was under the impression that these two had not been approved to be given together. Obviously that is not true.

Can you give me more info on this as I am contemplating taking Abraxane.

Thanks Jessica and take care

Irene

hey irene~
re:abraxane + herceptin "approved" as a combination therapy...they have never been studied together & the results & findings of the off-label use has never been examined by the FDA, as far as I know.(there is a current study @msk in nyc studying abraxane/carbo/herceptin on a weekly schedule, but too early to report findings. )when i was discussing utilizing this combo, my onc did say, "these two drugs have not been studied together..." but that she didn't anticipate that there should be any reason to expect the efficacy to be any different, than the approved studies of abraxane v. taxol, as solo agents. so technically, we were using abraxane "off label".but remember,drugs & drug combos (chemotx & otherwise) are often used "off label", for many years before clinical trials are even designed &initiated.(for example-wellbutrin an antidepressant, was used off label as a smoking cessation drug, for many years before clinical trials were designed, but eventually they were & now there's Zyban.)
also, remember abraxane is PACLITAXEL suspended in albumin. taxol is PACLITAXEL suspended in cremphor...the only significant difference is the vehicle that the active ingredient of the drug, paclitaxel, is delivered. i like to think of it as the difference between say, tylenol caplets v. tylenol gel-caps- same drug, different vehicle, same response in the body.
there's no reason to suspect that herceptin would react differently to paclitaxel in albumin v. paclitaxel in cremphor...but i guess we really don't know for sure.
without direct FDA approval, there might be a complication w/insurance covering the cost of the drug...which is ASTRONOMICAL!!! I just got my bill from the hosp & it cost ~$10,000.00 yes TEN THOUSAND DOLLARS per dose!my insurance co covered it without any hesitation.(due to the hospital's negligence & misdosing of my regimen I'm filing a complaint w/risk management to address this bill.)
so, long story short...i was using the combo off label, but it you look at appropriate dosing for abraxane, i did fall under the appropriate criteria(Stage IV, taxane refractory, etc).
Hope this info is helpful. I will say it was a treat NOT having to do the pre-meds with the Abraxane...I sure do hate being back on those premeds again.
2 more cycles of TCH to go...i know NED is in reach!
Take good care...prayers, faith & courage!

[Patty H]

Jessica,
I just got out of the hospital from xeloda. I am getting 3 weeks off everything. Then my Dr. is talking about putting me on abraxane, with herceptin. So what is abraxane like? Side effects? Hair loss? I have been on low side effects type of chemos for the last couple of years but have ran out ofr them so now it's talk of abraxane. Patty H

hi patty~
i'm sorry you were in the hospital from xeloda...hope your feeling better. i know you'll be glad to get home.
i was on the q3week Abraxane/Herceptin combo x 3 weeks. it was the first time i'd been on a regimen at that dose...previously i'd always done weekly tx, like weekly taxol/herceptin & even stayed on weekly herceptin during the year i was NED. it was nice to be able to have those 2 weeks off in between.
i tolerated it really well. minimal side effects, maybe a little nausea for a couple of days after, a little fluish too, but I used to feel that way whenever I did the triple dose of herceptin v. the weekly. hard to say what was making me feel crummy. my counts were fine & though they cautioned about the potentially more severe neuropathy, i didn't have any signs or symps in the 9 weeks i was on A/H. I did lose my hair again VERY QUICKLY. When I was on weekly TH the first time, my hair started to thin ~21 days after my first dose, then gradually until I just buzzed it. On Abraxane I think by day 14 my scalp was so sore & hair falling out so fast, I buzzed it off. now that i'm on weekly TCH there's a little showing of hair coming back, but nothing major & very slow.
i will say it was really great to not have to do the benadryl/decadron pre-med before the Abraxane! and Abraxane infuses over 30 mins, so that was a huge plus too. i just wish it had worked for me...maybe if they hadn't screwed up my dosages, but i guess we'll never know...all the research about abraxane is so great. i'm sure it will do well for you.
one thing i'd suggest is chatting w/your onc about doing WEEKLY tx v. q3week. there's some good preliminary data supporting "metronomic" chemotherapy-lower doses, but more frequently- having better anti-angiogenic effects than the q3week doses (google "metronomic chemotherapy" & there's a bunch of articles about it). memorial sloan kettering in NYC is currently doing a study looking at weekly Abraxane/Carbo/Hercep, but i don't think any results have been published yet. When I was researching Abraxane I made contact a woman on that study at MSK.At that point she was ~8months into treatment & she said her hair had only thinned, not fallen out in clumps. I'll see if I can find her contact info or her posting from the other web support group-when I do I'll fwd it on to you.
wishing you well, patty. Abraxane is going to do the trick for you, I just know it!
Take good care!
Prayers, Faith & Courage!

[Patty H]

Jessica,
My Dr. did say he would try and save my hair. I think he is going to do the weekly kind . I was just wondering if anyone had any luck keeping their hair by doing it weekly. Patty H

Hi Patty,no, Ilost my hair after 3rd week while on Abraxane/Herceptin. Good luck to you and as always, I am praying for you.

Dear Patty,

Best of luck and keep us up to date of your progress.

Question, why were you in the hospital on Xeloda??

Thanks,

Al