Taxol/Herceptin without AC?

CristlC · 10-30-2008, 07:36 AM

My question is whether anyone here has taken a regimen of Taxol/Herceptin without AC?

My quick story... had a bi-lateral mastectomy on 9/16/08 (6 wks ago) for extensive DCIS in my left breast. I opted to take both. During that pathology my nodes came back clear but they found a small tumor of IDC (.4cm). Also, I am PR/ER+ and HER2+++. So my Onc (Baylor) is recommending Taxol/Herceptin for 12 weeks weekly and then Herceptin every 3 weeks for a year.

In trying to research this I can't find others that have done this without doing the AC first. I know he was taking into account alot of things and personalizing a regimen which I appreciate. However, I want to make sure I do what I need to do to get this over with. I know he is taking into account, my age, my small tumor size, no node involvment, etc.

I went to MD Anderson here in Houston for a 2nd opinion and they recommended the norm - AC every 4 weeks for 12 weeks followed by weekly Taxol/Herceptin for 12 weeks and finish the Herceptin for a year. However, I felt like they had their protocol and this is what it is.. I truly "feel" better over at Baylor with the Onc who is a world renound doc in this field and his nurse practitioner is wonderful.

Today I have an appt at Baylor to ask him about all this. Does anyone have any advice? I would also love to find someone else that underwent Taxol/Herceptin without the AC first.

Thanks for listening, Cristl

BonnieR · 10-30-2008, 09:33 AM

I did not have AC but 4 doses of Taxol, Carboplatin, Herceptin together followed by one year of Herceptin alone. I think you will find others here as well who did not receive AC first. Hoping you get more replies. Keep the faith.

Sheila · 10-30-2008, 11:07 AM

I beleive that at last years symposium there was talk about the fact that AC was not apparently as benenficial to ER+ women...I will try to find the post...Jean, do you remember?

Sheila · 10-30-2008, 11:18 AM

This was a post by Jean...

Something you should also consider:
Anthracycline drugs have use limits - which means we can only have a certain amount of Anthracycline drugs.
So, maybe you want to save those drugs if needed way way down the line in life....

Also since you were not tested for TOPO2a you really do not know if Anthroacycline drugs would be of benefit to you. This is another area of debate as the standard of care at present is not utilizing this test to determine chemo treatment. Dr. Slamon has been on the cutting edge with TOPO2a testing. I have made treatment choices based on his advice which did include a TOPO2a test. I did have the test and was negative, therefore for me A/C would not be a benefit...(as I mentioned earlier this is still very much open for debate) We'll probably be seeing declining use of anthracyclines over time, as other regimens come along, but for most women with high-risk early breast cancer, anthracyclines and taxanes remain important drugs, and most onc. are not using TOPO2a testing to select therapy outside of a clinical trial. Topo2A has recently been passed by the FDA....

Determining the best adjuvant chemotherapy program to link trastuzumab with is very much an open question. In clinical practice, AC followed by a taxane plus trastuzumab or docetaxel, carboplatin, and trastuzumab (TCH) have emerged as the most commonly used regimens. The discussion primarily focuses on the risks of cardiotoxicity.

Dr. Slamon is of the thinking (the father of herceptin) that A/C is on the way out - as treatment with TCH is becoming the standard, especially for those who are early stagers node negative.

To respond to your question of "why isn't herceptin used first" we may in the future see early stage bc treated with just hercpetin, but for now Dr. Slamon believes that the best course is chemo/and /herceptin. We will have to wait for more data to be better informed. Currently there are global adjuvant studies which are looking at hercpetin alone vs lapatinib alone and herceptin and lapatnib being administered sequentially.

Clearly the most important question for research is why do some women resist herceptin and can we identify
those tumors and treat them. There has been some provocative data using hercpetin and lapatinib. There are still many questions to be answered.

Sheila · 10-30-2008, 11:19 AM

Another by Jean

Topo2a positive or negative...
Lizbeth, I understand your frustration on the delay in new testing being available. It seems it takes time for new testing to take a hold. This reminds me of the Oncotype DX testing for those who were on the fence with having chemo and it took a long time before centers began using the test...just a short while back many onc. said it was not standard care of treatment.

When I saw Dr. Slamon he insisted that I have the topo2a test prior to making any decison on chemo.
Because, if topo2a positive than A/C would be okay to go with, if negative (and I was neg.) A/C would not have benefit for me. Dr. Slamon was the only one at the time 2006 to offer the test. Most dr. did not even know about it and those who did (even now) do not use it.

Last year at the BCS Becky and I went to a lecture that Dr. Slamon was giving and I will share that the topo2a
was a much heated topic. Dr. Slamon has been saying for the last few years that the topo2a should be tested before making a treatment decison. Yes, he does favor
TCH .....since the trials proved to be desirable.

Why does it take so long? I can only answer when it comes to Dr. Slamon, long before the FDA approved
herceptin to ALL her2 women (remember early stagers)
were not approved and had to fight for it and get it off label and pray the insurance would cover the cost.
Dr. Slamon was saying...."All Her2 women should be given herceptin" how many did not agree with him.
Shocking isn't it? I am thinking it is the same with the topo2 ...and in a year or maybe two we will be reading
how topo2 is routine. Very frustrating...

Just recently I posted a medical article stating how STILL some women are NOT tested for HER2, can you believe that?

I want to know why testing for HER2 is not routine
on DCIS?

I hope this information helps.

'lizbeth · 10-30-2008, 05:38 PM

CristlC,

I did TH, Taxotere and Herceptin.

But there is a study out that compares TCH and TH. To get the same results without the Carboplatin the Taxotere is increased from 75 to 100mg/m2.

I think the study was BRIG006 or BRIG007.

CristlC · 10-31-2008, 09:24 AM

Thank you for all your responses! I am glad someone sent me over to this site. I have to make a decision and am so worried about picking one regimen over the other.

AC + Taxol/Herceptin
Vs.
Taxol/Herceptin

I am leanging towards going trusting the doctor at Baylor and going with the Taylor/Herceptin. He feels this will be a more personalized approach for me and my ovaries. I am guessing kids won't be in the picture but he said the AC would have more of a risk. He said my recurrence rate right now is around 10% and that the Taxol/Herceptin would bring me down to the 5-6% range. Adding, AC would bring me down another 1-2% but obviously with more side effects, hard on the ovaries, etc. ALso, mentioned the small size of the tumor that was there (.4cm) and node negative.

My Oncologist is a leader in the field, Dr. Osborne so I will comfortable staying there over MDA. His NP is wonderful.

So I am worried about picking Baylor over MDA and one treatment over the other. I am going crazy with all this and need to make a decision and move. I am scared to death of all this.
Thanks again for all your responses!

BonnieR · 10-31-2008, 10:33 AM

CristlC, I just wanted to say that I understand your fear and anxiety. I remember being almost paralyzed with indecision. I tried to quiet my mind and pray for a solution. Then different little "signs" would get put in front of me, things that helped clarify my thinking. Someone would say something, or a test result, or an article. So, take a deep breath and ask a higher power for some input. Keep the faith. And let us know....

11-02-2008, 01:26 AM

Christi-

I am in a similar situation -- just had mastectomy 4 weeks ago, 35yrs old, triple positive, no nodes, 8mm tumor. I have 2 docs who say to do 6 cycles of Taxotere, Carboplatin, Herceptin and say that's better than 4 cycles of Taxol/Cytoxan/Herceptin.

CristlC · 11-03-2008, 11:04 AM

It is all so scary. I am getting a arm port put in on Thursday and set to start 12 weeks of taxol/herceptin weekly and then continue the herceptin for a year and getting that every 3 weeks.

Jackie07 · 11-03-2008, 12:41 PM

Hi,

I think TCH has been the standard for a couple of years now. The research talks about AC first because during the study, most breast cancer survivors already had the old standard AC (Or sometimes with M).

The fact that many long-term survivors went back on 6 rounds of TCH shows the effectiveness of TCH. I think the current standard is 6 rounds of TCH and then continue H to make it a year.

Sheila · 11-03-2008, 05:15 PM

CRISTLC
Just wanted to let you know you will do fine for your first chemo....I will be thinking of you...that is exactly what I get, although I have been on it for mets for 1 yr 5 months so far....other than the hair issues, which by the way not everyone loses theirs, it has really been a piece of cake....sending you a big hug....the anticipation is the worst!

CristlC · 11-04-2008, 06:30 AM

Thanks to you all for your support. I am so scared and can't keep a clear head. I feel like this has taken over my life. HOpefully once all these decisions are made and all this has started my state of mind will improve. I think you are right,,, the anticipation is the worst. I made myself crazy before my bi-lateral as well. My mom died at 38 and I watched what the chemo did to her and I think that is in the back of mind even though I know it is much different now.

Again, thanks to all. I sure helps to here from people doing the same types of things.

mts · 11-04-2008, 06:54 AM

CristlC-
You commented that having kids would not be in the picture. This is not true. Your body can recuperate after chemo.
Yes, you will likely go through chemo-pause, but if you are young, you will likely get your period back and could get pregnant as well.
We have a member (Laurie) that could not get pregnant BEFORE chemo and now she is !

Many of us on this site have had a periods back with no problem. I know all to often this info is not provided by the onc.

mts · 11-04-2008, 07:01 AM

CristlC
Here is a link to a study on chemo and "getting" your menstrual cycle back.

http://www.cancer.gov/clinicaltrials...nstruation0206

mariapiedra · 11-04-2008, 07:43 AM

Hi, I was in a similar situation trying to decide between treatment plans. First onc wanted to go with AC x 4 & herceptin for a year. Second opinion at Dana Faber in Boston recommended a clinical trial: taxol & herceptin weeky for 12 weeks, herceptin every 3 weeks for the rest of the year. After a lot of research and posts to this site I decided to skip the AC. I've been doing the clinical trial of taxol/herceptin and it has been very tolerable. Had a setback with my "never used" chest port; it got infected & had to come out & then the infection landed me in the hospital for a week. My arm was beat up after the week in the hospital, but I've been doing quite well using the veins in my arm for treatments. I only have two more weeks of taxol/herceptin to go! I hope I can get through the entire treatment without a port, but if I end up needing one I will go with one in my arm before doing the chest port again. I know a lot of others have had success with them, unfortunately I did not. You'll do great, I understand the "first chemo anxiety" because I was there not too long ago, but it was fine and I look back and think that the anticipation was much worse than the actual treatment & side effects. Side effects for me have been very minor, the first couple of weeks I was tired. Then came the hot flashes. Now I do get some minor tingling &numbness in my fingers & feet. I've been doing acupucture and it has been helping feel more energetic & has helped reduce the intensity of the hot flashes. I'm still not sure it's helped with the neuropathy, but maybe after a few more treatments I'll notice a difference. Blessings!

Terri B · 11-04-2008, 07:48 AM

I have one treatment left. I had 12 weekly taxol/herceptin first (piece of cake for me. didn't even lose my hair) now i'm on FEC (5-fu, epirubicin, and cytoxin). I still have a little hair, the treatments have been a little rougher than the taxol, but still doable. Still working full time.

I am still having my periods. I think i skipped one. Honestly, i was looking forward to a little "chemopause". Not to be for me. :-(

You never know what your're gonna get until you get there. One thing's for sure, YOU CAN DO IT!! Also, you have come to the right place!!

Best of luck to you!