Thanks for answering my post

[Maggilu123]

My doctor is going to be on vacation next week, guess I will talk to the nurse and raise my concerns to her. I have been worried about damage to my heart, had heart surgery in 1984 for an Artrial Septal Defect and lately have been getting out of breath like I was before heart surgery.

I had them make me a copy of the Order Sheet so am sure about drugs.
Shows the following:
Epirubicin 200mg
Cytoxan 1000mg
5FU looks like 1000mg
Decadron 10mg
Herceptin 600mg

He also has me going back the next day for a Neulasta shot 6mg.

Thanks Al, Chelee and Christine for replying and giving me your imput, I really appreciate it.

Peg

[Chelee]

Hi Peg, I certainly don't come close to knowing as much about chemo regimens as so many other people that use this board. But from what I know....that is a combination of drugs I would be concerned about until I got alot more information. Maybe they have a good reason for this? I just don't know...I certainly am not a doctor.

I would really be concerned about the Epirubicin given at the same time as Herceptin? Both these drugs are known to have possible side affects on the heart. I am on herceptin and have to have a ECHO every 3 months to check it out to make sure its still pumping ok. If not they will take you off it for a while. Usually with herceptin any damage can be reversed if you are off it for a while..unlike from AC or Epirubicin type drug....from the way its been explained to me. (But don't quote me...I just want to make sure you get all the answers before you jump into anything.)

Did your doctor say they were going to give you all those drugs at the same time?

There are so many other people that I know can be of much better help then me. I am GLAD you are here asking questions though. Thats a GOOD THING. :-) Your a smart cookie. Way to go.

Hang on..and believe me...you will get some more replies that are more helpful. Hang in there.

Chelee

[Bev]

I'm not sure if it was your post Peg, but there was a discussion on this topic today. I didn't do the 5 Fu, but my understanding is that you don't do Epirubicin with herceptin at the same time. Especially if you have heart issues.

Re Neulasta, well it shouldn't be automatic. I would have my CBC the day before chemo. If that showed low wbc, they would schedule nuelasta. I only did one. Cure was worse than the disease. Your wbc's will always go down with chemo but they almost always go back up again after. Unless your count goes into the basement, you may be able to skip the neulasta. I guess you'll have to try it once. It all depends on your specifics. Good Luck, BB

[Christine MH-UK]

I have pasted below the blurb on the relevant MD Anderson trial, published in Feb. 2005 in the Journal of Clinical Oncology, because this seems to be closest to what you are getting. Are you getting the rest of a year of herceptin afterwards? If you are not, then you are getting this trial combo.

To qualify for this trial, patients needed to have the following, so you need to keep in mind whether you would have matched the trial criteria:
"Normal cardiac ejection fraction per echocardiogram.
Negative history for congestive heart failure. If history of cardiac arrhythmia, eligible after cleared by cardiology."

It should also be kept in mind that the one of the other trials using an anthracycline (adriamycin, which is harder on the heart than FEC) indicated that the heart damage peaked about eighteen months out, so the figure of 7 might not accurately reflect the potential of this combination to cause heart problems. Seven still means that 1/3 of the women who participated who had a 10%+ decline in left ventricular ejection fraction. On the other hand, the complete pathological response figure is brilliant.

I double checked the trials and on FinHer there was no decline in left-ventricular fraction. In fact, the women who got the herceptin seemed to be slightly less likely to have heart problems. That combo was (herceptin+taxotere)->FEC 60 (60mg per sq. meter of body surface area), but FEC60 is outmoded. (I can't tell from your prescription what you are on because I don't know your weight and height). Anyway, FinHer indicates that there aren't necessarily problems giving herceptin after epirubicin. FinHer has had a three-year followup, during which time absolutely no adverse heart problems were noticed.

It is believed that part of the reason that FinHer lacked cardiotoxicity is that putting herceptin before anthracyclines might actually lessen the heart damage caused by anthracyclines; however herceptin given together with FEC is still a potentially risky combo. Perhaps your doctor knows something about the results of this M.D. Anderson trial that make him feel that it would be safe, but it would be good to check, especially since you are concerned about your heart. Anyway, here is the blurb:

+++++++++++++++++++++++++++++++++++++

A Buzdar et al.

Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=15738535&query_hl=1&itool=pubmed_docsum
Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 424, Houston, TX 77030, USA.
PURPOSE: The objective of this study was to determine whether the addition of trastuzumab to chemotherapy in the neoadjuvant setting could increase pathologic complete response (pCR) rate in patients with human epidermal growth factor receptor 2 (HER2) -positive disease. PATIENTS AND METHODS: Forty-two patients with HER2-positive disease with operable breast cancer were randomly assigned to either four cycles of paclitaxel followed by four cycles of fluorouracil, epirubicin, and cyclophosphamide or to the same chemotherapy with simultaneous weekly trastuzumab for 24 weeks. The primary objective was to demonstrate a 20% improvement in pCR (assumed 21% to 41%) with the addition of trastuzumab to chemotherapy. The planned sample size was 164 patients. RESULTS: Prognostic factors were similar in the two groups. After 34 patients had completed therapy, the trial's Data Monitoring Committee stopped the trial because of superiority of trastuzumab plus chemotherapy. pCR rates were 25% and 66.7% for chemotherapy (n = 16) and trastuzumab plus chemotherapy (n = 18), respectively (P = .02). The decision was based on the calculation that, if study continued to 164 patients, there was a 95% probability that trastuzumab plus chemotherapy would be superior. Of the 42 randomized patients, 26% in the chemotherapy arm achieved pCR compared with 65.2% in the trastuzumab plus chemotherapy arm (P = .016). The safety of this approach is not established, although no clinical congestive heart failure was observed. A more than 10% decrease in the cardiac ejection fraction was observed in five and seven patients in the chemotherapy and trastuzumab plus chemotherapy arms, respectively. CONCLUSION: Despite the small sample size, these data indicate that adding trastuzumab to chemotherapy, as used in this trial, significantly increased pCR without clinical congestive heart failure.

[al from Canada]

From and interview with Dr. Clifford Husdis, May 23,2006:
"Now what about the patient who comes in with a preexisting cardiac issue and yet has a high-risk HER2-positive breast cancer? My sense right now is that without being able to do TOPO2 testing, you would err in the direction of giving the anthracycline. Another problem, which I think many medical oncologists don't always put to the forefront, is that if a patient has that degree of cardiac dysfunction, then the marginal benefit achieved with adjuvant therapy may not be so large anyway.

So the simple answer to your question is that right now there is no globally identifiable group of patients in whom the carboplatin-docetaxel regimen would be routinely appropriate. I do think that it is a good option for individual patients in specific circumstances."

He further goes on to say that if in doubt abot anthrcylines and herceptin, go with the Docetaxol / carbo / herceptin cobo. Everything I have read says DONOT GIVE CONCURRENT ANTHRACYCLINES AND HERCEPTIN! Can I say more? GET A SECOND OPINION!!
Good luck,
Ak