Anyone do Taxol and Herceptin only?

[Pygmy_Nuthatch]

Hi,

I was diagnosed a couple months ago. I've had lumpectomy and SNB. Good results (I know I'm lucky). Tumor only 1 cm, negative nodes, clean margins, no lymph-vascular invasion. ER + and PR + and Her2+++ (IHC).

I'm being offered standard AC + Herceptin + Tamoxifen or TC + Herceptin + Tamoxifen or Taxol + Herceptin + Tamoxifen.

It has been explained to me that the last option Taxol alone with Herceptin will have the fewest side effects but be just as effective. I have to have radiation on my left chest anyway.

Has anyone don't Taxol and Herceptin alone? Please let me know what you think. I have to decide soon and I'm not sure what to do.

P

[Chelee]

Pygmy, Welcome to the board...although I'm sorry you have to join us. I'm glad to see your onc is giving you all your options and letting you have a say in your treatment...as it should be.

Of course you know this is only a decision you can make for your self. Everyone is different...and we all respond differently to these drugs. But with your DX and since you have no node involvement and clean margins...I would think the TCH would be a good choice. But I am NOT a doctor, and I DON'T even play one on tv. :) But they have found TCH to be almost as good as "AC" and without as much risk to the heart that you have with AC. Its also easily tolerated compared to AC also. But again, this has to be your choice. Good luck and stick around...keep asking questions. Your off to a great start.

Chelee

[Pygmy_Nuthatch]

Chelee, Thank you for writing. I am glad to hear your thoughts and I don't mind that you don't even play a doctor on TV. Your friend, PN

[hutchibk]

When I was initially dxed, Herceptin wasn't available as a first line drug, it was still in trials... so I got Taxotere/Adriamycin/Cytoxan. I didn't get Herceptin until I had recurrence. After my first recurrance (14 months after finishing initial treatment), I got Taxol/Carbo/Herceptin for 5 months and it took care of my lung spots and chest nodes (and by that time had I been changed from Tamoxifen to Aromasin). I can honestly say that even though it doesn't make you feel wonderful, for me the side effects were not all that bad. Mostly fatigue and baldness, and neuropathy in my toes and fingers, and only a very little bit of queasies on days 3 and 4 after infusion. With my second recurrence, I got just Taxol and Herceptin. That was pretty easy to tolerate for me, too.

I don't know what the best route is to go. The choice isn't up to you is it? Your doc is just telling you what he is considering, right? One tid-bit of info that might interest you is that Carboplatin is the only one out of all that you mentioned that is small molecule and crosses the blood brain barrier...

Good luck. Let us know what you decide.

[Sheila]

Like Brenda, when I was diagnosed, Herceptin wasn't available...you are so lucky now to get it up front....I started getting it 1 1/2 years later when I had a recurrence....I was also node neg, small tumor as you can see in my signature...I had a mastectomy, no chemo and recurred....I would so the TCH as a minimum...I am on Taxol, Herceptin and Avastin Now and have been for 5 mos.....its not bad....and it takes me no time to get ready with no hair! Who can believe that when I started this journey, I had hair to my knees......Welcome to our group...you will find all the love, support and knowledge here from people who have traveled the same road.

[tousled1]

Welcome but sorry you have to be here. Whatever chemo on the list that you and your oncologist decide upon you will loose your hair. But don't worry it grows back. I had A/C and Taxatore and lost my hair and it rew back. Upon my recurrence I am now on Taxol and Carboplatin and lost my hair again! No big deal as long as the chemo is working. It's a difficult decision to make ut I'm sure that you and your oncologist will do what's best for your particular situation. Keep us informed. Just make sure that before starting Herceptin that your oncologist orders either a MUGA scan or echocardiogram to check your heart function. Herceptin can affect your LVEF (left entricular ejection factor). Also youhave the test repeated every 3 months while on Herceptin.

[MJo]

I would also take , Herceptin and Radiation at a minimum. I've gone to two lectures recently about breast cancer and both oncologists said
"Her2 is a more aggressive cancer and more likely to recur." Yes we have Herceptin now, but I was unpleasantly reminded at the lecture that Her2 is still a nasty cancer to have. I wouldn't take any chances with it. Some day doctors will be able to tell us that our Her2 cancer is 100% cured. THat's not now. The doctors said they are so aggressive at diagnosis with stage I, II and III because that's when there is a chance to cure the disease.

[MJo]

Sorry - I meant to say taxol, herceptin and radiation. Deleted the taxol.

[kareneg]

I had Taxol and Heceptin and it put me in remission for 2 1/2 years! The best years of my life. It is a very good treatment and very doable! All my best to you.

[Pygmy_Nuthatch]

Thank you for your great advice and support! It is very helpful to hear from you. Please keep the advice coming. Right now, I am leaning toward the Taxol/Herceptin/Radiation/Tamoxifen treatment. I would rather avoid the toxicity of Adriamycin and Carboplatin or Cytoxin.
What do you think?

[AlaskaAngel]

Hi,

I recently posted in the clinical trials forum here a link to the clinical trial that is being offered by Dana Farber Cancer Institute, NCT00542451. The title is, Adjuvant Paclitaxel and Trastuzumab for Node-Negative HER2-Positive Breast Cancer. You may already know about it but I thought I would mention it in case you don't.

AlaskaAngel

T1c, treated in 2002 with CAF x 6 followed by rads, and tamoxifen
No Herceptin

[Becky]

I believe if I had your pathology (with negative nodes) and had the choice of AC (adriamycin and cytoxin) followed by Herceptin for one year versus Taxol and Herceptin together with Herceptin continuing out to one year, I would choose Taxol + Herceptin.

All logic and previous studies show that a taxane (of which Taxol, Taxotere and Abraxane are all taxanes) is very key to eradicating Her2+ disease (especially when combined with Herceptin). HOWEVER, it is not standard of care and there are absolutely no studies to substantiate that it will work (although I would be absolutely floored if it didn't).

Therefore, I would ask for the standard 6 rounds of TCH (taxol or taxotere, carboplatin and Herceptin) with Herceptin going out one year. There are trials that show this works and works as well as 4 dense dose rounds of AC followed by 12 weekly Taxol + Herceptin with Herceptin going out to one year. You are not in a trial and the trial is just beginning so you will not be followed. You should not do the Taxol + Herceptin unless you get yourself in that trial. Your tumor is 1cm so even with negative nodes, you can still get standard of care. Ask. If the onc says no, go with just the Taxol and Herceptin (but this is not common and is used in women who have recurred and received chemo prior to in the adjuvant setting).

Just my thoughts.

[Pygmy_Nuthatch]

Dear AlaskaAngel and Becky - thank you for writing. As it turns out, the option of Taxol/Herceptin only is at DanaFarber and part of that trial that AlaskaAngel mentioned. I saw a doctor here in CA where I live and in Boston (DanaFarber) where my husband's family lives. Looks like we're headed to Boston. The doctor at DanaFarber is in the forefront of breast cancer research (well-published and big reputation and NICE!) and he feels that this is the right combination for me. I asked him about TCH and he said that he didn't like it for me because the T=Taxotere and the C=Carboplatin, both of which he said are really nasty and more than I need. He said that recently research has been questioning the 'C' in the TCH treatment. He thinks the Taxane is what is really critical for Her2. Also, I'm ER and PR+, so I'll do Tamoxifen after chemo too. It seems like this is hitting it hard enough. At least Dr. Harvard thinks so. My doctor here is CA likes the trial but isn't running it so she offered TC or AC + herceptin.

Has anyone else heard statments like this?

PN

[Becky]

I think its great and I think the trial is the way to go. I just could not recommend it without the trial (which is really what I was saying to you - as the Taxol + herceptin is not standard of care yet. But thanks to women like you, I think it will be but like everything, it has to be proven in a trial). Great, great, great.

This will be a good combination and without carboplatin, it will be much, much, much easier on your blood counts and fatigue level.

Stay in touch here as you go along. I love to stay as updated as possible (as we all do here) and this is an important trial as it is very important not to over treat.

Have a great weekend!

PS - Are you going to Eric Winer? He's the forefront of Her2+ BC and one of the BEST!!

[Pygmy_Nuthatch]

Dear Becky
You are very sweet and so encouraging to me. Thank you!!! I am glad to hear your thoughts. Yes, I will be seeing Eric Winer and I really did like him a lot! He was really accessible, kind, thorough and brillant to boot. I feel that I'm in good hands, do you think? You've heard of him too? This is all so new to me.

I will certainly stay in touch! I am happy to be in a clinical trial and 'take one for the team'.

Thank you,
PN

[Becky]

You are going to one of the best in the country, especially in regard to Her2+ BC. Although I am done (now a 3 year survivor), if something should come up again, I would go up to Dana Farber to see Eric Winer on next steps. I would then have him confer with my local onc (who I think is a genius too) and have them treat me.

Have a great weekend.

[Gerri]

PN,

Welcome to the support board. You have found a great place to ask questions. However, I have one for you. You stated that as part of your treatment you will be taking Tamoxifen. Is this the treatment plan that Dr. Winer has recommended? The reason I ask is because the use of Tamoxifen in the HER2 population is a topic often discussed on this board - many believing it is not the best option. I am pre-menopausal and on Tamoxifen until I go into menopause. Each time I visit my onc we discuss whether or not I should have my ovaries suppressed and start on an AI (like Arimidex) or continue on Tamoxifen until I naturally enter menopause (should be soon - I'm 54!). She will do whatever I choose but says that all the data is still not in favoring forcing such a switch. I attended a seminar a few weeks back and asked the same question of the breast cancer specialist there. He stated the same thing saying that while there is an 'indication' that AIs work better in HER2 patients, they are still not sure and need more data. So, I guess what I am looking for is one more onc's opinion. Since you will be seeing one of the premire specialists in the field, I am very interested in finding out if this is the course of treatment he has recommended.

I wish you all the best as you embark on this journey. Believe it or not, the time will go by quickly. I admire you for taking part in this clinical trial.

Take good care,

[Pygmy_Nuthatch]

Hi Gerri,
Thank you for writing. Yes, Dr. Winer is prescribing Tamoxifen after I finish the chemo. I'm 38 so the AI isn't an option (well, I'm hoping that I retain my fertility, but God only knows). I DID ask Dr. Winer about the value of Tamoxifen for a Her2 cancer, because I did read the news that you have also heard. Dr. Winer said that there is still likely to be a benefit and that only some studies showed that some Her2 cancers did not respond to Tamoxifen. He says that probably many do, although some do not and as of yet, there is no way to determine who will benefit and who would not. He thinks it is worth taking the chance that it will help since the side effects are usually tolerable. I really hope you are doing well. I hope that you feel comfortable with your choices. When I see Dr. Winer in a couple week (I'm moving pretty soon to start treatment) I will ask him this question about the choice between Tamoxifen and suppressing ovaries to start AI and see what he says, okay?
PN

[Gerri]

Hi PN,

Thanks for your response to my question - that info was very useful. That would be great if you would ask Dr. Winer the question again. While I do trust my onc completely, sometimes it is hard not to wonder if we are doing everything possible to keep this disease at bay. She is very open to discussing all treatment options with me and really listens to what I have to say. This is why I have held off forcing the switch to the AI. I think it makes all the difference in the world when you have faith in your doctors.

I have a feeling you are going to do just fine with your treatment. My onc said this to me the first time we met and she was right! My side effects were very tolerable, and while I didn't enjoy losing all my hair it was far less devastating than I thought it would be. I'm no longer in treatment (except for Tamoxifen) and am doing well - a little more tired than before bc, but still going strong!

Best of luck with your treatment. Please keep in touch and let us know how you are doing.

All my best,

[Pygmy_Nuthatch]

Hi there,
I will be starting my treatment at Dana Farber the week of Thanksgiving. I will be able to give thanks for my life and all the love and support that I have received! I'm moving from Northern CA to Boston for treatment (my husband has family there so it isn't too difficult of a temporary move).

I will start a new thread and tell you about what is happening in my treatment and anything interesting the doctors say (and that question for Gerri).
Love
PN

[SoCalGal]

There is a doctor at UCLA named Ken Conklin, in their Integrative Oncology Dept.

He has just finished a long term study using nutritional supplements, diet and acupuncture, to support women undergoing AC for Breast Cancer. Most of his study is about using CoQ10 to enhance the effectiveness of AC and to completely protect the heart. There is a lot of controversy about anti-oxidants.

You might want to check this out since you mentioned that you are in California. He is presenting his research at the Society for Integrative Oncology in SF on 11/15.

COENZYME Q10 DURING ANTHRACYCLINE-BASED CHEMOTHERAPY: A CASE SERIES WITH EVALUATION OF CARDIOTOXICITY AND CLINICAL RESPONSE, Kenneth A Conklin MD<o:p></o:p>


Kenneth A. Conklin, MD, PhD, is a clinical professor at the David Geffen School of Medicine of the University of California, Los Angeles, California
(UCLA) and a member of the Jonsson Comprehensive Cancer Center at UCLA, where he practices integrative oncology. Dr. Conklin received his PhD in Pharmacology from the University of Hawaii in 1971 and his MD from UCLA in 1974. Following the completion of an anesthesiology residency in 1977, he joined the faculty of the Department of Anesthesiology at UCLA where he served as the director of Obstetric Anesthesia until 1997. He completed the Medical Acupuncture for Physicians course in 1997 and began his practice of integrative oncology at UCLA that year. Dr. Conklin has published extensively. His most recent review articles pertain to the use of acupuncture for the cancer patient and the use of nutritional supplements during chemotherapy. Dr.
Conklin serves as a reviewer for the journal Nutrition and Cancer and as a consultant to the National Center for Complementary and Alternative Medicine (NCCAM).

[hutchibk]

Py - In your list of questions, ask the Dana Farber doc about whether it is important that Carboplatin crosses the blood brain barrier...

[Pygmy_Nuthatch]

Thanks Flori, that study looks really interesting. Brenda, I'll add that question to the list, it is a good questions. Py

[jsattaw]

Hi Py --

Sorry to chime in a little late. I wanted to provide encouragement to you as I was diagnosed with a similar pathology in 1998 when I was 37. I just had a lumpectomy with radiation -- they weren't testing for Her2 at that time in my area.

I had a baby in 2000 -- I didn't want to take Tamoxifen as the results from studies did not show an increase in mortality.

My cancer did recur in 2005 -- and it was Her2 positive. My treatment included a mastectomy and taxol+herception for 1 year. I also had a hysterectomy so I could take an AI (Arimidex).

I hope everything goes well for you -- you're with one of the best docs in the country and that should give you a lot of confidence in your treatment plan.

I'm sorry you're going through this but you've found a terrific support group here. Let us know how your treatment is going.

Jill

[jml]

Hi PN~
I love Taxol + Herceptin!I know, such a strange thing to say, right?
Taxol + Herceptin has done wonders for me, melting away liver mets each & every time my disease has popped back up again.
I tolerated the TH so well- zero nausea, low counts -managed w/Procrit & Neupogen-& bald as a bowling ball, but it did the trick.
If this is your first round of treatment, my docs always say to start with the fewer agents first, see how you respond & then add add'l drugs to the combo if needed.

I wish you the very best & hope you have all the efficacy & minimal toxicity, as I did.
Keep the Faith~

jessica

[Pygmy_Nuthatch]

Thank you Jessica! You are so sweet and made me feel better and even laugh a little at the bowling ball head. My best girlfriend, Kate, has been growing her hair for two years to send to locks of love. Guess who is going to get to wear her hair afterall?? Me! This company makes cool wig-things at reasonable prices - check it out. The are making a 'underhair' of Kate's hair for me for around $200.
http://www.hiphat.com/HowToOrder.aspx