Weekly Taxol and Herceptin vs. Dose Dense Taxol and Herceptin

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Hi – My first post and I’d like to first say how grateful I am for the site and everyone on it. My sister was diagnosed in January and ever since finding our way to the site shortly thereafter, it’s a been a tremendous source of information and encouragement to us both. Thank you!<o></o>

<o></o>Some background for my question: after my sister’s mastectomy (age 48 pre-menopausal, stage IIA, 1 positive node, ER-/PR -, Her2+++), she had oncology consultations with Dr. Antonio Wolff at Johns Hopkins and Dr Nicholas Robert at Fairfax hospital and they both recommended the same regimen - 4xAC every 3 weeks and then 12 weekly Taxol/Herceptin followed by Herceptin every 3 weeks for the remainder of the year. <o></o>

At the time, we asked both docs about Dose Dense administration and they both said that while they would use DD for ER- patients, they do not use it for Her2+. I don’t think we got a totally clear answer as to exactly why, but one thing they both said was that the safety data was limited to a pilot study at Memorial/Sloan of 70 patients and to them (and Hopkins in general, in the case of Dr. Wolff) the cardiac toxicity risk was not worth the trade-off for the “potentially small incremental benefit” of DD for Her2+ patients and they felt comfortable with the fully studied regimen they were recommending. Dr. Wolff also said that weekly Taxol was a form of “densification” in that the total the Taxol administered is 240mg/m2 over 3 weeks vs the standard 175mg/m2 every 3 weeks. Feeling comfortable that both oncologists were recommending the same regimen, my sister started AC in February under the care of Dr. Robert, just completed her 4^th round and is scheduled for her 1^st weekly Taxol next week.<o>

</o><o></o>However, given the recent recommendations of the ASBD regarding DD, we brought u the subject again at her appt last week and Dr. Robert said that those recommendations did not apply to Her2+ patients. He also said that weekly Taxol had been shown to be better than every 3 weeks but that weekly Taxol had not been compared to DD Taxol so that he was “very comfortable” with the weekly Taxol. We, unfortunately, are not so comfortable especially with the couple of posts that have been on the board recently that have mentioned the tremendous benefit of dose dense (I think Becky may have indicated a 38% survival benefit – even better than Herceptin!?!). So our question is, should we be insisting on DD Taxol? Does anyone have specific studies we can bring to Dr. Robert to use as justification? If he continues to resist, is this important enough that she should look for another oncologist? Any information/advice/opinions would be greatly appreciated! Thanks so much in advance for your help.<o></o>