Taxotere, Carboplatin and Herceptin
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JRyan - hello and welcome!!! I am also early in my TCH treatment - my 2nd one is tomorrow (yippee....). The ladies on this board are an INCREDIBLE resource and so supportive. Sorry you have to be here, but glad you found us.
Love74 - I too am strongly considering only doing 4 treatments. No studies have been done of the effectiveness of 4 vs 6 TCH's, but they HAVE been done on 4 vs 6 with AC in early breast cancer patients. The study below included 20% HER2+ patients and found no significant difference between 4 vs 6 cycles. Now, I am assuming those patients had AC-TH due to the HER2+ component, but I haven't looked at the original study...so someone may come back and correct me on this. That's why I love this group...so many minds to think about this stuff!
Breast Cancer: Four Cycles of Adjuvant Chemo Sufficient for Most Patients
http://journals.lww.com/oncology-times/Fulltext/2011/02250/Breast_Cancer__Four_Cycles_of_Adjuvant_Chemo.7.aspxSome salient points:
"We found that six cycles is not superior to four cycles of therapy for patients with primary breast cancer and zero to three positive axillary nodes," said Lawrence N. Shulman, MD, Chief Medical Officer of Dana-Farber Cancer Institute, in his presentation of the results of the Cancer and Leukemia Group B (CALGB) 40101 trial.
The patients in the study were an average of 52 years old; 64% had estrogen--receptor-positive tumors, and 20% were HER2-positive.Using a 2×2 factorial design, the researchers randomized patients to have either four or six cycles of doxorubicin plus cyclophosphamide (AC), or to four or six cycles of the taxane paclitaxel.At a median follow-up period of 4.6 years, there were 150 relapse-free survival events among patients in the six-cycle arm and 138 events in the four-cycle arm. "Although there are only 288 relapse-free survival events at this point, based on the present data, our statistician friends tell us that the Bayesian predictive probability of concluding superiority of six cycles with the 567 events originally planned for is very small-only 0.001," Dr. Shulman said.Subgroup analyses based on ER status and HER2 status also showed no statistically significant difference between the four and six-cycle arms for either relapse-free or overall survival rates.
And I dug and found another article to get the HER2+ specific results (can't find that link right now):For HER2-positive patients, relapse-free survival was 93.4% and 92.6%, respectively, and overall survival was 96.6% and 96.0%, respectively.
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I wonder if they collected information on tumor size as well?
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JR - welcome. Yes the scalp does get painful/tender. I'd like to encourage you to find the monthly thread for women going through chemo - one starts each month. It is very helpful - while this thread is all women going through (or having gone through) TCH, and you can get lots of specific answers, the monthly thread (Starting Chemo May 2012) will be full of women who are going through chemo TOGETHER. That group gets really bonded. I was in the April 2009 group and we are STILL a tight bunch over 3 years later. It will give you a new group of sisters who all lose their hair together, etc. Please give it a try.
I will encourage you to buzz your scalp with clippers when it really starts to shed (usually around day 18 or so after the first TCH) but NOT shave it with a razor. Not all your hair will fall out and the part that stays will give you a head start (excuse the pun) when it is time to regrow. I had a salt/pepper blotchy awful head which was UGLIER than being totally bald. But when it was time to regrow, it went faster than the women who were cue-ball bald. So keep that in mind.
Amy
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Lago - that would indeed be helpful to know. I'll see if I can get my hands on the original article...but gotta get through 2nd TCH tomorrow first! Remind me please if I forget!
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thanks DanceT. Good luck tomorrow
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Thanks Lago. I survived the treatment...now if I can make it throught the next week without significant SE, it will be an amazing blessing!
I've been SO much more tired, all day today, with this 2nd treatment. Not sure why. Just feel like I could keel over and sleep.
All three drugs given to me today instead of split over two treatments. I am starting on Herceptin on the lower weekly dose though, instead of every 3 weeks. Hoping that will help decrease the severity of the hit on my white blood count, plus maybe not be as hard on my heart. Will also get Neupogen.
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Hey Ladies. Have any of you had your vitamin d level checked? I had mine done and it came back at 20 which the nurse said is considered really low, so I am now on a vit d supplement. How bad is it for it to be this low? I forgot to ask the nurse and didn't want to call and bother her with it. Thanks!
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slgarcia - Mine was in the teens after chemo, and I think this is pretty common. Hard to know if it was that low before treatment, or if treatment caused it, because it was not checked at the outset. I also started taking Vit D at my MO's direction and mine has come back into the normal range within 6 months. I am continuing to take the Vit D because the thought is that higher end of the normal range is better for BC peeps. There are some thought that low Vit D and BC may be linked, but not sure if there is any definitive basis yet.
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Hi Everyone, I've been following the comments daily, but don't comment too much as you gals know so much more than I do. I do have a question regarding PORTS. I went in a couple of weeks ago for my Herceptin infusion. The nurse had a bit of trouble getting the blood return, so she put my chair back and had me take deep breaths. This seemed to work. I thought nothing of this, but the next week when I came back for my Herceptin infusion, the nurse could get no blood return. She put me flat on my back, and had me do several breathing techniques; no luck. So she had the doctor order some kind of medicine to clear the port. Even after an hour, no luck. I had to get the infusion through a periferal catheter. I called earlier this week concerned about having to take the TCH treatment on Friday through my regular veins. I told them I did not want to destroy my veins b/c as of rt now, they are good. They can't use my other arm because that is the cancer side where I had a lumpectomy and a couple of nodes removed. So, what is your experience, if any with this kind of port problem? The nurse seemed to think there was a good chance the port would work this week because that medicine they put in there has had a week to work. She said sometimes a fibrin sheath grows over the tip of the catheter. I just hope I don't have to have the port "fixed" by the intravenous radiology people. Does anyone have any advice on how I should deal with this based on your own experience? Maybe I'm just needlessly worried. Thanks for listening,
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shannon, mine was somewhere in the 30's, I think that is "normal range", but not high enough according to my onc's standards. He likes it much higher b/c he feels there is a relationship between Vit D and breast cancer, as specialK said. I'm on 4000 mg/day, plus the little bit that is in my daily vitamin.
Alice, I'm glad you asked that question - and look forward to any responses. At the end of my infusion Tuesday my onc nurse had trouble pushing the saline flush through (they had no trouble drawing blood before treatment). He did a couple heparin flushes (with effort)...says it should be ok (it did seem to work fine for my treatment the whole day)...but I'm going back in Friday and will be asking the doc to check it. Hoping I don't have an issue either. Uggh. It's always something. Keep us posted!
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Alice - I wouldn't worry too much about the port. When I went for my first Herceptin only tx they couldn't get a blood return. I did several breathing and coughing techniques with no luck. They put the medication in and after about 30 minutes it worked. I was also told that a sheath can form and is very common. I was lucky that the medication worked quickly but that doesn't mean yours won't work next time. Good luck!
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I have always had blood return problems. Here is what works for me...I bend over at the waist with my hands behind my back and head up. They also have to flush it 3-4 times as well. I always know that they are in because I get the saline taste in my mouth. Also...drink a bunch. (why does that always seem like the answer to everything???) It is very frustrating, I know!!!
I have read lots on the Vitamin D thing...I don't think I have been tested, but my MO poo poo's any supplements and stuff, but I'm going to be starting back up after I go in next week.
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Hello all!
I've been following along since my first treatment which was March 8. I'm now looking forward (well not really) to my 4th and last treatment on May 10! Was wondering if anyone has started the Herception only phase? I'm suppose to do another ten months, every 3 weeks Herceptin infusions. Are there lots of side effects still? I've had just about everything with TCH, except for neuropathy, even have weird earaches that my MO can't quite figure out. Was just hoping it would get better once I'm on Herceptin alone
Thanks for any info! Have loved this board and all the wealth of knowledge and strength it provides.
Here's to the good days!
-Yvette
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Sorry you've had so much trouble. My MO had me on several supplements made it through all 6 TCH with no slowing down. Vitamin D3 800, Vitamin E 1200, prenatal with iron, L-glutamine 30g for 3 days after tch 5g the rest of the time. The L-glutamine was to help prevent neuropathy due to the taxotere. I just finished my year of herceptine and have only few issues or side effects (ex:weight gain and achy joints)
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Hi Yvyc! I'm still in the middle of my TCH (2nd one Tuesday). My first one was pretty rough. 2nd one - jury is still out. I didn't have ear aches, but I did have ear popping and ringing after the first one; it went down over time but never went away completely. It is now louder again after my 2nd TCH. I had a hearing test after my first TCH to confirm no hearing loss. I will have another hearing test next week to make sure there is still no hearing loss after two TCH's. It is worriesome to me, but the audiologist reassured me that I would not have marked hearing loss with just one TCH, so I'm taking it it treatment by treatment.0
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Yuc, I have two more left, I finish in June. Then I start herceptain only. So I am interested as well, but like anything else, I'll have to wait for those special SEs with my name on them.! LOL! Here hoping there won't be any! Thank for the heads up fujjimom.
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Hello
I started Chemo that started in March x 4 with the AC which the last one slammed me into the hospital.
Glad to have found you and plan to read up. I start 12 rounds of taxol and herceptin on Tues. Blah
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Dougies'wife, kelloggs and others who commented. Today I went in for TCH. I was concerned that the nurse wouldn't get the blood return but it came fast and furious. I was so relieved. I saw my oncologist today and he is having me come in for a Neulasta shot b/c my absolute neutrophils dropped to 400. He warned me about SE of aching and maybe mild fever. Thx for telling me not to worry too much. This is such a great thread with all you knowledgeable ladies. Have a wonderful SE free weekend.
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slgarcia05 there seems to be a lot of women diagnosed with breast cancer and low D. I was diagnosed with low D months before my diagnosis. I was in the single digits! With supplements I got it up to 79 (last time I was tested) which is a little high but they are not worried.
I thought normal range was between 18-72 but that might be dependent on the type of testing you had done.
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Ps. I meant to thank Dougieswife for reminding me to drink a lot. I had a friend picking me up at 7 am for my 1st appt. I never sleep well the night score treatment so I spent a good part of the night dri king water. :-)
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Alice - glad everything flowed for you. If you are getting the Neulasta, take a Claritin (regular 24 hour kind) the day you get the shot and for several days after. The first Neulasta can cause a bit of bone pain but the Claritin does help! Have a great weekend....here's hoping your SE's are mild.
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Dancetrancer - Sorry to hear about your ears, mine is definitely more pain/achy. Went to see an ENT last week, they checked my hearing too, and all is fine. He thought it might be TMJ related, so I got a night guard and an antinflammatory med. Still have pain, but not as bad some days, it's so weird! I'm hoping it will stop after I'm done with TC, but my MO said it may be the Herceptin causing it! Ughh, don't know if I can take it for the rest of the year..0
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Alice - so happy to hear your port worked fine! I had mine accessed today and they could get saline, etc. through it, but initially couldn't get blood to draw. They injected lots of different stuff and eventually the blood started flowing fine. The nurse wasn't worried about it at all. She said it is usually a positional issue, and they can get it working. She said ports can be tempermental. It was a relief to hear her say that AND to see it working fine!
Yvyc, thanks for the empathy - I hope the new tx approach works for you! It is odd, isn't it? One just never knows what all is going in our bodies with all of these drugs. You do what you gotta do, though. Never heard of Herceptin and ear troubles...but heck it hasn't been around very long, so anything is possible. I hope it is the TC, and it goes away for you after your last treatment.
All - I am 3 days post my 2nd TCH. Doing much better so far compared to last time. I had the D train day 1 post a.m. (I have lost 6 # in 2 days! Yes - drinking, drinking, and eating!), but since then, no D or C. Probiotics and prune juice seem to be helping to keep me from one extreme or the other. Bad indigestion yesterday afternoon, but better after extra meds taken. This morning was the worst - sharp stomach cramps (gosh, those HURT!) after eating breakfast...take my breath away...doc had advised to take Magnesium Oxide if this happened again, so I took some. MUCH better within about 30 minutes or so. No return of stomach cramps.
Had bloodwork done this morning, white counts still ok, so no Neupogen yet. I feel wiped out/tired, but no fever yet, so real happy about that. Will get repeat bloodwork Monday - expect counts will be down by then and will start Neupogen.
Overall, so far really feel that I'm handling this one MUCH better...hope I'm not jinxing myself!!! Still have the weekend to face, LOL. I suspect only getting 2 mg/kg Herceptin this time compared to the loading dose of 8 mg/kg on my first round is making an impact in how I'm feeling as well.
Thank you all SO MUCH for your continued support and help. You guys are so great.
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The ear pain could be from the Herceptin. The worst side effect I had (thank God) from my first H only was jaw and ear pain. It was gone within hours. The jaw pain was similar to chewing stale gum.too long.
Glad to hear you are feeling pretty good, Dance!!!!0 -
Dance - so glad it is going better. Hope it continues. I had those stomach spasms and it was the worst part of my chemo SEs BY FAR. I finally (at tx #5) got a drug called Bentyl (onc wrote rx for me) and it worked GREAT. I think I mentioned this to you before. But if you continue to have those spasms, DO NOT SUFFER through them. Ask for this Rx and take it - within 15 min the muscles relaxed. I only used it a few times, but it made a huge difference, and I should have asked for it sooner.
Somebody asked about SEs of Herceptin alone. (Sorry I forget who it was.) I had almost none. I declined the benadryl in the drip so that i could drive myself to/from and not be drowsy. I would go get it done and go back to work and about my day. I did have some muscle stiffness (like when getting up after sitting for a while, it took me a few steps of hobbling till i could move about easily) and that resolved when H was over. I could smell it in my urine the next day or so. And in retrospect, i think it fatigued me a little. But at the time, compared to chemo, I thought it was AWESOME. So be encouraged - it is NOT like having chemo for a whole year. Once you get past your 4 or 6 TCH, the "H-only" part is MUCH easier.
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Hi Amy! Thank you so much for the reminder about Bentyl. I did have it on my list of things to ask him for - but when I brought up the stomach cramp issue he immediately said he wanted me to try Magnesium Oxide. I wanted to ask for the Bentyl...but I figured I better not push it with my requests...fortunately the mag worked well for me. I still have the Bentyl request in my pocket should the mag not work the next time - thank you so much! Those cramps are indeed the worst, I think, of all the symptoms. So sharp! It makes me stop whatever I am doing at the moment and freezes me in my tracks.
I just woke up from a nap - ahhhhhh. My hemoglobin has been just below normal since after TCH #1 and has yet to recover fully. Taking it easy! Will be a weekend of watching movies with the hubby. Hope you all have a nice weekend!
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Does anyone know if the order in which the Herceptin is given makes a difference on infusion day? ie. Herceptin, Tax, Carbo vs. Tax, Carbo, Herceptin?
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dance - I don't know but mine went tax, carbo, herceptin0
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I doubt it. My order was the same as Omaz.
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Thanks guys. I was just asking b/c my onc nurse said the prescribing pamphlet for Herceptin said to do it Herceptin, Tax, Carbo. I asked him if we could do Herceptin last b/c it would count towards my end time that I need wearing my cold caps (I have to wear them 4 hours post last chemo, aka 4 hours post Carboplatin). He didn't have a problem with it. Just wanted to make sure I wasn't screwing up the effectiveness of my treatment by making that request!
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