Come join others currently navigating treatment in our weekly Zoom Meetup! Register here: Tuesdays, 1pm ET.
Fill Out Your Profile to share more about you. Learn more...

Taxotere vs taxol, effectiveness and side effects

Options
Brightness456
Brightness456 Member Posts: 174

Hi everyone. I'm hoping someone can help me understand the differences between taxotere and taxol. From what I understand, they are essentially the same, but taxotere is a more aggressive drug, recommended for her2+ people.

My main concern about taxotere is the increased chance of permanent hair loss, but my MO initially brushed that off, saying there's only a 1% chance of permanent hair loss. She said I should have taxotere because taxol isn't as strong. Still, it's not her hair that might be gone forever. I wonder if taking taxol longer would be the equivalent of the stronger drug in taxotere for a shorter duration?

I'm meeting with another MO tomorrow and would like to go in asking intelligent questions. Can anyone help me understand the differences in basic terms? I know it's "just hair", but when it's your own hair it matters, at least it does to me.

Thank you in advance. I've really appreciated the knowledge and support I've gotten on this site

Comments

  • specialk
    specialk Member Posts: 9,221
    edited July 2017
    Options

    Taxol (paclitaxel) and Taxotere (doxetaxl) are indeed both taxanes, but Taxotere is a stronger dosing. The current prescribing guideline for Taxol as a stand alone chemotherapeutic agent for Her2+ breast cancer is for patients who are stage 1, usually 1cm tumor or smaller, and node negative, to be accompanied by Herceptin, abbreviated TH - and is usually given post-surgically for 12 weeks with Herceptin, then the Herceptin is continued for the balance of the year. Taxol can be used in a combined regimen with an anthracycline drug - Adriamycin given with Cytoxan for 4 dose dense infusions, then either 4 dose dense Taxol, or 12 weekly Taxol given with Herceptin, and with Perjeta, AC-TH(P), if warranted by your clinical findings - usually 2cm tumor or larger, or node positive. If Perjeta is used then chemo is usually neoadjuvent. If the suggested regimen is Taxotere, Carboplatin, Herceptin, and possibly Perjeta, TCH(P), for 6 cycles, Taxol is not a suitable substitution. This regimen is usually given neoadjuvently if accompanied by the Perjeta. If Perjeta is not used either of these regimens can be given adjuvently. Here is a NCCN link to the types of chemo regimens given for Her2+ patients:

    https://www.nccn.org/patients/guidelines/stage_i_ii_breast/#56

    One thing you might consider is using cold caps with Taxotere to preserve your hair - cold capping generally works well if you use it with taxane based chemo, rather than anthracycline based. I think the oncologist you spoke with is underestimating the risk of alopecia with Taxotere, while still a rarity it is greater than 1%.

  • danix5
    danix5 Member Posts: 141
    edited July 2017
    Options

    Taxotere is a stronger dose and has more side effects. First onco said TCH and I got a second opinion and chose the onco that chose TH for me instead of TCH. I am BC two time winner. This current one is stage 1 triple positive high grade. But tumor was 1cm or slightly larger. I already had bi- lateral mast and oppher/hyster in 2008. So this time it was just two surgeries ( needed to clean margins) and TH 12 weeks, radiation 33 treatments- 10 boots to sternum ( where cancer grew) Herceptin for one year, and Arimidex 5+ years.

    I would say Special K gave you great guidelines so read up, write your questions down, and know that it is a horrible place we are in choosing.... but at least we are early enough to still have a choice.

    Best to you and big hugs. So sorry you had to join!

    Dani

  • BarredOwl
    BarredOwl Member Posts: 261
    edited July 2017
    Options

    Although they are both in the general class of "taxanes", the drugs paclitaxel (Taxol) and docetaxel (Taxotere) are two distinct drugs with different chemical structures as illustrated below:

    image


    The main structure is common to both. However, they differ at two positions:

    (1) The nature of the substituent "R1" (at the very top, center); and

    (2) The nature of the substituent "R2" (located just above the inset box).

    For the actual substituents at those positions, see the inset box, which identifies what R1 and R2 are in each compound.

    BarredOwl

  • jackster51
    jackster51 Member Posts: 139
    edited July 2017
    Options

    I did not get my hair back after Taxotere - ( it's actually a 10% chance, not 1%!) or eyelashes or one eye brow. That was 5 years ago. I also still have crippling neuropathy that prohibits me from wearing closed toed shoes or being on my feet for more that a few hours. Had I known about either of these permanent side effects I would have made a much different decision. Wishing you the best.

    And it's not "just hair" when it's your hair.

  • smulse
    smulse Member Posts: 1
    edited October 2017
    Options

    I am due to start chemo next month. I am still trying to decide between THC vs. TH treatment. THC every 3 weeks for 18 weeks plus Herceptin continuing for 1 year is what my MO recommends. I am leaning toward TH every week for 12 weeks plus same Herceptin regimen as THC. I am told the only reason THC is recommended is the size of my tumor, 2.5cm. Anyone out there have similar experience?

  • stephincanada
    stephincanada Member Posts: 29
    edited October 2017
    Options

    There is a 2015 article that examines the difference in efficacy and side effects between Taxotere and Taxol titled "Balancing activity and tolerability of neoadjuvant paclitaxel- and docetaxel-based chemotherapy for HER2-positive early stage breast cancer: Sensitivity analysis of randomized trials". I don't know if the study is considered good evidence or not.

    In the end, I chose Taxotere (which followed an anthracycline) over Taxol. Taxotere carries a greater risk of permanent hair loss, while Taxol puts the patient at risk of neuropathy (neurotoxicity). I figured that I would rather be permanently bald than in permanent pain. My mother developed permanent neuropathy from Taxol and she really suffers from it.

    Here is the abstract (if anyone wants the rest of the article, please PM me):

    "Paclitaxel and docetaxel represent the most adopted taxanes in the neoadjuvant treatment of HER2-positive breast cancer. Questions still remain with regard to their difference in terms of activity and tolerability.

    Events for pathological complete response (pCR), severe and febrile neutropenia (FN), and severe neurotoxicity were pooled by adopting a fixed- and random-effect model. A sensitivity analysis to test for the interaction between paclitaxel and docetaxel was accomplished. Absolute differences with 95% confidence intervals (CIs) and the number of patients needed to treat/harm (NNT/NNH) were calculated to derive the Likelihood of being Helped or Harmed (LHH).

    Data from 15 trials (3601 patients) were included. Paclitaxel significantly increases pCR rate by 6.8% in comparison with docetaxel (43.4%, 95% CI 41.1–45.7% versus 36.6%, 95% CI 34.3–39.0%, p = 0.0001), regardless of the chemotherapy backbone, with an absolute difference of 9% and 9.2% for anthracy- cline-based or free-regimens. Paclitaxel significantly improves pCR versus docetaxel with a single HER2-inhibition by 6.7% (p = 0.0012), with no difference if combined with a dual HER2-inhibition. Severe neutropenia and FN are significantly lower with paclitaxel, with an absolute difference of 32.4% (p < 0.0001) and 2.5% (p = 0.0059), respectively. Conversely, severe neurotoxicity is slightly higher with paclitaxel (3%, p = 0.0001). The LHH ratio calculated for pCR and severe neutropenia is 2.0 and 0.7 for pac- litaxel and docetaxel.

    Although the activity of neoadjuvant paclitaxel and docetaxel HER2-positive breast cancer is considered similar, the slight advantage in pCR, the significantly lower neutropenia and FN, do favor paclitaxel (in the weekly fashion) over docetaxel, despite the slightly worst neurotoxicity."

  • KimCee
    KimCee Member Posts: 170
    edited October 2017
    Options

    Hi there,

    I had taxotere 18 years ago and my only side effect was watery eyes. I will say that my hair grew back very fine, sparse eyebrows and eye lashes. I see my oncologist on 10/12. If I have a choice, I will choose taxotere again. I do not want to deal with the neuropathy that my fellow BC friends dealt with

  • Janet217
    Janet217 Member Posts: 2
    edited March 2018
    Options

    I am sorry you are or had to face such choices. I took Taxotere and was never warned of permanent hair loss. I almost wish I had done nothing because it may sound vain but if you are a young woman or still dating or working loss of hair can be devastating! It causes self esteem issues, suicidal thoughts and yes, while it's just hair, it's your hair! Hair will help you feel healthy and vital after all that you go through. It is horrible to have the wrong people identify with you... have it negatively impact your work and dating. My hair has minorly come back after using biotin and rogaine.: it is fine fine fine and straw like unlike my previous hair! People now avoid me and wigs are uncomfortable but you can see my scalp and work doesn't want me to talk about my hair but clients still think I am on chemo... I never get to appear healthy and I look 15-20 years older so if you don't mind being 50 and having 75 year old men flirt with you... I can't really recommend taxotere to anyone and feel the drug should be pulled! It causes alopecia in 10% of woman according to studies from UK. Best wishes and I hope your outcomes were positive!!!! I wonder as I have an autoimmune disorders of Crohn’s and ms if that could be why I permanently lost my hair. They need to do research to find out who lost their hair and who didn’t say at least they might know more about who are bad candidates for taxotere

  • Meg101
    Meg101 Member Posts: 26
    edited March 2018
    Options

    My chemo included Taxotere. My hair fell out on the14th day after the 1st round. It started growing back in a few weeks after it fell out and was almost 1/4" long by the end of being on Taxotere. I started the next type of chemo a month later (Adriamycin, aka Red Devil). I lost all my hair again on day 13 after the 1st round. I also lost my eye browse & eyelashes while on Adriamycin). I finished chemo about 2 months ago and my hair is barely starting to grow back again, but not my browse & lashes. I felt physically better while taking Taxotere and my hair was growing back thicker than ever before. It was the Red Devil that took my hair, eye browse and lashes, and they haven't started growing back yet except for some "peach fuzz" on my head. We are all different in the way our bodies process various chemo regimes.

    As for the neuropathy issue while taking Taxanes, I used CryoMax ice packs on my hands and feet before and during each infusion and had no problem with neuropathy. I bought ice packs on Amazon.

    To prevent mouth sores, I chewed on ice before and during each infusion. I had one mild little sore after one of the infusions, but that was probably due to not rinsing often enough with baking soda and salt. When I increased the mouth rinsing, the sore went away.

    There are a few threads on BCO about Cold Capping to keep your hair from falling out during Taxotere chemo. I've heard that Cold Capping has improved in the last few years and that it actually works best for those on Taxotere. It's a bit pricey, but worth it for those worried about hair loss while on Taxotere.

  • GwennyMD
    GwennyMD Member Posts: 68
    edited March 2018
    Options

    It has been 5 years since I was told I needed chemo. My chemo plan was ACT. When I was finishing the AC we discussed Taxol vs Taxotere. There was no discussion about permanent hair loss or permanent neuropathy. The doctors were recommending Taxol based on a study that showed that 89% of women on Taxol survived 5 years without recurrence vs 85% of the women on Taxotere. At that time, I was still working full time and did not want to take off a day every week for Taxol vs a day every 3 weeks for Taxotere. I also did some research and saw that every chemo drug therapy that was dose dense (taken more frequently that once every 3 weeks) had a better result in the studies. Since I had already planned to have a BMX at the end of the year, I did not feel that the 4% difference did not matter.

    Personally, I do not know if I would have made the same choice if I had been told about permanent hair loss. Fortunately, my hair did grow back but I have 2 friends who were not so lucky. I do, however, have permanent neuropathy.

  • Molly316
    Molly316 Member Posts: 10
    edited November 2018
    Options
    I just read your post regarding your hair loss after taxotere treatment. May I ask if your hair loss was all of your hair or just in some places on your head? I also took taxotere and completed chemo six weeks ago. My hair is not really returning. I am very concerned. Thank you.
  • MiCyn
    MiCyn Member Posts: 29
    edited November 2018
    Options

    Hi Molly316 .. I came here tonight looking to see if others had experienced slow hair growth after chemo. I finished Taxotere 6 1/2 weeks ago. I have no sign of hair growing back yet. I didn't think too much of it until I was at radiation today, and chatted with a lady who just finished chemo(Taxol) 3 weeks ago.Her hair is coming in quite fast. I did ask my RO on Tuesday about it. He said sometimes it takes as long as 8 weeks to see growth, and that I shouldn't be too concerned for now. Hopefully he's right..

  • Molly316
    Molly316 Member Posts: 10
    edited November 2018
    Options

    It sounds like we are at the same place. I do have peach fuzz but that is about it. The hair on my legs is also growing. I see my doctor tomorrow and I’ll let you know what she says. I have a friend that took taxotere 10 years ago and her hair is very thin. It barely covers her scalp. She has to wear a wig. I’ll keep in touch.

  • Molly316
    Molly316 Member Posts: 10
    edited November 2018
    Options

    Hello, well I saw my MO today and she said that she was hoping my hair would be more abundant at this point. However, She said that it is beginning to come in and it is not spotty. That was a good thing. She said let’s just wait and see. Easy for her to say. Now I am really concerned. Hope you have better results.

  • barqySpaniel
    barqySpaniel Member Posts: 1
    edited November 2018
    Options

    I understand the frustration. From the studies I've seen, Taxotere has significantly reduced risk of peripheral neuropathy compared to Taxol. With the increased risk of permanent alopecia. My fiance was taking Taxol, and started to get neuropathy. She decided the risk of permanent alopecia was less scary than the chance of permanent neuropathy.

    So far, the alopecia seems to be temporary, and no additional neuropathy.

    None of this is easy. And there seem to be no treatments without side effects. And clinicians don't know what side effects people will get. Some seem more likely than others with certain drugs, that's for sure.

    It's another year on for you, I pray your neuropathy has reduced.

  • carolita
    carolita Member Posts: 1
    edited December 2018
    Options

    Thank you for sharing ! How is your hair growth now? Im now facing to choose in between these medicines. Your review is highly appreaciated