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Topic: Chemo dose reduction/modification

Forum: Triple-Negative Breast Cancer —

Share with others who have ER-/PR-/HER2- breast cancer.

Posted on: Apr 18, 2019 03:07AM

Dee1987 wrote:

hi there I was diagnosed last year with a 1.5cm trip neg carcinoma and I was set out to do dose dense ACT. I cope well first 2 doses of ac then my dose was lowered as my wbc dropped to 0.7. A few weeks ago I started dual taxol and carboplatin(I found it I was brca positve) and the same thing happened again my blood counts were all over the place so they’ve changed my taxol to weekly infusions and lowering my carboplatin. Has this happened to anyone else?

Stage 1a er 15% pr 0 her2 - Dx 11/5/2018, IDC, Left, Stage IA, Grade 3, 0/2 nodes, ER+/PR-, HER2- (IHC) Chemotherapy 1/16/2019 AC + T (Taxol)
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Apr 18, 2019 04:01AM FrackingHateCancerMPBC wrote:

Hi there Dee 1987,

I'm sure it happens all the time or often enough. I'm just offering support because it didn't happen to me.

My Hemoglobin & red blood cells dropped and my white went through the roof. I do not know why, in fact my platelets are still at 510. That I found out yesterday while clearing for reconstruct surgery.

I hear though that a 20% reduction and a move off of Adriamycin as well as sometimes going to 2nd generation drugs. Shortening cycles etc. This is because my doctor offered all these things. Is the Carboplatin for BRCA + ?

I'm still new to this. What does er 15% mean? Your estrogen receptors are positive but only at 15%? Is that low for estrogen? Are you considered ER positive then?

OK then. I think the doctor doesn't want to kill you, so lowers the dose. That's my limited understanding of how that works. Was it non-optional in that the doctor didn't give you a choice but simply said you have to change? Are you communicating well enough with your MO?

Someone else will answer your post with experience and insight. From me it's all questions, I'm like a bad cop bad cop tonight. Just always asking personal questions and now I am wondering is 1987 your birth year, high school or college graduation year? Don't answer it it's none of my business.

I am playing catch up with my school/work while the boob replumps or whatever it's doing. Shouldn't be writing on the forum this late. That said, I am participating more actively in my treatment since I joined up, and asking docs more questions and that is proven to increase positive outcomes in all illnesses across the board and this is my health so yada yada, it's a good thing. Yes I just did a whole thing there all by myself. I do need sleep.

Fracking out, pillow is calling. Welcome to this thing called life.

Dx 2/19: Plastic TN (MpBC) | 3.9 cm | Neg Nodes | BRCA Neg | Stage 2 | Grade 3 | 16 days Dx to LUMP | ACT halted | LUMP | Dent Repair was Fat Graft | Summer of RADS | Now 🤞🏽 Inspire hope, live well & be VIGILANT for 5 years (TN) and beyond 🔭🌋👑.
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Apr 18, 2019 05:46AM Dee1987 wrote:

hey yes carboplatin is for my brca gene.1987 is my birth year and my estrogeni was weakly positive but I’m still considered triple negative. My ac dose was reduced by 20% and now my carboplatin is reduced by 15

Stage 1a er 15% pr 0 her2 - Dx 11/5/2018, IDC, Left, Stage IA, Grade 3, 0/2 nodes, ER+/PR-, HER2- (IHC) Chemotherapy 1/16/2019 AC + T (Taxol)
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Apr 18, 2019 08:14AM Momchichi wrote:

My AC was reduced by 20% I think and my dr made it sound like it isn’t unusual to do so and that the doses are based off clinical trials and then adjusted for the individual. I also skipped the final dose of both AC (for my triple negative) and TCHP (for my HER2+) due to being hospitalized. Again, my dr didn’t seem surprised or worried. Best wishes to you as you continue treatment

Dx at 38, TN in breast, HER2 + in some nodes. TN met to L2 at 40. Dr thinks I was never HER2+ & it was a false + from neoadjuvant chemo - whaaat??? Dx 7/19/2017, DCIS/IDC, Right, 4cm, Stage IIIC, Grade 3, 16/19 nodes, ER-/PR-, HER2+ (FISH) Chemotherapy 8/9/2017 AC Chemotherapy 9/27/2017 Taxol (paclitaxel) Surgery 1/18/2018 Lumpectomy: Right; Lymph node removal: Underarm/Axillary Targeted Therapy 2/15/2018 Herceptin (trastuzumab) Targeted Therapy 2/16/2018 Perjeta (pertuzumab) Chemotherapy 2/16/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 6/23/2018 Whole-breast: Breast, Lymph nodes, Chest wall Dx 6/19/2019, Stage IV, metastasized to bone, Grade 3, ER-/PR-, HER2- (IHC) Radiation Therapy 8/11/2019 External: Bone Chemotherapy 9/3/2019 Xeloda (capecitabine) Dx 11/22/2019, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 12/6/2019 Carboplatin (Paraplatin), Gemzar (gemcitabine) Chemotherapy 1/6/2020 Abraxane (albumin-bound or nab-paclitaxel) Immunotherapy 1/9/2020 Tecentriq (atezolizumab) Targeted Therapy Trodelvy (sacituzumab govitecan-hziy)
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Apr 18, 2019 02:36PM FrackingHateCancerMPBC wrote:

Hi Dee1987,

I'll get this bumped for you to maybe get more responses, by asking more nosy question, that you do not have to answer!

I didn't see any surgery on your profile other than sentinel node removal, and congratulations on the NEG nodes and the early detection!! 'm guessing you did some of surgery already and it's just not listed? That BRCA test was ordered right away with your young age (and the TNBC to boot), correct? And then do you have radiation on your plan as well coming up?

As well Dee posting directly in the "Calling all TN's" thread might get you a better response. A lot of TNBC ladies monitor that thread. I'm guessing MANY of them have had CHEMO mods. Plowing through it exactly as planned the first time has got to be the exception and not the rule. But maybe I'm wrong, I'm new to this.

I wish we could post polls here, would be great to find out.

Fracking

Dx 2/19: Plastic TN (MpBC) | 3.9 cm | Neg Nodes | BRCA Neg | Stage 2 | Grade 3 | 16 days Dx to LUMP | ACT halted | LUMP | Dent Repair was Fat Graft | Summer of RADS | Now 🤞🏽 Inspire hope, live well & be VIGILANT for 5 years (TN) and beyond 🔭🌋👑.
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Apr 18, 2019 03:03PM Dee1987 wrote:

sorry I’m not really good with technology I need to get my partner to update everything. I was diagnosed in November last year with a 1.5cm weakly er positive(15%) technically trip neg and being treated as so. I was operated first and had a single mastectomy and started act 30 days later. In the meantime I was doing ac I had the gene test as my mum is an ovarian cancer survivor of 15 plus years and my aunt diedof breast cancer 30 plus years ago. When we found out I was positive they then added carboplatin to my mixture and I done one dual dose of it with taxol and it wiped my wbc so niente I get a reduced dose of it and they’ve changed my taxol to weekly. After chemo I have to remove other breast and ovaries

Stage 1a er 15% pr 0 her2 - Dx 11/5/2018, IDC, Left, Stage IA, Grade 3, 0/2 nodes, ER+/PR-, HER2- (IHC) Chemotherapy 1/16/2019 AC + T (Taxol)
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Apr 18, 2019 03:05PM Dee1987 wrote:

no I don’t have radiation as I had a mastectomy and nodes were clear and no lvi either although I might get a second opinion about tha

Stage 1a er 15% pr 0 her2 - Dx 11/5/2018, IDC, Left, Stage IA, Grade 3, 0/2 nodes, ER+/PR-, HER2- (IHC) Chemotherapy 1/16/2019 AC + T (Taxol)
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Apr 23, 2019 09:46PM anotherNYCGirl wrote:

Dee, - I was in a similar situation.

After my first round of AC, my wbc was dangerously low, and my blood pressure too high, I had a slight fever, rapid heartbeat, etc., even with neulasta!

My oncologist decided to divide the A and the C for the rest of the treatments. C was given as my next round, then A, then C until the regular amounts were given. It took a few weeks longer, but it helped! I was also given a 'red card' to show in case I developed a fever over a certain amount, at which point I was told to go to the ER. The card would allow me to be isolated as much as possible from other patients who would have posed extra risk for me with such low counts. (Fortunately, I never need to go to the ER.)

After AC, I had 4 dose dense taxol, and found that easier.

I hope you are getting through the remainder of your treatments feeling ok!!


Dx 1998, DCIS, Stage 0 Surgery 3/18/1998 Lumpectomy: Left Dx 6/2000, ILC, Stage IA, 0/3 nodes, ER+/PR+, HER2- Surgery 7/11/2000 Lumpectomy: Right; Lymph node removal: Right, Sentinel Chemotherapy 8/1/2000 CMF Hormonal Therapy 2/11/2001 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 2/12/2001 Breast Hormonal Therapy 2/12/2006 Femara (letrozole) Dx 2/2014, ILC, Grade 3, 0/3 nodes, ER-/PR-, HER2- Surgery 3/25/2014 Lymph node removal: Left, Right; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 5/2/2014 AC + T (Taxol) Surgery 11/20/2014 Reconstruction (left); Reconstruction (right) Surgery 1/14/2015 Reconstruction (right): Tissue expander placement Surgery 5/28/2015 Reconstruction (right): Latissimus dorsi flap, Silicone implant Surgery 2/22/2016 Reconstruction (left): Fat grafting, Nipple reconstruction; Reconstruction (right): Fat grafting, Nipple reconstruction
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Apr 24, 2019 06:56AM Dee1987 wrote:

thank you I was worried not having full amount affects survival. I spoke to my oncologist yesterday and apparently modifications are normal and that carbo depends on my creatinine level. I was supppsed to do dose dense taxol then I had my genetics come back positive so they added carboplatin and had to change to every 3 weeks but after one dual infusion I was almost wiped so they have put me to weekly taxol and I have carbo every 3 weeks but slightly lower dos

Stage 1a er 15% pr 0 her2 - Dx 11/5/2018, IDC, Left, Stage IA, Grade 3, 0/2 nodes, ER+/PR-, HER2- (IHC) Chemotherapy 1/16/2019 AC + T (Taxol)
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May 28, 2019 11:16AM jrominger wrote:

My wife just started her chemo (A/C) on May 16th. She did a blood test 7 days later and her WBC count had dropped to zero! Everything else is fine. She is to have another blood test tomorrow and 2nd round of chemo on Thursday if counts improve. I appear to have gotten a slight cold so I am masked up and sleeping and bathing in another room. We assume that if allowed to do chemo on Thursday they will reduce the formula. I can keep you posted.

Dx 4/25/2019, IDC, Left, 2cm, Stage IIA, Grade 3, ER-/PR-, HER2- Chemotherapy 5/16/2019 AC + T (Taxol)

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