Taxol or no Taxol after the newest research

trigeek

Well I am  scheduled to go through 4 rounds of AC and 4 rounds of Taxol for Stage 2b ILC. (with 2 node involvement determined by SNB, did not go for axillary removal)

Now in light of the latest research showing that the Taxol actually did pretty much 'zilch' for HER- gals I am trying to wriggle myself out of that part. I have done 2 AC's so far. In one of the threads there was a mention of AC needing Taxol to potentiate it but have not seen any reference to this fact anywhere.

I had an appointment with my oncologist on the day that this study was released so he did not have the details on it yet to discuss, but in my next appointment for the 3rd AC next Thursday I will bring it up again.

Any thoughts on this ? I wish the study publisned in the New England Journal of Medicine

(http://content.nejm.org/cgi/content/short/357/15/1496 )

had a lobular criteria, unfortunately it  did not have it.  I hate what this chemo is doing to my body and want to take control asap.

Thanks a bunch !

aike

I am in your same shoes.  I have stage 2 Lobular, mastectomy, and am shocked by this news.  My oncologist is still gathering info about the article too...but does not want to change the course of my treatment.  I see him tomorrow when I get my third round of AC...then next round is the Taxol...for 4 times.  I think we have to listen to the advise of the Dr's and do what they say.  My husband is a phsician and says this study is a retrospective study...meaning the intent of the study was not to determine if taxol "worked". It just happened to be information formed during the original study of another nature.  There have been plenty of other studies proving that ac+t does work, and that is our hope.

shrink

I posted this on several other threads:

I went for my 3rd of 4 Taxol treatments yesterday.  The tumor board at the hospital wants to keep me on this regiment even though I am ER+ and HER2-.  I have iBC, DCIS, IDC and ILC - nuc. grade 3, 6cm.  Since this is a very aggressive mass they want to throw everything they have at it.  In general the medical community is not changing the protocol until more studies are done.  I went to a conference given by the UP last week and the onc/moderator spoke to this study.  The bottom line for me is that after 4 rounds of AC and 2 rounds (ev. 3 wks) of Taxol, the tumor is almost gone.  So, even though the Taxol is supposed to be ineffective for me, something made that demon shrink like hell.

TenderIsOurMight

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD004421.





Taxanes for adjuvant treatment of early breast cancer.



Ferguson T, Wilcken N, Vagg R, Ghersi D, Nowak A.



BACKGROUND: Adjuvant chemotherapy improves survival in pre- and post-menopausal women with early breast cancer. Taxanes are highly active chemotherapy agents in metastatic breast cancer. Their role in early breast cancer was examined in this review. OBJECTIVES: To review the randomised evidence comparing taxane containing chemotherapy regimens with non-taxane containing chemotherapy regimens as adjuvant treatment of pre- or post-menopausal women with early breast cancer. SEARCH STRATEGY: The Cochrane Breast Cancer Group Specialised Register was searched on 9th January 2007 using the codes for 'early breast cancer' and keywords for taxanes. Details of the search strategy used to create the register are described in the Group's module in The Cochrane Library. The reference lists of other related literature reviews and articles were also searched. SELECTION CRITERIA: Randomised trials comparing taxane containing regimens with non-taxane containing regimens in women with operable breast cancer. Women receiving neoadjuvant chemotherapy were excluded. DATA COLLECTION AND ANALYSIS: Data were collected from published trials and abstracts. Studies were assessed for eligibility and quality and the data extracted independently by two review authors. Hazard ratios (HR) were derived for time-to-event outcomes, and meta-analysis was performed using a fixed-effect model. The primary outcome measure was overall survival (OS); disease-free survival (DFS) was a secondary outcome measure. Toxicity and quality of life data were extracted when reported. MAIN RESULTS: We identified 20 studies, 12 of these (7 full publications, 5 abstracts) had sufficient data published for inclusion (11 for OS and 11 for DFS) in the review. The weighted average median follow up was 60.4 months. All studies fulfilled quality criteria either adequately or well. Amongst 18,304 women with 2483 deaths, the HR for OS was 0.81 (95% CI 0.75 to 0.88, P < 0.00001) favouring taxane containing regimens. Amongst 19,943 women with 4800 events, the HR for DFS was 0.81 (95% CI 0.77 to 0.86, P < 0.00001) favouring taxane containing regimens. There was no statistical heterogeneity for either OS or DFS. AUTHORS' CONCLUSIONS: This meta-analysis of studies supports the use of taxane containing adjuvant chemotherapy regimens with improvement of overall survival and disease-free survival for women with operable early breast cancer. The review did not identify a subgroup of patients where taxane containing treatment may have been more or less effective. Dosage and scheduling of the taxane drug is not clearly defined and we await results of the next generation of studies to determine the optimal use of taxanes in early breast cancer.



Note: Cochrane Database is a respected British performer of detailed clinical trial reviews.The Cochrane Collaboration was founded in 1993 and named after the British epidemiologist, Archie Cochrane.T.

trigeek

Thanks Tender.. but there is no mention of the HER here if I am not mistaken.. so everything is bundled up.

Shrink that is great news and is giving some meaning to going with the T.

Sigh.. guess I just have to bite the bullet and get them over with and hope that my body will recover from all the toxins.

TenderIsOurMight

It's a tough road your on, Trigeek. I journeyed that way myself six some years ago.



Do what your heart tells you to do...then you won't look back.



Tender

LizM

I talked to a women yesterday who was undergoing lumpectomy after neoadjuvant chemo.  She was strongly ER/PR ++ and her2 negative.  After dose dense chemo of 4 AC and 4 Taxol there was no evidence of any tumor on imaging.  She is not the first person I have talked with who was hormone receptor positive and her2 negative who has had a very good response with dose dense AC and Taxol.  Because my chemo was after surgery I will never know if it worked but hearing from those where neoadjuvant chemo worked gives me hope that I did not do the chemo for nothing. 

cp418

LizM - Thanks very much for your post.  I've been wondering too if the chemo 4 AC and 4 Taxol worked for me either post surgery and strongly ER/PR++ and her2 negative.  It was a tough price to pay if done for naught. Joann

roseg

 This link talks about the newly approved drug, but one of the comments below asks about Taxol and the status with her. The response to the comment sheds some light on why it's still a good treatment for aggressive cancers, even if they are not her+. 

So it's not the article, although that's interesting in itself, it's the comments below. 

http://scienceblogs.com/terrasig/2007/10/ixempra_ixabepilone_approved_f.php