Taxol/Herceptin WITHOUT AC???

Mocity

My question is whether anyone here has taken a regimen of Taxol/Herceptin without AC?
 
My quick story... had a bi-lateral mastectomy on 9/16/08 (6 wks ago) for extensive DCIS in my left breast.  I opted to take both.  During that pathology my nodes came back clear but they found a small tumor of IDC (.4cm).  Also, I am PR/ER+ and HER2+++.  So my Onc (Baylor) is recommending Taxol/Herceptin for 12 weeks weekly and then Herceptin every 3 weeks for a year.
 
In trying to research this I can't find others that have done this without doing the AC first.  I know he was taking into account alot of things and personalizing a regimen which I appreciate.  However, I want to make sure I do what I need to do to get this over with.  I know he is taking into account, my age, my small tumor size, no node involvment, etc.
 
I went to MD Anderson here in Houston for a 2nd opinion and they recommended the norm - AC every 4 weeks for 12 weeks followed by weekly Taxol/Herceptin for 12 weeks and finish the Herceptin for a year.  However, I felt like they had their protocol and this is what it is..  I truly "feel" better over at Baylor with the Onc who is a world renound doc in this field and his nurse practitioner is wonderful.
 
Today I have an appt at Baylor to ask him about all this.  Does anyone have any advice?  I would also love to find someone else that underwent Taxol/Herceptin without the AC first.
 
Thanks for listening, Cristl

PS - I posted this over on the chemo thread as well.  Just looking for anyone. 

DLL

Hi, Christi:  I, too, receieved an initial recommendation for AC+TH. (That recommendation came from Mayo). However, I chose a different regimen also approved for HER2+, called "TCH" (Taxotere, Carboplatin, Herceptin).  No AC.  This was recommended by a very reputable local breast cancer specialist in a major metro area. My sense from watching these boards over the past couple of months is that there are a lot of HER2+ women on THC (as well as on the AC-TH).  Not sure why your Baylor oncologist is not including the Carboplatin -- I'd be interested in learning why.

 Good luck! 

Mocity

I will ask today!  Thanks DLL!

bluedasher

Cristl, the basis for prescribing Taxol plus Herceptin is a study that compared any chemo with and without Herceptin. Herceptin without chemo is off label. I also had a pretty small IDC - mine was 0.6 to 0.8 but my DCIS was also smaller and I don't know if that makes a difference to your doctor's recommendation.

The Adriamycin in AC has heart risks and even a small (<1%) long term risk of luekhemia. If it causes a decrease in heart function one may not be able to get the Herceptin. I didn't feel that the benefit of chemo with it would outweigh the heart risk 

TCH was in a study that compared it with AC-TH and the benefits were very comparable with less heart risk and somewhat better on short term side effects too. My oncologist and I agreed that that was the right chemo for me. 

There is a stie with interviews of breast cancer researchers about chemo: http://breast.cancerqanda.com/adjuvant/her2/

That link should bring you to the set of interviews about HER2+ chemo. One of the interviews is with Dr Slamon and he talks about why he uses Taxotere instead of Taxol. 

suemed8749

Cristl: I had almost the same treatment as DLL - Taxol/Carboplatin/Herceptin. There is a TCH thread on the Chemotherapy forum and a TCH vs ACH thread on Her2+. Many women with Her2+ don't get the AC.

Best wishes to you as you begin treatment -

Sue

moonchild64

It is my understanding from my onc that the TCH regimen is a newer cocktail that has gained more momentum in 2008 following studies regarding the concerns of serious SEs of AC on the heart, especially when combined with Herceptin.  A couple references I found on the subject:

http://www.prescribingreference.com/news/showNews/which/FDAApprovesTwoBreastCancerRegimens5301

http://www.cancernetwork.com/breast-cancer/article/10165/1164019 (see Other Key Results)

Mocity

I am seeing alot of people that did TCH but not just TH......

mother78

Have I replied to this before?

My mother is taking only Taxol/Herceptin weekly for 12 weeks and then Herceptin alone every 3 weeks for a year.She had a small tumor, 1.2cm, a lumpectomy, no node involvement, but they did not get clear margins, so she had another lumpectomy. Originally her surgeon said she would just get radiation, but after the pathology showed HER2 +, her onc suggested the chemo. She is already 78, so she really just doesn't want a recuurence within 10 years.

mother78

Also, I am confused about your having a 5cm tumor but Stage 0. I thought that had to do with the size of the tumor, and so 5cm would be higher than 0. I am a novice at this whole thing though. Do you mind sharing how old you are?

Mocity

Sorry, my signature is confusing!  I had DCIS 5cm that was Stage 0.  So I had a bi-lateral mastectomy.  During the pathology of my breast tissue they found IDC that was .4cm and Stage 1.  They also found out that I am PR/ER+ and HER2+.  Because of my age (37) and family history (mom died at 38) and the fact that I am HER2+ they are recommending chemo+Herceptin.

mother78

As young as you are, I would think a more agressive treatment than just Taxol/Herceptin would be in order.

Mocity

I guess that is the big debate?  I am starting Taxol/Herceptin this Friday and am scared to death of it all.  In some ways I have been very agressive.... bi-lateral mastectomy brought my recurrence rate down to 10% (small IDC of .4cm).  Some would say chemo is aggressive for a tumor this size.  Who knows.  Praying and hoping I am making good decisions.

dmooney

Hi CristIC!  I am also receiving the Taxol/Herceptin protocol.  My Her2 result came back at 2.2 originally, but my oncologist wanted to retest it since it was "on the fence".  It came back 2.8, so they recommended the chemo/Herceptin combo and felt it was the best way to go.  I have already had radiation and have had 8 treatments.  4 to go.

Don't worry about the treatments.  You will get through them.  I haven't lost all of my hair, but it is really thin. I didn't shave it like a lot of people told me to do.  I'm glad I didn't.  I still have enough hair that I can wear a hat or bandanna - it looks kind of cute.   I do have hot flashes - that is tough; and just got over a cold (4 1/2 weeks later).  But over all, it's not too bad.  You don't feel "yourself", but I know it's only temporary. 

 Take this time to let yourself "do less".   Let people help you.  It was the hardest thing for me, but I'm trying.

 Good luck!

Mocity

Thanks dmooney!  Good to hear someone that is going with the same protocol - that is encouraging!

My hair is pretty fine/thin as it is.  So scary even though I have 2 great wigs ready to go.

Are you doing it weekly or every 3 weeks?  I am going with weekly for 12 weeks and then continue the Herceptin every 3 weeks.

I like your advice..... "take this time to let yourself do less".

Thank you!

mother78

dmooney and CristlC, that is the same treatment/protocol as mom.

wow, that is great dmooney, you're 3/4 done. I wonder if the hot flashes is because you're estrogen +. with mom estrogen- and way past menopause i hope she won't get that SE. will you do the Herceptin every 3 weeks for a year too?

noellech

CristIC,

Your diagnosis is just like mine. I had a larger area of DCIS in left breast with 0.5 cm IDC ER/PR+++ and Her2+, but Grade 1. My docs at Northwestern recommended TCH 6x with herceptin for one year. Onc said only recommending this because of my age, 42 - otherwise no chemo. Such a small tumor, chemo is normally borderline. Docs also said results with AC are very slightly better, but higher risk of heart issues. If my tumor had been larger or nodes involved, she would have recommended AC first. Hope that helps.

Boscoe

My bi-lateral is not scheduled til 11/17-right now have an initial diagnosis of DCIS, but very high risk-so oncologist says I have to be prepared that invasion could be found in pathology.  If invasion is found-he said he would recommend T/H (never mentioned carboplatin, so not sure about that) over the AC because AC and Herceptin together and really high risk for heart problems.  As terrified as I am of doing chemo, but I'm atleast hopeful after reading how high the success rates are with this.

Mocity

Hi Boscoe,

Thanks for the info.  Good to hear someone would recommend the same regimen.

Good luck with your bi-lateral.  I had mine 9/16/08 so I am about 7 weeks out.  The waiting is so hard!  I researched and worried about it so much.  I am now doing the same thing with the chemo.  I am hoping once i get started I will feel better about things.  There are so many big decisions, dr appts, etc. that I am just going crazy with anxiety.

If you have any questions that I can help with since I have been through that part I would be happy to help!  I will wish for you that there is NO invasion!!

Cristl

Boscoe

Thanks CristlC:)  On one of my computers I saved the study I was talking about with this regimen.  If I can locate it, I will post it on here.  I wish you all the best, sometimes I wish I could get a button that could freeze time so I could let my brain rest from information overload!

Mocity

Thanks Boscoe... I know what you mean.  My brain needs to STOP!  My first chemo was Friday and all went well.  I am just exhausted!

Boscoe

I'm glad to hear all went well with your tx..I'm in the countdown phase to surgery (next Monday morning) and then the waiting game for the pathology.  I'm almost to the point I don't care anymore what it says-I just want an answer!

mattscot

I recently obtained my first opinion from MSKettering in Basking ridge NJ -- their protocol is AC TH (dose dense every 2 weeks)  plus Herceptin weekly. They performed an internal study in which they determined that when Herceptin combined with dose dense chemo reduces the risk of heart problems..  I note the doctor I met with did not highlight the risk of heart problems with AC + Herceptin. -- only alluded to the fact that other hospitals may suggest TCH instead. 

They also have a pending clinical study of Taxol + Herceptin weekly-- 

I am so thankful for this site and this board --- to be able to get up to speed on these issues in a fast manner --      I go to a second opinion at a local Hospital with a good reputation (much closer to my home and work -- so good chance I will be going there)

bluejay1

I got Taxol with Herceptin weekly for 12 weeks and am now getting my herceptin every 3 weeks, along with taking my tamoxifen.

I had wanted to get into a study that recommended the taxol/herceptin combo, but I just missed enrollment deadline. BUT, I used an oncologist who actually recommended Taxol alone with herceptin anyway. It was a hard decision, and I had conflicting recommendations... I was trying to decide between taxotere/cytoxan and taxol alone, but my doctor that there is no gold standard yet for stage 1 people with no node spread, so no one could say for sure what is best; that all the studies are using data for stage 2 patients. She felt that for people with node-negative small tumors, 1 cm or less, Taxol alone with herceptin, especially for ER+ people who would use hormonal meds, was adequate. I will also enroll this summer in a study for the Her2 vaccine. 

pmm10414

I am currently doing ac and then will do herceptin taxol prior to surgury.  Herceptin will continue every three weeks for a total of 1 year

pmellon

I am currently faced with the decision of whether to enter a Phase II trial for Taxol/Herceptin  instead of AC.  These words all meant nothing a couple of days ago, so I am really trying to understand, but it looks like some of you have wrestled this same decision.  I am having BiLat on Monday and then need to make this decision in the next 2 weeks.  I so want to avoid the scary side effects as much as possible, however, don't want to risk anything in the process.   Since I'm stage IIa and it looks like others contemplating were at lesser stages, I'm getting nervous.  I am node neg.  Any thoughts or info anyone has would be so greatly appreciated.

Mocity

pmellon,

There is a thread somewhere (I think IDC forum) that helps with this one.  I was Stage 1, node negative..... hard decisions I know.  Good luck

pameliza

I am just ending my every 3 week year of Herceptin.  It was first given weekly with Taxol for 12 weeks then I continued on with just the Herceptin.  I have always wondered about the Taxol only and Herceptin protocol and felt kind of alone with it.  February 27th will be the last day of being on a treatment. Glad it's over but also kind of scary to not be taking anything.  

I was put on Femara after the Taxol but couldn't handle the side effects.  Now I am trying Tamoxifen but that is making me feel lousy as well. I am considering stopping it. I am confused about how much it will help in comparison to quality of life.  

Anybody have any thoughts about Tamoxifen or not after Taxol/Herceptin?  Thanks!! 

Pam

Mocity

HI Pam,

Just a quick note..... I finished my 12 weekly Taxol/Herceptin 3 weeks ago.  I am the one that started this thread.  I made that decision and pray it was the right now.  Taxol was very hard to me near the end.  Now, today, I am going for my Hercptin only treatment.  My Onc has suggested Lupron to suppress my ovaries and any estrogen production instead of tamoxifin. He said 1/2 would say Tamox and others are nowing suggesting Lupron.  Who knows.  It is so scary to know what the RIGHT answer is.  How do you do follow ups since you have been done with chemo?  Scans?  Blood tests?  I have just met a few that have done the TH without the AC first.  Looks like I am like you.... triple positive and node negative.

How have you been feeling?

joan33

I was just diagnosed with HER2 positive (6.72 level) and estrogen progestin positive breast cancer and am also confused with two different recommendations.  I have lump size 1.9cm, no lymph node, stage 3 invasive DCIS.  The Duke oncologist recommends herceptin/taxol weekly for 12 weeks then lumpectomy and radiation herceptin for a year then tamoxifen.  Other hospital has same treatment except for first two months AC.  How have those done who followed the regimen without AC?

Thanks 

HES112

Hi Joan...

I did this treatment I had a small node negative .8mm her2 postive lump.  I had lumpectomy and followed with Taxol and Herceptin for 12 weeks and then Herceptin for year (given every three weeks).  I also had radiation and now I am on Aromisin.  I started on Tamoxifen but had a hysterectomy last year.  This was a trial when I received it in May 08...I believe it is used fairly often with small (under 1 cm) node negative breast cancer....

Hope

Farmgirl97756

I had breast cancer diagnosis and was Her2 + but ER/PR - ultimately chose TCH v ACT it was less heart toxic. Now sick to learn only Herceptin May have cured my cancer with no bilateral mastectomy nor chemo! My diagnosis and treatment were in 2010 at 48. I do believe I w never fully recover and have also recently learned Taxotere is known to oncologists to cause permanent hair loss but they continued to use it and NOT tell patients. I wish you well and hope yourjourney thru cancer and life with new normal is better than my experience.