Ladies in your 30's getting FEC-D protocol?

calmandstrong

Hello Ladies, 

Haven't been on here in a while. Hope everyone's doing ok. I've had a few rough weeks. Side effects of constipation, severe heart burn, bone pain, fatigue..it all sucks! I'm all done with the FEC (woohoo), and starting Taxotere this Thurs. Not sure what to expect but hoping it's better than FEC. Either way, half way done!! 

jetnet91

calmandstrong, how did your Taxotere go?  I had my first one on March 25.  I found the ice-packs painful, but days 1+2 + part of 3 pretty good.  I do have bone pain and feel very tired now, but it is much better than the nausea with FEC.  I am giving myself nupogen injections (to increase white blood cell production) for 5 days- today will be day 4.  Wondering if the bone pain will ease after the injections are over.  Also my ears ache.  Anyone have that?  I am finding it easier with the Taxotere and I am glad to be over halfway through.  How is everyone doing?

robsp

Did you take Neupogen/Neulasta shots right after the first infusion? 

My MO says that could prevent febrile neutropenia, but my health insurance does not agree to pay for prophylactic use of Neupogen shots for FEC regimen, only if I have exam proving that I have very low WBC. 

I think I will pay 700 US$ for 5 neupongen shots by myself, is not very cheap in Brazil, but I´m not sure. 

Could you share if in US protocol for FEC regimen use prophylactic Neupogen shots? 

Neupogen has his own side effects and I not sure if I should wait for real need of this drug. 

Tam178

Hello everyone,

I was diagnosed with Invasive Breast Cancer in Dec 2013 at age of 36 and although the tumour had clean margins from my lumpectomy and all 5 lymph nodes removed were clear, Oncologist have recommended Chemo (FEC-d 3 cycles each) plus 16 daily radiation + 5 day boost plus hormone therapy fro 10+ years..

I was happy to see a thread dedicate to fec-d - seems to be very common in Ontario Canada and Europe but not in USA and for those who are very young like me!

Sorry to see the thread hasn't been super active lately - hopefully everyone still has it on their "favourite" list and return to share more!

I had my LAST FEC yesterday (wahoo) but am nervous about d cycles; I had the dose reduce by 15% for cycle 2 & 3 as I had such awful mouth sore & ulcers that I was on hydromorphone for the pain to be able to drink

 robsp - in Canada they do not routinely give Neupogen or Neulatsa to boost Neutrophils and even with mine being 1.1 before cycle 2 (have to be 1.0 to go ahead here) he still did not recommend them during fec due to side effects. They ARE routinely given for D by my cancer centre. HTH

Nice to "meet" you all - any advice heading into the Taxotere would be most welcome coming off 3 fec! Thanks!!

robsp

Thank you for your reply. I will talk with my MO about the risks of Neupogen shots and decide what I will do, but is good to hear your opinion and about Canada guideline. 

Did you take EMEND for nausea ? 

Tam178

I do have Emend for pre fec chemo and day 2/3 mornings. Also have dexamethazone 12mg before & 8mg with emend. Also ondanestron 8mg before & 8 hours later. Worked well for round 2, not so good for round 3 so far. Needing the "as needed" stemetil too .

Good luck!

robsp

Tam178 or anyone else, When do you  begin to feel the first side effects of FEC? My first infusion was yesterday (18 hours) and I feel nothing until now.

I decided to use prophylactic Neupogen shots for FEC regimen, although some US and Canada guidelines do not recommend. 

Some major trials of FEC regimen shows that risk of Febrile Neutropenia is near 10%. Some major guidelines recommend Neupogen shots only if the risk is above 20%.  I do not know the economic weight of these guidelines, probably if cheaper to treat 10% with febrile neutropenia than give Neupogen to everyone. 

Pacs 01 Trial

http://jco.ascopubs.org/content/24/36/5664.full .

Some UK guidelines recommend prophylactic Neupogen shots for FEC

Audit of Febrile Neutropaenic Episodes in Patients undergoing High dose Adjuvant
Chemotherapy for Breast Cancer at the Christie Hospital
http://www.rcr.ac.uk/docs/oncology/pdf/Conroy_2010...

Guidelines for the use of G-CSF & Pegfilgrastim (Neulasta) - review Nov 2013 (103.16 Kb)
http://www.gmccn.nhs.uk/hp/portal_repository/files...

My treatment started with Weekly Taxol instead of Docetaxel and my Neutrophil count started with 1.9 before FEC infusion. Risk of infection started to rise below 1.5. I decided to assume the risks of Neupogen side effects and try to lower my risks of febrile neutropenia, delay the treatment or reduce my dose of chemo.

Oncearunneralwaysarunner

robsp - I started getting FEC side effects within about 4 hours of starting my treatment and they consisted of mild nausea and unbelievable fatigue that lasted for over a week. We all react differently so maybe you will have minimal side effects, let's hope that is the case

As for the Nupegen, I was not taking it during FEC but did five injections with each of my docetaxel treatments. My blood work was within the margins my doctor established throughout my treatment, I don't know if he would have prescribed it during FEC if there would have been an increased risk for neutropenia. 

Hope everyone's treatments are going as well as they can.

Tam178

Hey Rob, same for me as Oncearunneralwaysarunner; within a few hours .. The first was possibly also due to a super long day with getting my picc line inserted at 9am followed by chemo at 11 which actually started closer to 1pm... 

For current round 3 the nausea was back even with cocktail that gave me none in round 2 and now the mouth sores are back at day 9

good luck!!

robsp

The side effects of my chemo were not very bad until now (5 days after chemo). I felt little discomfort in the stomach for 3 days after chemo, but no urge to vomit. I felt  the sensation to eat something that was not digesting very well. I tried to drink more water , but I only drunk 1.5 to 2.0 liters. My chemo is FEC 90 (F- 600 mg/m2 , E- 90 mg/m2 , C-600 mg/m2) and the medications to use at home were  Emend ( 2 days after chemo) and Zofran like drug 8mg twice a day for 3 days. Next week I am going to see my blood counts. I think I had no side effects of 5 neupogen shots until now. 

robsp

Now is 10 days after first my FEC chemo. Neupogen shots did not help me, maybe I need more shots. My neutrophil count is almost zero , 60, when normal range in my exams is above 1700. Although extreme low  neutrophil count I feel no symptoms. My MO give me 7 days of antibiotics (Levofloxacin). 

I am reading some information about neutropenia related to chemotherapy and says that 85% of infections is due the bacterias that is already inside our body. We have about 10 times more bacterias than human cells, maybe these neutropenic precautions with food , contact with other people, etc it is exaggerated if our major enemies live  with us.  

I hope that in the next 10 days my neuthophil count is enough to next infusion. 

Tam178

To continue FEC-D treatment... or not? Advice welcome!

I am looking for opinions, although I know the decision is mine to make, but anyone who could voice opinion either way I'd welcome the feedback.

Helpful info: I am 37 yo with kids age 3 & 5, and the IDC tumour was 1.8cm max with DCIS found too and 0/5 lymph nodes tested positive. ER/PR +ve HER2 -ve. Lumpectomy +SLNB (Jan 2014)+ Radiation (21 treatments to breast incl 5 day boost) & Tamoxofen to follow chemo. Plan was for 3 FEC & 3 D chemo...

I completed one FEC round (25 Feb) at full dose but due to mouth ulcers (plus nausea etc) dose was reduced by 15% for round 2 (11 Mar) & 3 (1 Apr) where the nausea and mouth sores were still present but lessened. I started Taxotere round 4 (29 Apr). I had Neupogen injections daily (day 3-7) which caused me awful bone & muscle pains from my jaw to my ankles and I could barely walk and spend most of those days in bed with the heating pad and doses of hydromorphone every 4 hours plus Celebrex twice a day... Just for extra fun on day 7 (just as the mouth sores re-appeared!) I developed a fever of 38.2C and ended up at the ER with Neuts 0.04 and was admitted for Febrile Neutropenia with IV antibiotics. The blood culture came back positive for staph and confirmed sepsis - scary stuff with no immune system. After 3 days my WBC were up to 12.6 (good fighting the infection!) and Neuts were 1.9. I was let home on day 4 (last Friday) with 3 more days of Cipro antibiotics. I did start to get less body pain since I came home (stopped the hydromorphone) and yesterday I actually felt I wasn't in pain just moving and have even stopped taking the Celebrex!

I've also got awful dry eyes (taxotere causing this) had awful constipation from the meds which caused an anal tear (great fun!) and have to brush my teeth & use medicated mouthwash 4 times a day plus myrhh tincture to keep on to of the mucositis... All this is NOT fun!

I met with my oncologist today who was very sorry for what I'd been through and basically offered me two choices... But I only have until Tuesday to decide (when next chemo is due)

1) Continue Chemo - this would be a 15% lower dose (again) for at least round 5 and then possibly (but unlikely) go on to round 6... Likelihood in his opinion is that I will be hospitalised again with another infection due to the increased risk with my sore mouth and previous reactions...

2) Abandon remaining Chemo and look at removing my ovaries as soon as I'm well enough after radiation is complete to give me additional protection given the ER/PR +ve receptors.

My med onc. was stongly leaning towards option 2 as he feels he's "broken me" enough so far and really wants to "cure me not kill me"!!!

So far I have agreed to proceed with the paperwork for option (1) so I will have the choice, but the more I try to weigh up pros & cons the more I am leaning to option 2... Getting the PICC line out before the summer to enjoy the water with my kids plus no more chemo sound SOOOOOO inviting. BUT if I can stick with at least 1 more chemo he said there around another 1%ish benefit in the chances of recurrence...

WHAT WOULD YOU DO??????????????????????????????

yensmiles

Hello everyone!

I enjoyed reading this thread, the concerns one has, and also the effects of the chemo. So sorry to hear of the side effects Tam178.

I'm from Malaysia and FEC seems to be the popular choice here too! The oncologists don't think too much when it comes to breast cancer, it's considered "Bread & Butter" due to frequency and everyone pretty much gets the same treatment. Here, FEC is usually 6x. Or if it is FEC+T, then it is 3x FEC and 3x T.

On June 5th, I'm scheduled for my first chemotherapy session. Still troubled by thoughts on whether I'm making the right decision, as all this is just preventive. Feels like I'm attacking my body with what might suspiciously be there (and yet might not be).

robsp

Tam178 I´m sorry for your side effects.

I had two rounds of FEC, but little side effects from chemo and Neupogen. I am neutropenic now , 0.1 of neutrophil count. I do not know if is possible in your case change chemo protocol, but in my case I had weekly taxol instead of Taxotere, both drugs are the same class of taxanes. My neutrophil count was always above 2 during weekly taxol and many people had few side effects, although I have some neuropathy in my feet that I hope go away, but there is no treatment.

Some links that I found where MO changed from Taxotere to taxol.

http://forum.breastcancercare.org.uk/t5/Chemothera...
http://breastcancerat38.blogspot.com/2012/09/taxot...

You had no lymph nodes with cancer, Oncotype test could help you but I think should be done after surgery, maybe you do not need chemo , but it´s a very expensive exam.

Do you know if your pathology report indicate something where you have more chance of recurrence like Tumor Grade 3 , high ki67 , vascular invasion ?

It´s very hard to suggest something. Maybe you can try to continue your chemo if you think you can deal with your side effects and risk of severe infection.