Why TC every 3 weeks instead of weekly after reading article

LisbethS

My MO wants me to go on Taxotere and Cytoxan every 3 weeks for 4 rounds, starting next week. Paperwork says I'll be on several other prescriptions including Neulasta and Decadron. But after reading this article on breascancer.org, it sounds like weekly would be more effective and maybe less side effects (with either Taxol or Taxotere) instead of every 3 weeks.

I don't work so going once a week is not an issue. I had a UMX to remove IDC 1.8cm grade 3 ER+ HER2- High OncotypeDX=40, BRCA2+, node negative 0/1, clear margins. After chemo I'll be getting prophylactic MX on other side (with bi-recon) and ovaries/tubes removed due to BRCA2+.

Did I read that Taxol is more apt to cause neuropathy? If so, is it temporary? And I read that Taxotere although rare, can cause permanent hair loss but haven't heard about Taxol.

So I want to ask my doctor about weekly instead of every 3 weeks but want to find out pros and cons first. Do they do Taxol with Cytoxan or would the Cytoxan need to be changed to something else? I hate when I ask doctors about changing something and they say ok then I regret it later and wished I hadn't changed it.

So my questions are:

Pros and cons of: Taxol vs. Taxotere (mostly worried about neuropathy and permanent hair loss, don't care about temporary hair loss)?

Pros and cons: weekly vs. every 3 weeks infusions.

Thanks!

Hopefloatsinyyc

taxanes are hard on the system, and they aren't created equal.... But taxol is definitely easier for most patients vs. Taxotere. Your MO may not consider them "swap/worthy" however so it's spa discussion you should have. As for your MOs decision to go with a traditional cycle or dose dense there are usually specific parts of your pathology which determines the protocol....you should definitely understand his reasoning. He may feel like throwing so much toxicity at you does not increase benefit.

ElaineTherese

Hi!

Your oncologist probably wants you to get Cytoxan, which is usually not given with Taxol. Instead, weekly Taxol is typically given after four rounds of Adriamycin/Cytoxan. By doing Taxotere/Cytoxan, your oncologist is giving you a shorter regimen. According to your regimen, TC will take you three months. AC+T takes five - six months, depending on whether you do AC dense dose and whether your oncologist wants to give you a break between regimens.

Both Taxotere and Taxol can give you neuropathy. My neuropathy was very minor and short-lived (fingertips tingled for awhile). Only Taxotere can produce permanent hair loss, though that is very rare and can be countered with cold-capping.

Neulasta is a shot you'll get the day after your infusions. It encourages the production of white blood cells and helps protect against infection.

Decadron = steroids that you take before your infusion. You might want to get some OTC sleep aids or take Melatonin. Decadron can really keep you awake.

Good luck!

muska

Lisbeth, I think you should ask your MO to explain why he recommends this particular regimen. I would also get a second opinion.

I was offered a choice between dose dense TAC and AC+T. Second opinion MO said TAC. I went with AC+T that allowed me to avoid neulasta because the infusions were every three weeks and have taxol instead of taxotere.

LisbethS

Thanks for all the great information. Really helped me. Like ElaineTherese said, if I wanted the shorter 3 month regimen then I needed to stick with CT. If I went longer (~6 mos) then I could do Adriamycin/Cytoxan followed by Taxol, but the Adriamycin can cause permanent heart issues and I already have POTS so CT is the best solution for me. So in a nutshell it's CT: short regimen and rare permanent hair loss vs. AC+T: longer regimen & possible heart issue. So I'm sticking with CT.