allergic to taxotere and taxol, what next?

a2mm

Hello,

I was originally scheduled to get 4 cyles of taxotere + cytoxan, had an allergic reaction to taxotere and then switched to taxol. I had a worse (and quite scary) reaction to taxol and am now wondering what is next. I am ER+/PR+/HER2-, lymph nodes negative, but the grade 3 of the tumor and my age (45, premenopausal) and my oncotype (27) was enough for my oncologist to recommend chemotherapy. However, I am questioning how/whether I want to proceed with chemotherapy. I also recently found out that I have a mutation in Chek2 but my specific mutation seems to be most associated with breast cancer and not other cancers, so I will likely opt for a mastectomy as well. Does anyone just have a course of cytoxan and nothing else? Does that even "count"? I am worried about some of the other chemo options given family history of heart disease, among other things. Anyone else go through a similar situation?

Thank you,

Shelly

1982M

Many people who are allergic to taxol get Abraxane. However, I heard there is a shortage right now so some people have difficulty with accessing it depending on where you are from.

MinusTwo

Cytyoxan is often combined with Adriamycin. What is your MO recommending?

kris_2000

I had reactions to taxol too. My MO added IV benadryl and a steroid. I still had a reaction so they doubled the IV benadryl. On top of that they had to titrate it every time too to avoid a reaction. Once we got all of that worked out, then I was fine. They continued to monitor me closely each time.

GG27

I had 4 anaphylactic reactions to taxol on a trial, they changed me over to Abraxane & I haven't had a problem since.

a2mm

My MO is suggesting we try abraxane. I am just really nervous that I will react as I did to taxotere and taxol, which was scary; and even more nervous I may be sensitized now and have a worse reaction. If I react to abraxane, then I need to decide between AC and CMF.

GG27

I was very worried as well as you can imagine after 4 anaphylatic reactions. They should sit with you for the whole time when the infusion starts & have supplies on hand to mitigate any reaction. Apparently Abraxane causes few reactions. It is much more expensive which is why they start with taxol.

Sarah_78

One of my chemo friends had allergic reaction and was switched to paclitaxel albumin-bound nanoparticles (Abraxane) like GG27, she is sailing through without any problems right now. Hope it works with you too.

4sparky

I had anaphylactic reaction to first three doses of Taxotere and MO wanted me to stop it but I requested the option to pre-med (steroids and famotadine) the day before infusion to see if I could complete my set treatment. I also received more Benadryl day of and was able to get through my remaining treatments without a reaction. You have to do what you are comfortable with and under the guidance and direction of your MO. I wish you the best in finding treatment that your body can tolerate and that is alsoeffective for your diagnosis.

gamzu710

I've been having rashes/hives on my stomach and chest every week with Taxol; it seemed to be a stable, transient reaction that was more of an annoyance than anything until last week (#9 of 12) when it suddenly got a lot worse. The nurses were all over it immediately and were able to knock it down with Benadryl and Solu-Cortef without getting out the EpiPen, but it was a bit scary. They were able to re-challenge me with the extra meds, but at an excruciatingly slow drip. I was there for almost 7 hours.

My MO put in a request for abraxane and although there is a shortage and they weren't 100% sure they could get it, they did procure an allotment for me and got my insurance to approve it in under 24 hours, so I will be switching to that this week for the last 3 rounds. Their backup plan was to basically snow me with pre-meds and run the Taxol at 50-75 mL/hour. They also wanted me to pre-medicate by taking Claritin every day. Prior to last week they'd been able to titrate me up to 200 but after the bad reaction, they re-challenged and only got to 100 before I started reacting again, and even at 75 the rash was coming and going and coming again, so we weren't sure that would work this week either. So it might have just had to be the world's slowest infusion and an all-day affair. My MO did not want to skip the last 3 rounds because of my young age (and I agreed).

Abraxane is supposed to not cause the same reactions because it's bound to human albumin and not suspended in Cremophor like Taxol is. Apparently the Cremophor is what triggers a lot of people. So if I were you I would try to be optimistic that this will work (that's my attitude!). And if it doesn't, have a discussion with your MO. They have a lot of tools in the chest and it's best to make the most informed decisions you can without borrowing trouble.

illimae

abraxane for sure. I was allergic to both too, the severe reactions are likely to the PEG or similar chemical added to the chemo. Abraxane uses albumin (a human protein) instead. I was still given premeds but did my full length of cycles without reactions and it works great. It’s more expensive because of the albumin but insurance should cover it since you’ve already tried the others. I came here 5 years ago with the same issue and suggested it to my MO after getting the abraxane recommendation. It was life saving advice. Good luck!

Spookiesmom

I had 4 a/c infusion was supposed to have 4 taxotere. Immediately after the first one I had an extreme allergic to it. MO stopped any further chemo and I was done. Was NED for 7 years. Found small lump on other side. Currently on ibrance and letrozole doing well

a2mm

Thanks everyone for your anecdotes and encouragement. Fingers crossed the abraxane works well in all regards!

ARmom4

I also had reactions to Taxol and Taxotere. We tried Taxol first. I had a reaction the first time and was able to continue after they slowed down the infusion. Then, I had a pretty severe reaction on the second infusion. So, we switched to Taxotere. First infusion went fine. Then another bad reaction on the second infusion. My cancer was early stage so we didn't proceed to a harsher chemo.

I learned later that Taxol and Taxotere are both made from the same plant. The Pacific Yew tree. We must be allergic to that. I'm not sure if Abraxane is made from that tree or not. It's worth finding out though.

moth

Just to clarify the taxane class.

Taxol = paclitaxel used to be made from the Pacific yew. It led to a near collapse of that tree population.

Taxotere = docetaxel was at first a semi synthetic based on the European Yew & went into production to deal with Pacific yew shortages

Abraxane = nab-paclitaxel. It's like plain paclitaxel but instead of camphor based solvent, it is protein bound.

All of them are now made synthetically. It was one of the triumphs of drug development to get these drugs synthesized and widely available.

Abraxane tends to cause the least allergic reactions but it is expensive and also currently there's a shortage of it. Something with the supply chain apparently

illimae

Abraxane is also from the yew but it does not contain a chemical solvent to make it water soluble like taxotere and taxol do. In my case it is clear that it’s the chemical, not the yew that I reacted so badly to.

GG27

My MO says it's mainly the delivery system that people have the reaction to, not the drug itself. At least that's what she is seeing. When BC Cancer changed the delivery system, she says that's when they saw a huge uptick in allergic/anaphylatic reactions.

Spookiesmom

Somewhere back then I learned it’s polysorbate 80 in the taxotere that causes problems. Don’t know if that’s true.

illimae

spookiesmom, yes, polysorbate 80 is a big no for me (also poly 80 and PEG are so closely related that I remain unvaccinated because of them), cremophor is in the taxol, I think, and it was a bit worse for me. Strange how some of us a just so sensitive to them. I believe only about 2% have reactions severe enough to discontinue the med and being one of us can be pretty scary, you learn quickly.

gamzu710

a2mm--I had my first abraxane today after becoming too allergic to Taxol last week to continue with it. I was very nervous, especially when they told me they did not plan to give me ANY Benadryl or steroids ahead of time because I shouldn't need it.

Well, nothing happened. Despite no premeds, I had no reaction to the abraxane whatsoever. The nurse turned it on, it ran 30 minutes, and it was done. The only differences was that it is apparently heavier in solution so it took them longer to mix it, and then the nurse had to flush the line with saline at the end to make sure all of it got pushed through.

So what I learned is that it was definitely the Cremophor suspension I was allergic to, not the paclitaxel itself.

Hopefully it should be as easy for you!

a2mm

Thank you, gamzu710, this is the first thing that has put me at ease all week. I will receive my first infusion of abraxane tomorrow. Fingers crossed all goes well! Thanks again.

ARmom4

Taxol and Taxotere are semisynthetic. They are still derived from the European Yew. They harvest just the needles so they don't destroy the tree. Both use a different solvent. So, as in my case, having reactions to both means you're allergic to a common ingredient. My MO says I'm allergic to the Yew.

mugsy

Three weeks ago, I had an anaphylactic reaction to Taxotere during first round of TC. After benadryl, steroids, ativan...we were able to continue the Taxotere for the first round. I went for second round yesterday and had the same bad reaction to Taxotere. MO switched to Taxol and I tolerated it OK. So I must be allergic to the binder in the Taxotere.

a2mm - I hope your first abraxane went well for you today!!

moth

they don't even harvest needles anymore. They just grow the plant cells they need

"paclitaxel using our proprietary Plant Cell Fermentation (PCF®) Technology, an environmentally-friendly process that produces natural pharmaceutical ingredients directly from plant cells. Our paclitaxel is a 100% natural and GMO-free product derived from a proprietary cell line developed using plant cells of the species Taxus chinensis v. marei." https://phytonbiotech.com/apis/paclitaxel/

But yeah if you're allergic to the plant cell that might be an issue

a2mm

Thank you, everyone. I had my first abraxane infusion today and everything went well (knock on wood!). They pre-loaded me with dexamethasone and benadryl and started really slow but eventually worked up to the full rate. Next week will be pre-loading again at full rate, and then we will see of we can start tapering the premeds. Thanks again for your valuable insight. For those who got abraxane, feel free to share wisdom about mitigating side effects.

gamzu710

I definitely felt worse today than I'm used to the day after chemo, but was still pretty functional, so it's all relative. I'm wondering if it has to do with not receiving any steroids this time; I think I may be finally feeling the immediate effects of Herceptin. I've felt mildly queasy on and off today, and a bit flu-y this evening, but the thermometer says everything's fine and I have no other symptoms--in fact, the lingering cold symptoms I've had for the last 2.5 weeks seem noticeably better today if anything. I took some Advil and a long nap and have had a decent-sized dinner and been late-night snacking like a fiend, so I'm certainly not feeling that bad.

Suddenly this afternoon water also started putting me off and I've been drinking a ton of Coke. I've been trying not to do that during chemo but I figure giving into the craving is better than drinking nothing. It's only another few weeks so if drinking too much Coke is how I get through, then OK, I guess.

I felt like I was in a rhythm with Taxol generally knowing what to expect, and these last 3 weeks are kind of a mystery. Definitely didn't mind not waking up beet red and with zits all over my chest from dexamethasone, so everything's a tradeoff.

illimae

My suggestions for abraxane are to go ahead and rest when you need to but do try to take advantage of the steroids and go for a short walk a few times per week. I found, and studies indicate that staying active combats fatigue. Closely watch finger and toes nails for lifting and possible infections. By the 4th month, I had to tape my nails down, so I wouldn’t catch them on something. I also did go to a lower weekly dose when neuropathy began to creep up. And although I did eat mostly healthy foods, by the time the last few cycles approached, I could only tolerate ramen noodles and candy, everything else tasted like ass sweat 🤢. I lost 35 lbs and cried when my favorite pizza finally turned on me but at that point, my MO even said to just eat what I could and resume my good habits when I can. Good luck!

moth

I've been on abraxane for 12 months (& taxol for the 9 months before that). I ice hands and feet during treatment. My exp (& studies confirm) is that abraxane is easier wrt blood counts, but hits harder with neuropathy than taxol. For me it also causes bone pain but it's so far been easily managed with gabapentin and naproxen. I walk every day, but the couple days after infusion I don't do much else and I need a nap. I can't really taste much - I just eat cause that's the plan.