Anyone taking Adriamycin for Chemo
Comments
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My Oncologist has suggested a combination of Adriamycin and Cytoxia (he has errors in his writing, so not sure of the exact spelling). And then later Taxol. Is anyone taking a combination of these medications for Chemo?
Someone at this site pointed to me about the serious side effects affecting your heart with Adriamycin. My Oncologist avoided informing me of something as serious as this. Honestly, I just cannot go through Chemo knowing that this drug could actually damage my heart, not today, but a few years down the road. Here is a link for this drug http://www.webmd.com/drugs/drug-52891-Adriamycin+IV.aspx?drugid=52891&drugname=Adriamycin+IV
Anyone with information please respond. The nurse is supposed to go through the chemo process with us this coming week. I am thinking of postponing everything. My surgery is over, the cancer is gone with clear margins. Even with tripple negative cancer, I feel like just doing local radiation therapy and forgetting about Chemo. My God, I don't want get heart attack instead of cancer. Can someone please help, I am totally freaking out. I cannot go through chemo and destroy my beautiful healthy body for which I have worked so hard all these years.
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Check out this thread.
http://community.breastcancer.org/forum/69/topic/749681?page=1#idx_16
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Hi,
I will be starting ac ( adriamycin & cytoxan in Sept. Following that I will be getting Taxol & Herceptin. I have the same concern as you about the cardiotoxicity of A and of Herceptin. A little backgound on me case. I had DCIS with a 1.2 mm area of invasion. 0/5 nodes were negative, margins were clear ( I had a mastectomy). But I was HER2 positive. Because of that factor my onc recommended the AC followed by TH. When I questioned him about the heart SE,, he said there was only a 3% chance of it occurring, especially since I did not have any high risk factors for heart disease. I took that with "a grain of salt", went home, and started researching. He also mentroned that so far, he has not had a patient with heart SE and he is a professor of breast oncology at MD Anderson.
Here is a good article.
http://www.cancernetwork.com/breast-cancer/content/article/10165/1389095
It says that the risk factorr with the highest correlation of heart SE is the total cumulative dose. Another article stated that the standard dose is 60 mg/m2. I have not been able to find out what my dose will be yet, but I am hoping that it is the standard.
In reading some of the other posts in the Chemo discussions about Cardiotoxicity I've learned that some women are dead set against adriamycin, and others have ad the treatment with no side effects. I know this does not help much. I even questioned why I needed chemo if the margins & nodes were clear. But that is only 2 of the 3 ways cells can travel through your body. I guess chemo takes care of the 3rd way-through blood. Radiation can only target specific areas. My HER2 status makes mine faster growing. I'm not sure why triple negatives require chemo. There is a forum for triple negatives. Maybe you can check it out.
If possible get a second opinion. Many women do. Also, if you search online using cardiotoxicity and adriamycin as search terms you will find more articles., although not many are comforting..
Finally, I reconciled myself to my treatment by realizing that I'd rather take my chances on heart disease, than let cancer eat through me. Sounds pessimistic. But that's how I'm handling it.
Margaret
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I did 4 rounds of AC without problems; my doctor explained that my doses were below the level that could cause heart problems (I believe he said if you would have more than 6 treatments of A, then you start to get in trouble; they calibrate any individual session's dose with your weight). Also there are studies which have shown that if you exercise while on Adriamycin, that reduces your chances of any heart damage even more. I think if you are in good shape going in, stay as active as you can be during, and resume a good exercise routine after; then you should be fine. You really need to do everything you can to get rid of this disease NOW; if it comes back you will be doing chemo for the rest of your life and heart diease will be the furthest thing from your mind. Best of Luck! Ruth
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I went with AC-TH because my oncologist convinced me it had the best results with Her2+ tumors and that the risk of heart damage is dose dependent and low in early stage breast cancer treatment. We all weigh the risks and benefits and go with whatever treatment we can live with in the long run. I'm with Margaret, I'll take my chances with heart problems over dealing with cancer again.
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I am not triple negative but there are also triple negative people doing TC which has a lower chance of damaging your heart.
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I had A/C and 12 weeks of Taxol, along with 6 months of Herceptin. My onc. was much more concerned about the potential heart damage from Herceptin than Adriamycin. I had a mugascan every 3 months to monitor my heart. I did have enough of a decline that he pulled me off the Herceptin. Future problems are possible from the Adriamycin, but unlikely. I had a heart cath after treatment to do a more thorough check of my heart. The cardiologist said I have "minor impairment" -- he didn't like the word "damage." But I'm fine. I can do whatever I want. I'm exercising regularly and building myself back up.
I'm not worried about future heart problems. If they come, they come, but cancer is a horrible disease and I don't want it back, ever. I'm doing everything I can to stay healthy and strong and keep the cancer at bay.
I used all the tools in my arsenal to beat the cancer. You never know what microscopic cancer cells may be floating around and the chemo can help. It wasn't any fun and it wore me down to a nub but in the overall scheme of things, that time was just a blip on my radar.
If you're healthy and in good shape, you have a head start if you do go into chemo. Keep up your exercise, etc., as best as you can and it'll pay off afterwards in your body's ability to recover. You won't destroy your body with chemo -- you may set it back some, but you'll rebound.
Having said all that... it is a personal decision and you may chose to skip chemo. Talk with your dr., the nurses, get a second opinion... whatever helps set your mind at ease and helps you make a decision that you feel is best for you. Good luck. We're all here for you any time.
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Lovely - I did 6*TAC. My onc had me do a MUGA scan prior to getting Adriamycin to make sure my heart was strong enough for it. He also did a follow up MUGA scan to check for any damage. While there was a bit of a decrease in the values, I'm still well within the normal range. Like Nature says, I can do whatever activities I please without any restrictions.
I would share your concerns with the nurse and ask about what tests like a MUGA they may do prior to make sure your heart is strong enough. You may also ask the nurse about the risks v. benefits of you doing chemotherapy - that should give you a good idea of whether the risks are worth the benefits to you. If you're still concerned after talking with the nurse, then as so many others have recommended, get a second opinion. Even if the second onc recommends the exact same thing, he or she may be able to explain it in a different way that will help you to make your decision. Good luck.
Mary
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I had 4 DD Adriamycin and Cytoxin (Red Devil) and one DD of Taxol (got neuropathy right out of the gate in all fingers and toes, so she switched me to 3 remaining doses of DD Taxotere. I had no heart issues prior to the chemo (and not after either), but my onc does not do the Red Devil without a MUGA scan or an echocardiogram prior to the chemo. If your onc has not scheduled you for either of the tests I mentioned, I would demand to know why. I do not know anyone that got it without having the testing done prior. While I hated every minute of the chemo, I, unlike most of the gals that have had the above combo, had a much more difficult time with the Taxol and taxotere than I did with the AC. I wish you well and an uneventful journey. It's not pleasant, but if I did it, you can too. Just keep telling yourself - "this too shall pass." I worked full time through it all other than the Thursdays I had my infusions - side effects began to hit on Saturday and Sunday for sure) - didn't bounce into work on Monday - more like a slow crawl. God bless.
Linda
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Ladies
I had my second lumpectomy on August 18th. The wounds are fresh and they are itching like crazy. When should I start Chemo? I know that infection is a threat when doing Chemo. I have seen pics of women who have had infections on their breasts and they are not fun. I want to make sure I am completely healed 100% before I start Chemo. My surgeon will see me in 10 days, however, I don't feel very confident with her recommendations thus far. She might say it is okay to proceed, but I just want to make sure my body is in tip top position and no chance of an infection before I start chemo. Anyone knows anything on this subject?
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Dear Lovelyface,
I started my chemotherapy yesterday about 4 weeks after lumpectomy and less than 1 week after the port placement. I felt it was a little quick after the port but the incision (about 1.5 inches long) seems to be healing. I did get an infection under my arm from the sentinel node biopsy that I had with the lumpectomy. It did not become apparent until day 11 post lumpectomy and that delayed treatment a week while I did antibiotics. Now it feels fine (thankfully!). Were you thinking of getting a port?
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Hi Omaz
Thanks for your response. Your timing seems really reasonable, which is 4 weeks after lumpectomy. I did get a port put into my arms and that too is very itchy today. My first lumpectomy had not healed all the way as I had hard lumps and some bleeding still, when they went in there again and did another lumpectomy on the left breast. Now the breast is even smaller, black and blue and hard from the second lumpectomy. I had the drain for about 6 days but now that is out. I think I will use my own judgement as to when chemo should start, as I had found from my first lumpectomy that the breast tissues take quite some time to heal. The hole which is left behind from the lumpectomy gets filled with blood and slowly builds. Bleeding is also part of the process and takes a while. The surgeon has not given me any antibiotics thus far as I don't think I had an infection after the first operation. How does your port feel? Is it like a big huge lump on your arm? Are you comfortable with it being there for 5 or more months? Mine is like a big marble there and I hate the presence of anything foreign in my body, but I guess I have to live with this. I hope the discomfort goes away pretty soon.
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I am glad you brought this up because I haven't had any tests done on my heart since doing Adriamycin/Cytoxin and then Taxol so this is a question I will ask my oncologist when I see him.
I didn't have any tests done prior to chemo but that I believe is because I had full testing on my heart done 6 months earlier. I got kicked in the chest by a 1500 lb horse. It was because of that kick in the chest I found out that I had breast cancer.
The IHC facilities here in the Salt Lake Area are all on line with one another. I can go into any IHC facility and they will have a full health history on the computer to look at. This is how my breast surgeon found out I broke 4 ribs in April without even talking to me first. I guess my account is flagged to him, my oncologist, and my GP.
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for what it is worth
I had 4 rounds of AC- every other week-- a Muga scan beforehand--- good heart.... and I tolerated it very well-worked through most of it....it is not pleasant, but it is doable. I think if you are in good health going in, it helps. Other than the bc, I was extremely healthy and I think that made a difference..... there are other types of chemo and you may want to discuss those with your onc.
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I had one FEC and one AC with allergic reactions to both the E and A on my second treatment of each. I now am on a odd combination of Taxol, Cycotin and Herceptin to finish off my Chemo but I am able to tolerate all of these drugs well. The A and E drug are from the same family so it was not a surprise that I reacted to both. My oncologist is trying to get in 6 cycles of Chemo. I am starting my final cycle on Sept. 8.
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Ladies, the treatment they have recommended for me is every 2 weeks X 4 treatments = 8 weeks of Adriamycin & Cyloxan. And then every 2 weeks X 4 treatments = 8 weeks of Taxol. Or they could give the taxol weekly X 12, I believe these are smaller doses if a person cannot tolerate it.
And then radiation, although they didn't specify how many weeks. does anyone know how many weeks they do radiation in one breast only?
Other drugs they will use will be Neulasta (increase blood cells), Aloxi (for nausea and vomiting), Decadron (for symptom managment).
Ladies, do you think that going through 4 months (16 weeks) of Chemo is way too much? The nurse said it is standard therapy. I don't think I have read that anyone actually has gone through so much treatment, have you? Please write back and tell me whether any of you have done this much Chemo, which is 16 weeks, actually 8 total treatments.
thanks.
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I did 16 weeks of chemo - 4 treatments 2 weeks apart of Adriamycin/Cytoxin and then 4 treatments 2 weeks apart of Taxol so it was 16 weeks all together. I did chemo prior to surgery and then rads. Normally the doctors will have you wait 3-4 weeks between the various types of treatments so that your body can heal up. So I had a 4 week break between chemo and surgery and then another 4 week break between surgery and radiation.
One of the standard protocols for radiation is to go 5 weeks Mon-Friday and then the 6th week they do a booster radiation for 5 days. 30 treatments in all of rads. Rads was probably the easiest for me as far as SE but I got so darn fatigued by the rads - each week it was more and more difficult for me to get anything done. The last 3 weeks of rads I was sleeping at least 14 hours a day. Not everyone gets the fatigue to the point I did but do know you will get tired and it is cummulative - in other words the fatigue gets worse as you go along. I would have to say from reading here for the past 1.5 years is that the standard for rads is 25 to 30 treatments.
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LovelyLady, I can feel your anxiety and you will be in my prayers. I was diagnosed as triple positive. I took A/C every 21 days for 4 cycles from July 09 to January '10, followed by 12 weekly treatments of Taxol and 11 weekly treatments of Herceptin. We discontinued Herceptin (we because my doctors and I are a team) because it lowered my ejection fraction much more than the Adryiamicin did. The risk does exist but the affects can be reversed with medication, exercise and heart healthy eating.
I was released from my surgeon two weeks after my lumpectomy and started chemo about 3 weeks later. I started radiation about 2 weeks after my last Taxol treatment.
I was blessed to "breeze through A/C" if there is such a thing
with no illness but a few minor aches, some fatigue and neuropathy. As someone else posted exercise, diet and attitude can make a hugh difference. If you are a praying person, then you may know that prayer supercedes all of the above.With radiation, I took 6 weeks of radiation on my right breasts - that was daily x5 so about 30 treatments. Each treatment only last a few minutes.
Lovelylady, be encouraged to continue to ask your questions here. As you can see, we are very willing to share our experiences with anyone who has to join us in this community. Take care and remember to breath. Hugs, Wanda
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Dear Lovelyface,
I did six of each (AC +T) with Neulasta support and I was just fine. True, I dragged, but I exercised all the way through. I haven't had a MUGA scan since, but I did cycle the 204 miles of the Seattle-to-Portland just six weeks after finishing radiation. (Did in two days though, not one.)
Standard therapy (Gen 3) is 4 dose dense of each and is exactly what you describe.
I had much less fatigue with Taxol than with AC as my red cell counts came back up. And I didn't have any major fatigue with AC until about round 4.
As Ruthbru says, exercise reduces cardiotoxicity so if you can get out and walk every day, it will greatly help things. - Claire
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Lovelyface ~ UCSF is a great source for a second opinion. Two years ago they spared me from A/C treatment because they (like UCLA) no longer uses that chemo agent UNLESS the patient is her2+ Their research shows her2+ is the only bc that benefits from adriamycin.
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Nico1012 - Wow, that is really interesting! I am HER2negative as you know already. I used to have an insurance before which allowed me to go to UCSF, I know several gynecologists there. I will try to research under UCSF and see what I find so that I can have information in my hand when I talk to my Oncologist. What a waste if it does not work on HER2negative people. I assume that you are HER2 negative (yes you are, I just saw your diagnosis). May I please ask then, what other drug did they use in your case instead of adriamycin? I will try to talk to my oncologist today. If only I could know what drug replaces that, that would be something I could look into and ask about it. I have heard that UCSF has a really great BC program, is that true?
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Nico1012-
I would love to find out more information about this as well. Do you have any links for research from UCSF that explains why Adriamycin doesn't benefit Her2- people?
Thanks so much!
Tori
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My oncologist prescribed CMF; an oldie but goodie. I have a mild mirtal valve prolapse so I did not want adriamycin. Also, I think I was the poster who mentioned this to you. Your doctor should have mentioned the cardiotoxicity of A. I think I, as a pt, would ? what else he isn't telling me so that I can make an informed decision.
CMF is referred to as "chemo-lite".
Sometimes you want to use a bulldozer to kill an ant (strong chemo for early bc) but sometimes you have to consider the overall effects of the bulldozer. You are wise to ? this.
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I did chemo prior to surgery to shrink down my 4cm tumor so that 1/2 of my breast wouldn't have to be removed to get clear margins.
I am also HER2 negative
The chemo shrunk the tumor to the point it wasn't palpable and I ended up at the last minute right before surgery having to go downstairs for a needle guide wire so the doctor could see where my tumor originally was.
I stand here and will tell you that Adriamycin does work. It is not fun at all but it is doable. It was amazing how this golf ball size tumor shrunk to nothing.
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Hi Janice
Thank you so much for the assurance that Adriamycin does work. I am all set to go and start chemo and it is really scary to start not knowing whether something is going to work or not. I am tripple negative, so am more scared than others. I wish I had had the knowledge to do the chemo before the second surgery like yourself. My surgeon was horrible, she went in again and took a big chunk out, my breast now looks like it is half a mastectomy. I will bring up all these issues and make a formal complaint about this surgeon. I really really thank you so much with all my heart for your email, as it has helped me a lot today. You are my angel today!!!!!!!!!!!
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Lovelyface - sorry you had such a horrible experience with your surgeon. My surgeon took out a chunk of my breast - every bit of tissue where the tumor originally was plus the clear margins. However, he sewed the tissue together in the inside of my breast. You would think I would have this huge dimple in my breast and I even questioned him why my breast looked so normal considering how much he removed and he said it was the way he sewed me up. If you couldn't see my scar (although small) you would never be able to tell I had breast surgery.
The surgeon was a "general surgeon" but he specializes in breast surgery. I don't NEED any reconstruction but I am going to go ahead and get my breasts lifted just because I can and they tend to droop when you are 50 years old.
If you have any questions when you start chemo - let me know. I am more than happy to help you.
Funny story though - everyone kept telling me DRINK WATER DRINK WATER DRINK WATER to flush out the chemo. I hate drinking water. My thought was "if I flush out the chemo then I am not leaving it in my body long enough to work - I want that chemo working" Ok, wrong response but it didn't harm me to not drink water. Yes, it is better to drink water and keep hydrated. Just wish I could tolerate the stuff. I figure coffee is nothing more than flavored water. I know the caffeine does dehydrate your body but I can't live without my coffee.
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Lovely, with the surgery; know that it will be about a year before your breast will be at its finally shape. The fat will redistribute itself and fill in the gaps to a great extent. My tumor was also 3 cm, and at first I thought, 'Did they do a masectomy by mistake?!!!' I wore a partial breast form for awhile, couldn't wear my favorite swimsuit because the size difference was too obvious etc. But after a year, I realized that I really did look pretty even again, and dug out and could wear that suit again. So hang in there, that part will get better with time. Ruth
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Lovelyface ~ Here is one of numerous articles that arose from studies presented at the 2009 San Antonio Breast Cancer Symposium RE: anthracyclines (Adriamycin) http://www.medscape.com/viewarticle/713854
Dr. Dennis Slamon, Director of Breast Cancer Research at UCLA and inventor of Herceptin states unequivocally that Adriamycin should not be used in her2- patients. The research to supprt this is easily found by using any of the following search terms on Google: Dr. Dennis Slamon, San Antonio Breast Cancer Symposium 2009, Anthracycline use in her+ breast cancer or http://www.hemonctoday.com/article.aspx?rid=41512
Since adriamycin is always given with Cytoxan, the logical conclusion would follow that those who have experienced "success" from A/C chemo, can just as well attribute that "success" to the Cytoxan, not the adriamycin, in the instance of her2- status.
The prevailing chemo therapy for hormone positive, her2- bc is Taxoterre and Cytoxan either 4 or 6 treatments. There are threads on bco devoted to T/C only treatment and repeatedly women have reported that they are doing this regimine because the risks of A/C far outweigh the benefits for her2- patients.
To quote Dr. Slamon directly:
"The overwhelming data, and I do mean overwhelming, indicates there is only a small subpopulation of women who incrementally benefit from anthracyclines over non-anthracyclines in breast cancer," he told HemOnc Today.
"That was initially thought to be all HER2-positive patients, about 20% to 25% of all breast cancer patients, leaving the other 75% to 80% not benefitting incrementally but certainly experiencing all the toxicities," he said. "You can argue for their use if there is some incremental benefit, but when other drugs have the same or better effects without the toxicity, why is this even being discussed?"
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Check out this forum regarding Taxotere and hair loss before you make any decisions. I was on Taxol and having a very difficult time so they wanted to put me on Taxotere and I refused - I was adament that I do not receive Taxotere
http://community.breastcancer.org/forum/23/topic/701423?page=16#idx_471
Sorry, I don't know how to make it a clicky!
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Jancie ~ Taxol, Taxoterre and Abraxane are bio-identical drugs. The only difference is what the Tax is mixed with. In the case of Taxol, it is mixed with a chemical detergent called cremophore, In the case of Taxoterre, it is mixed with a water soluable polymer and Abraxane is mixed with albumin which is naturally occuring in the human body. The reaction to the drug (if there is one) is typically not a reaction to the Taxane but to the substrate with which it is mixed. In the case of Taxol, cremaphore is relatively highly allergic, while polymers are less so and albumin has no allergic response properties. Again, the "Taxane" part of each of the three is identical. Hair loss occurs with all three Taxanes.
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