Weekly taxol x12 versus DD taxol x4 in Her2+

I am currently a 6 year survivor. Back in 2005, when I was diagnosed, dose dense was the way to go. Since then, it appears things have changed. I did 4 AC dose dense, followed by 4 Taxol, dose dense. We also introduced herceptin when Taxol started. I received a herceptin infusion every 3 weeks for one year.



For the record, I was stage 2B.



Blessings.......



Mary Jo

I did DD  AC + Taxol, followed by Herceptin, but that was an accident.  My onc didn't know I was HER2+ until after chemo.  She would have chosen weekly Taxol x12 and I wish that is what I had done.  With DD Taxol, you get 80% of the Taxol that you get with weekly.  With more Taxol and Herceptin, I would have gotten much closer to a complete response.  *sigh*  

I had an experience that was a bit of a combination.  I had the dose dense AC, which as I understand it, allows less time between treatments for the cancer cells to repair their damage.  With less time to repair themselves, they are more likely to die when the next treatment hits them.  The way that it was explained to me, Adriamycin and Cytoxin work kind of like a bomb hitting a building - they blast fast growing cells (including the cancer cells) and the bigger and more frequent the "bomb" (the AC dose), the better the outcome.

Taxol works differently.  If the AC is a bomb that destroys the building, Taxol works by weakening the building's support structure, leading to the building's eventual collapse.  Taxol attacks the microtubule functioning of the cells (which is responsible for the cell building blocks).  The fast growing cells weaken through structural damage and while the Taxol is not a "blast" like AC, it relentlessly (every week for 12 weeks) hits the fast growing cells (cancer) with that weakening agent.  Healthy cells can recover between treatments (for the most part - though fingernail cells have a tough time of it), but cancer cells are less able to recover and eventually die.  The key here is to have the repeated dosing on a regular basis.  And as was mentioned before, you can get more Taxol into your system when you go with the 12 weeks as opposed to the dose dense variety.  Also, you are hitting those cancer cells more frequently with the 12 week dosing - a key to being more successful.

 My experience with Taxol was a little different because of some personal issues.  I had 8 weekly doses and the 9th dose (one week after the 8th dose) was a triple dose that finished my treatment.  This was not done to make the treatment any more effective - I needed to alter the schedule for other reasons.  I must say, that last triple dose hit me hard.  Though I had mild neuropathy up to that point, I had some serious neuropathy after the triple dose that later resolved significantly (about 2 months later).  

It is so hard to be patient with 12 weeks of weekly treatment, but I know that I have read studies that indicated a couple of percentage points (absolute risk - worth noting) of a survival advantage to the 12 week as opposed to the 3 week dosing of Taxol.  I would really want to see the studies to do any differently.

Good luck to you on your journey.  While on the AC, it is difficult to think that you will ever feel better, but once I started the weekly Taxol, I continued to feel much better healing from the AC.  I did not really start to experience any true side effects from the Taxol until about week 6 and those side effects were very, very mild.  

 God bless.  Kelly

ccjj -- my second opinion was also from the mayo clinic and he agreed with my medical oncologist that I shouldn't even consider anything but 12 weekly.  I was bummed at first because I also wanted to be DONE as soon as possible.  But those extra four weeks are really nothing compared to everything we're going through.

For what it's worth, my second opinion doc also said "if he were me" he'd do ovarian suppression shots (I'm pre-meno, and 33yrs old) if I could tolerate it.  He said there is some evidence that the Her2+ characteristic drives the cancer growth in triple-positive cancer, and that there isn't really evidence about ovarian suppression, but that he'd probably do it just in case even though it isn't the standard of care.  I decided against it for now though.  

Kelly - that is a great summary!  I wish I could have done AC dose dense.  I was pregnant when I got AC so they gave me the extra week to recover, partly to spread it out I think and also because I wasn't able to have nupogen shots.

oops edited to fix a typo!

i did DD A/C, followed by weekly Taxol. The debate never arose - my onc simply said the weekly Taxol was the protocol, and he (and of course, I!) liked the decreased side effects from a weekly (ie smaller) dose.

Well, my experience was AC every three weeks for 4 months, then the Taxol 3 weeks on one week off for 13 doses (there was a screwup and I got a dose of Taxol on an "off" week that was supposed to be herceptin only).

The results were excellent, I had a total pathological response from chemo, but my pathology is hormone negative, Her2+++.

I would go with the weekly.  I wouldn't let my oncologist lower my taxol dose when I started getting some nasty neuro effects, because I wanted to "go with the stats", if you get my meaning - if such and such a dose works for a large percentage of folks, that's the path I wanted.  One thing we sure do know about cancer is we don't understand it well at all.  Dosage schedules might make a difference. 

I got the TCH combo...taxotere, carboplatin and the year of Herceptin (every three weeks).  Finished all September 16th....

Just happened to see your email while looking for people who are doing or have done the 12 weekly sessions of taxol.  Wanted you to know that your explanation was just what I needed to hear.  I've had a pretty hard time of the ACx4 every two weeks.  Started out pretty good but my WC goes way down low and I've had to take antiobiotics each time for the last 3 times.  I'm very fatigued and have lost my taste buds.  I guess it's pretty common but I frankly look forward to begin the Taxol treatments this next week.  I have Stage 2, Triple Negative Breast Cancer, a lumpectomy with no cancer in the nodules.  Understand that the reason for my chemo is the TNBC.