Is Neulasta necessary?

neverthought · March 2015

Is Neulasta necessary? Seems to be the standard of care in my community.

But my common sense tells me that, if nothing else, dosage should be titrated to height and/or weight. Does a 98 lb woman need same dose as 140 lb woman? Seems like something that can cause cancer should be given at lowest dose that is effective. And is it really necessary to get WBCs up to 75????

Just wondering. Makes me miserable and scares me at same time.

Dx 1/31/15, Stage I Grade 3, 3cm dcis + invasive + lobular 0/4 nodes, ER-/PR-/HER-

Surgery 02/04/2015 Mastectomy (left)

Chemotherapy 03/11/2015 Cytoxan, Taxol

CassieCat · March 2015

I don't know if it's always necessary or not, but I got a shot after each of my 6 rounds. Over the course of my 6 infusions, by WBCs ranged from a low point of 3.1 to a high of 13.7. For me, I am glad I had the shots as I think they helped keep my WBCs normal and helped me avoid extra infection risks.

wrenn · March 2015

It is titrated and measured to fit your weight and height. Not sure what else goes into the calculations

Spookiesmom · March 2015

Don't think it causes cancer. If you have bone pain from it, take NONdrowsy Claratin.

Maureen1 · March 2015

So sorry (((never thought))) wish none of this was necessary…Neulasta helped me avoid illness during chemo when my white blood cell counts dipped below 1! YIKES!! I never got as much as a cold even though it was flu season and I am a nurse working in a hospital with sick patients all day., so…yes, for me it was just what I needed to get thru chemo. If you have doubts about any part of your treatment you can always question it and ask your MO to explain so you are comfortable with your plan…hang in there (((Hugs))) Maureen

muska · March 2015

I think Neulasta shots are given when AC infusions are two weeks apart. There is another protocol that is bit less aggressive when the same infusions are three weeks apart. Three weeks give you more time to recover in between the infusions so Neulasta is not required. I was offered to select from these two protocols and selected the second one because I did not want to have Neulasta shots.

Sjacobs146 · March 2015

I have never ever read or heard that Neulasta causes cancer. Do you have any data to back that fact up?

I would talk to you MO if you don't want to have the injection. Not everyone gets it. Perhaps if you quarantine yourself so that you are not exposed to as many germs, you could go without it.

SpecialK · March 2015

You can ask your MO to refrain from Neulasta and see how your counts do, then administer it if it is necessary. Some docs do this as a matter of course, and some insurance companies require this as they want proof that the drug is needed. You can also ask for Neupogen, which is not one injection, but a smaller dose given over a number of days. Some insurance companies will pay for one or the other, so you would need to check on that. Some centers require you to inject yourself if you do the Neupogen, other ones just have you come in. If your WBC is at 75 you may not need the marrow stimulation, but WBC is something that can be affected cumulatively by chemo drugs, so if you had a super response to Neulasta after the first injection, you may not have the same on subsequent ones because your WBC may drop more precipitously.

Neulasta is something that seems to be physician preference and custom, and sometimes practice protocol - depending on your center. I had 6 Taxotere/Carboplatin/Herceptin and received Neulasta after each round, even though it was given every three weeks.

doxie · March 2015

I had 4 X TC and had Neulasta 3x. Skipped the 4th due to an allergic reaction to it. After my 4th round my WBC dropped so low I had to wear a mask for protection. I was so embarrassed because I had to go to work, regardless. It was the first week of the semester and I had to be there for advising and to teach. Just avoided going to the ER due to a slight fever.

My secretary was a peach! She policed my office door and quizzed everyone whether or not they were ill before letting them speak to me.

SpecialK is correct. You don't have to have it until your WBC gets too low and/or you stay away from people. It's somewhat dependent on your situation. The high WBC helps keep you out of the hospital due to a 100.5 ???degree temperature. (Not sure how high - it's been a while.) I had chemo during flu season. Didn't get sick at all until after rads. Go figure.

neverthought · March 2015

Thanks everyone. I guess I am just anxious. Do wish the dose could be tailored to the patient. I only weigh 98 pounds!

KBeee · March 2015

My MO did not give it to me with my first 3 rounds of TC becUse I was "young and healthy". I landed in the hospital with a 103 temp and neutrophils were 0.22...... way low! He used Neulasta for the next round. Even thoughI ran a temp that round, I avoided the hospital because my WBCs were within normal limits.

TortyLass · March 2015

Hi there. I'm on TC every 3 weeks (for 4 rounds), and my MO prescribed 1 Neulasta shot to be taken on the day after each infusion. Unfortunately, my insurance wouldn't cover Neulasta, so instead, I am doing 1 shot of Neupogen per day for 7 days after every infusion (which the insurance will cover - go figure). Even so, after infusion #1, we tried only 5 shots and my neutrophils dropped to 500. EEK. I was on home quarantine. It takes 7 shots to keep my levels robust enough to proceed with the next treatment.

Jerseygirl927 · March 2015

had terrible bone pain after neulista shot, dr was considering not using after second round of chemo, but because my levels were so low, he ordered it for me, otherwise if levels were good, he would have skipped a dose. I took the clariton the day before and day of and after, plus hydrated better, so far so good.

Kicks · March 2015

I never thought about rather or not Neulasta was calibrated to size - I just thought it was like a 'flu shot' - same amount for all. Also, the RN who gave me the shot never weighed me. I did not get the Neulasta shot at the Cancer Care Institute where I did chemo, I had to vo to my VA Center for the Neulasta.

I did Neulasta with my 4 DD A/C neoadjuvant and had absolutely no issues with lower WBC - in fact was very high. When it was time for 12 weekly Taxol adjuvant, I was told that as long as my WBC stayed up there was no reason to do Neulasta. It did stay well up so didn't do any Neulasta. I did not limit where I went (or what I did) during those times and never 'caught' anything. But we are all unique and what 'works' for one does not for all.

Before Chemo, I had fought 'big tiime' sinus infections all my life and caught every cold that was going around but never anything serious. In the 5+ yrs since last Chemo, I have only had a minor sinus infection once. So - if would seem to me that chemo did have a positive effect for me (besides attacking the IBC).

doxie · March 2015

Neulasta is given as a 6 mg shot - the good old one size fits all. I've read of someone on bc.org who negotiated a lower dose. Might be worth a try to request this. I got it once at my CVS, mistakenly, and it came as a prepackaged shot. No reason the nurse couldn't lower the dose by squeezing out some of the med before giving it to you.

eheinrich · March 2015

I will be given Neupogen which the internet says is calibrated for height/weight.

Not really sure what the differences are between that and Neulasta though.

ruthbru · March 2015

I did dose dense AC every two weeks so had to do Neulasta (my choice, I wanted to get it over with as soon as possible!). I loved the Neulasta shots because I wanted to keep teaching and had a lot of other things going on too (I still had a child at home). With Neulasta, I didn't have to worry about my WBCs tanking and getting sick because of that.....and I didn't have to worry about treatment getting delayed because of illness or a low blood count. If you get bone pains, take Claritan (not Clarian .

Leighrh · March 2015

I am scheduled for 4 rounds of A/C every 3 weeks. My MO said he would not give me the Neulesta unless he saw that I needed it. He said with ppl my age he has only had to give it to one person in the last 10 yrs that he can recall. I hoping to not need it!

Trvler · March 2015

Leighrh: How old are you?

Leighrh · March 2015

42

Trvler · March 2015

So if you have a blood draw on the day after and the WBC is good, do they not give it to you?

Leighrh · March 2015

He is not planning to give it to me at all. Will do weekly blood draws just to monitor me, if he sees it's needed he will give it.

Trvler · March 2015

Interesting, Leighrh. I will ask if this is an option. Although in my experience, doctors aren't big on you second guessing their protocol.

SpecialK · March 2015

The blood draw would need to be a week after chemo - the nadir for WBC is at the 7-9 day point.

Leighrh · March 2015

Yea, I think every doc has their set way of doing things. I was shocked at my first appointment with him when he asked about my concerns and I told him about the shot.... He wondered why I even thought I would have to get it!! He told me to stop reading the internet! LOL

Trvler · March 2015

I get a little irritated with doctors who say that. It is just their way of saying don't question anything they do. I have learned 1000 x more on the internet than from any doctor I have been to during this whole thing. I get that hypochondriacs blow things out of proportion. But as the patient, you have to advocate for yourself.

Leighrh · March 2015

Oh yea... I do still read Especially here!! But I do take everything I read with a grain of salt.. everyone's experience/cancer/treatment/side effects are going to be different.

ruthbru · March 2015

If I had gone with the 3 week program, I wouldn't have had Neulasta shots unless a problem developed. With the every two weeks, you have to have the shot.

mysunshine48 · March 2015

I am not in chemo yet, but have already been told I will need it I am having a BMX on April 10. My doctor did a Mammoprint test on the biopsy slides. Well, it came back on the high side. (He said scores are either high or low) Highs get chemo. Why did I have the Occtotype that I read about so much. I see very few, only one other person, who said she had a Mammoprint. Which is a better indicator? Now I am really worried. Especially with reading the previous threads about the possibility of getting really sick and dying which on chemo. I am 66. I am wondering if I should get a pneumonia shot right now, before surgery? No one mentioned it. They asked me if I had had a shingles shot and a flu shot, but nothing about pneumonia. I am getting really nervous and scared about all of this. Anyone have answers?

Lynn

ruthbru · March 2015

DON'T read horrible 'really sick'almost died' threads, that is not the experience of most women!!!! Ask you doctor about the pneumonia shot right(call right now). I don't know if there has a certain amount of time you would need between it and surgery and/or chemo. If you have time, I'd say it would be a good idea. (No one mentioned it to me either; about 6 months after I was done with chemo and having my regular annual checkup with my GP, it was he who insisted I get a pneumonia shot, even though I was a little young for it at the time).

208sandy · March 2015

I never had a neulasta shot and was perfectly fine but did stay away from crowds and sick toddlers - never had a cold, the flu or anything else for the first two years after treatment. I was given a shingles vac and pneumonia shot a couple of years ago - the shingles vac was new then - would suggest you get the pneumonia shot if you have enough time before treatment starts - I am 69 years old and very active I was diagnosed at 63 and the treatment(s) chemo and rads were doable - stay off the web if you're scaring yourself .

Is Neulasta necessary?

Comments

Categories