Carboplatin?

Hi Sam, I'm in Canada so I'm sure the protocols are a little different. I had FEC -D chemo the first time. Had complete response but still had whole breast radiation with boosts. 18 months later I felt a thickening under the scar of lx. Sure enough I had a local recurrence. Salvage mastectomy was performed and I begged for chemo. She took my case to the tumour board and they agreed to try carboplatin and gemcitabine. My TN came back as metaplastic which is very rare but my MO said that newest studies showed promise for carboplatin for TN despite being brca negative.

With docetaxol I had horrible bone pain but no nausea. Carboplatin/gemcitabine combo knocked the shit out of me. I gained 35 pounds and felt totally exhausted as my blood counts were affected BUT it was totally doable and I would do it again. Good news is that was two years ago and I'm feeling really good! I would do everything possible available to irradicate this- but that's me. My one thought has always been the regret i would feelif I didn't do everything possible.

Hi Sam,

I have a slightly different story to consider. Like you, I wanted everything I could get to combat this. I was diagnosed in April 2015 with a 2.2 cm TNBC. So I enrolled in a clinical trial that did 12 weeks of Taxol followed by 4 ACs (given every other week). The trial drugs that were added were Carboplatin every 3 weeks during the Taxol phase, and also I either got Veliparib or a placebo during the Taxol phase. I was very pleased with this arrangement because I felt I was getting the 'varsity team' of chemos....the standard of care plus more.

But in the end, it's not clear to me at all that the Carboplatin benefitted me, and I seriously wonder if it hurt me. Here's why. Every time I had Carboplatin, my blood counts took a HUGE beating. I felt fine, overall could not complain about how I tolerated chemo. But I had 4 chemotherapy postponements due to low blood counts, and each time it was right after a carbo treatment. After all of this neoadjuvant chemo, I had surgery, and unfortunately still had residual cancer (although it had shrunk considerably, down to 0.8 cm). I was devastated; I was sure I was going to get a pCR.

I will never know the role carboplatin played. I suppose it's possible that it helped, and if I didn't have carbo, my residual tumor may have been bigger than 0.8cm. But I am inclined to believe that the delays in chemo that were caused by carboplatin (my taxols were pushed off by a week in each of those 4 instances) may have prevented me from getting a pCR. Although my MO tried to reassure me that a few one week delays would not be a big deal, there is a reason that the weekly timing schedule is set up that way, and delays can have a negative impact.

In the end, I guess I wish I had not participated in the trial and had the carbo. But if I go back to who I was 2 years ago, I would have had a hard time saying no---I had very much a, "more, more, more!" mentality.

I think the evidence is very split on the benefit of carbo for BRCA negative women like myself. Read this article that summarizes the two most recent (and somewhat conflicting) studies:

http://www.ascopost.com/issues/january-25-2016/rol...

The American study is more relevant; the German study I believe did not have the normal standard of care drugs involved.

Anyway, I do not mean to dissuade you. You may not even have your blood counts drop (although carbo is notorious for doing that for many women). I just realized that I did not even have the imagination back in April 2015 to picture what a possible downside of "more, more, more" could be. I thought, I'm tough enough! Give me everything! I never knew that having extra toxic chemo could jeopardize the scheduling of my chemo, and perhaps with no benefit to make up for it. So this may just give you extra questions to ask your oncologist to spur a longer conversation.

Good luck with your decision. It's so hard, but once you make your decision, you will feel so much better and hopefully never look back!!

Tulips

Hi Sam:

I was in Australia at the time of treatment and my plan did not include Carboplatin. I had my husband and his father (both physicians) talk with a BC specialist in the US and she said she would most certainly add Carboplatin to my treatment plan. We took that information to my Oncologist (who had coincidentally been to an Oncology meeting the night before to discuss the use of Carboplatin in TNBC patients) and he agreed to add Carbo to my weekly Taxol.

I must say, the Carbo did knock my blood counts way down and I had to skip treatment number nine as a result. In the end, I received seven Taxol/Carbo (all in all I had four A/C, eleven Taxol and seven Carbo) treatments. I opted to stop the Carbo after I missed treatment number nine so that I could maximize the remaining Taxol.

I didn't feel bad with any of my treatments. I had some stomach cramping but never nausea and it was at it's worst toward the end of treatment but nothing that was too bad. I was able to workout and stay active throughout treatment but did feel I was winded easier during the Carbo phase as my counts were low. I also had to have two transfusions due to low blood counts in order to proceed with a couple of my treatments.

I did end up with a pCR and most likely would not change a thing if I were to have it all to do over.

Good luck with your decision and treatment!

hello!

I had AC x 4, Taxol x 12 and Carbo x 4. My blood counts took quite a hit towards the end and I had to take 2 blood infusion, plus filgrastim injections after each treatment. The filgrastim injections made me feel worse than the chemo. I hurt all over, muscles and bones. I wouldn't so anything different. So thankful I opted in for the study and was chosen to receive the carbo.

I had my mastectomy before chemo. My MO told me in a previous study she conducted, she had 2 patients with TNBC that had chemo before surgery and were given carboplatin and they both had PCR. She was very happy when she found out I'd get carbo as well...i entered into a study of the effectiveness of carbo on TNBC. Best of luck to you. I think the worst side effect i had from carbo was everything tasted terrible....except eggs...lol...eggs tasted good through out my treatment

I do not have the BRCA mutation. I started chemo before my genetic testing results came back. My MO added carboplatin because she said it would increase my chance of PCR, which I DID achieve!! The taxol/carbo weekly combo was MUCH easier for me than A/C. A/C kicked my a$$ but maybe it was because I had it after T/C...? I don't know. I did develop an allergic reaction to the carboplatin around dose 7 or 8 and had to stop. Best wishes.

Hi Tulip, I just read your post. I'm on Carboplatin now. I was diagnosed in Oct 2016 - TNBC - no lymph nodes involved - Stage 1A - grade 3 - tumor size 1.8cm - my aggression rate was 95% - brca negative. I started my AC & Taxol 8 rounds - 2 weeks apart. They were tripling up on my Taxol bc I only had 4 doses. Post chemo MRI showed no sign of the tumor - I was declared "Cancer Free". I had a double mastectomy a month later and the tumor was there 2mm with 3 live c cells in it and a 80% aggression rate. When I went back to my oncologist - post surgery - they let me know I'd be going back to chemo with 4 rounds of the carboplatin and six months of xeloda (oral chemo). First round went well, second round wbc was 0.8. They gave me 2 shots of a Neulasta type drug - one right then and again the next day - then I did my chemo - so the delay was only 3 days. My wbc went from 0.8 to 5.1 in those 2 days! I'm not sure what the heck was in that stuff but it worked! I have done so well throughout this - but going back to chemo set me back emotionally. I'll take the extra protection - but I'm just having irrational fears. Seeing you as a two year survivor helped ease my fear. Ironically, your post I'm replying to was posted on 4/11 - the first day of my carboplatin. I guess what bothers me is my aggression rate of 95% and then 80% after chemo. Do you remember your numbers on the aggression rate. Our diagnosis are very similar and you doing so well after two years - I'd like to think I'll be okay too. I will be okay, my faith is very strong - but I now that things are winding down - 2 more chemo sessions and then my final reconstruction on June 28th - then I'll just be out there! I have the Xeloda which really is a wonder drug - but was just wondering about your diet and exercise, etc. I think having my four kids home from college has set me off with worry.