Choices, Choices (Taxol, Navelbine, Halavan)

Pajim, they are all powerful drugs. All are good choices.

As far as Taxol goes, I have taken 3 taxanes - Taxol, Taxotere and Abraxane. I had a severe allergy to Taxol and had to quit that treatment 2 minutes into my first infusion. A very tiny percentage of people go into anaphylaxis due to allergy to the binding agent, cremaphor. With Taxol, you would have a better quality of life as far as toxicity goes if you do it weekly (and I believe it is ever so slightly more effective that way), but weekly is tough with work. I did Abraxane recently on an every 3 week schedule for work convenience whereas most people do that on a weekly schedule. In the long-term, the biggest challenge with the taxanes is neuropathy in legs/feet and possibly hands (depending on your job). I worked full time through a very potent dose dense course of Taxotere (which is higher than the recommended FDA safe dose and extremely toxic) for 2 months and high-dose Abraxane for 7 months but it did get challenging near the end with each. I could walk but had some trouble with moving all around the building as frequently as I usually would and cut back on discretionary walking. I also had some challenges wearing heals but that may not be an issue for you. However, no one else noticed and I didn't have to modify my work schedule although I did find myself planning out tactical issues like how to reduce the amount of walking I needed to do throughout the day. I found that sublingual Vitamin B complex helped a lot with the neuropathy, particularly in the hands.

I haven't tried Halaven or Navelbine but either of those could be next for me. I am switching from Doxil to my next med and am trying to get into a trial but could take either one of those if the trial red tape takes too long. My MO has been recommending Halaven and I am interested in Navelbine myself. I have heard that Halaven is pretty tolerable, overall. I have heard the same thing about Navelbine. Navelbine has an oral pill formulation which is available in Europe and has been for a long time but the manufacturer never pursued it in the US (beyond clinical trials, some of which are still ongoing). Very annoying to me as I was researching this last night and it appears the only reason it hasn't been marketed in oral pill form in the US is money. Navelbine has been generic for a long time and there isn't much money in generic drugs. So sad and very frustrating. If it were available in oral formulation, I would jump on that as an option.

If I were faced with Taxol, Halaven, Navelbine or a trial of oral taxane (tesetaxel, I presume), with your treatment history and work situation, I would take the oral taxane. I have read a lot about it and it sounds promising. Much more convenient and it has been reporting less side effects, particularly less neuropathy and hair loss than IV taxanes. Good luck making your decision.

Talking about oral chemo brought to mind that methotrexate does exist in pill form. In Italy they use it for breast cancer. Might be worth looking into. I am pretty sure tablets are available in the States too.

Pajim, like everybody, we're following your choices closely! You're approaching six years, past time when the hormonals are crapping out- but how about Alpelisib/Faslodex, in case a PI3K mutation is causing the endocrine resistance? (Or did I ask you that already?)

Hi Pajim,

I have also been trying hard to squeak every possible hormonal treatment in an attempt to avoid IV chemo. I'm now on my third trial. My current trial is for a pi3kca inhibitor with fulvestrant - I qualiified after doing a FoundationOne genomic profile that found I had the mutation.

I haven't had any of the three options in the metastatic setting. I had taxol when I was Stage II and hated it. My oncologist had offered Navelbine before I started my clinical trial in 2015. I understand erubilin/Halaven can be tolerable - and I believe the clinic visit is short.

I'm chiming in here to mention that Phase 1 trials may be very time consuming. I am not working so I've been able to manage it, but it might be hard if your employer isn't truly accommodating. For the first 8 weeks of my current phase 1 trial I had to go weekly. 3 of those visits were multi-day. 3 of those days involved 8 hours of hourly blood tests. So be sure to ask about time commitment for the oral Taxol trial, which otherwise sounds quite interesting.

Good luck with your choice.

Pam, I am sorry to hear your last combo didn't work. I'm not really in a position to advise on the options given to you, except that perhaps something that may not depend on your gut microbiome or liver enzymes may be a better choice given that your last oral med may have failed you. A lot of "mays" there. Lol. I am rooting for you with every toast I make this Season.

just want to give a plug for Oraxol. I was on iv taxol weekly for 2 years and then switched to the Oraxol trial. The difference was like night and day. The oral was so much easier to tolerate without any of the side effects of the iv. There were a lot of tablets to take and a fasting protocol that takes a bit of getting used too but all in all a very doable treatment.I had 2 good years on Oraxol before it stopped working. I would recommend it to anyone