Efficacy of Adriamycin

Should no longer be used? I mean..we all know the cardiotoxicity it can cause. The new drug combo is cytoxin and Taxol or Taxotere for triple negs. I wish I hadn't had to get the Adriamycin, but I did.

Nobody is following me up on this heart stuff. Are others getting followed up? I had a muga before chemo and that was it. I finished chemo over a year ago and my onc said I didn't need a follow up on that. Do they wait til I have serious heart problems? I mean..I get no scans or anything until I get symptoms of mets. Is it the same with my heart?

Ravdeb: I see my PCP every 3 months. Because I have high blood pressure. Once a year he does a cardiolyte stress test.

My onc believes no routine tests unless you are having symptoms. I disagree with that philosophy. I think we need close follow up after our treatment.

Nicki

I was told that if your MUGA scan was okay after the last treatment your heart was okay. I always asked for my MUGA scan results because they will let you go down to a 50% ejection fraction before stopping the drug (50% is the lower limit of normal). I would have refused the drug if my MUGA scan numbers dropped. I also read that if you do get heart problems from the drug it might not be reversible. If there are other drugs out there that are just as good without this side effect, I am all for it. I could not find anything that said if you did not have problems with it during treatment that you could suddenly get it later on (heart problems) although you can develop leukemia years later (very rare).

Hi Triple Neg -

Who is saying that Adriamycin should not be used anymore? I have not heard that ...

Prior to doing dose dense AC, I had a MUGA scan. When I decided to go beyond 4 treatments, I had another one ... which oddly, scored better than my first one!

For me, AC, was very effective w/my trip neg, recurr bc and mets.

CalGal

Here is a little more from the San Antonio conference.

SABCS: Anthracycline May Be Superfluous in Breast Cancer Regimens

By Crystal Phend, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
December 15, 2006


MedPage Today Action Points

* Explain to interested patients that the study suggests that Adriamycin may not be necessary in chemotherapy regimens containing Taxotere and Herceptin, but further study is needed.

* This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.


Review
SAN ANTONIO, Dec. 15 -- Breast cancer patients may get similar benefit with less cardiotoxicity if the anthracycline Adriamycin (doxorubicin) is dropped from the adjuvant chemotherapy regimen containing Taxotere (docetaxel) and Herceptin (trastuzumab).

So found the second interim analysis of the Breast Cancer International Research Group study (BCIRG 006), reported Dennis Slamon, M.D., Ph.D., of the University of California in Los Angeles, at the San Antonio Breast Cancer Symposium.

The second interim analysis included 3,222 patients with early stage HER2-positive breast cancer followed for a mean of three years. The patients were randomized to receive adjuvant therapy consisting of Herceptin-Paraplatin-Taxotere or Adriamycin-Cytoxan-Taxotere-Herceptin or the control regimen Adriamycin-Cytoxan-Taxotere.

Disease-free survival advantage at three years was similar between the Herceptin-containing arms with and without Adriamycin (6% and 5%, respectively), he said.

There was a reduction in relative mortality for the Herceptin- and Adriamycin-containing arm (41%, P<0.0041 versus the regimen without Herceptin, designated as control) compared with the non-Adriamycin arm (34%, P<0.017 versus control).

However, the advantage was overshadowed by an increase in cardiac and leukemia toxicity in the Adriamycin- and Herceptin-containing arms compared with the arm without Adriamycin, Dr. Slamon said. There was five times the risk of significant cardiotoxicity in the Adriamycin- and Herceptin-containing arm compared with the non-Adriamycin arm.

Although Adriamycin has been a mainstay of breast cancer therapy, Dr. Slamon said, "If we are causing more problems than we are solving, I think we need to do something different." Some cardiologists have complained that with the use of anthracyclines, oncologists are merely exchanging death by breast cancer with death by congestive heart failure.

At baseline, patient characteristics were similar between arms with a mean age 49 and 54% hormone receptor positive and 29% axillary lymph node negative in each. By three years, there were 462 disease-free survival events including 185 deaths.

Compared to the control arm at the three year follow up, the researchers reported:

* The relative reduction in the risk of relapse was 39% (P<0.001) for the Adriamycin- and Herceptin-containing arm and 33% (P=0.0003) for the Herceptin arm without Adriamycin,
* The hazard ratios for disease free survival were 0.61 (95% confidence interval 0.48 to 0.76, P<0.0001) and 0.67 (95% CI 0.54 to 0.83, P=0.0003), respectively,
* Overall survival was 92% for the Adriamycin- and Herceptin-containing arm and 91% for the non-Adriamycin Herceptin arm compared to 86% in the control arm, and
* The hazard ratios for disease free survival were 0.59 (95% CI 0.42 to 0.85, P=0.004) and 0.66 (95% CI 0.47 to 0.93, P=0.017), respectively.

Regarding toxicity for the Adriamycin- and Herceptin-containing arm compared to the Herceptin arm without Adriamycin, the researchers reported:

* Fewer cases of congestive heart failure (four versus 20, P=0.0015),
* Fewer asymptomatic left ventricular ejection fraction declines (8.6 versus 18, P<0.0001),
* Fewer cases of leukemia (four in Adriamycin-containing arms versus none in the non-Adriamycin arm),
* More grade 3 and 4 thrombocytopenia (5.4% versus 1.2%), and
* More grade 3 and 4 anemia (5.8% versus 3.1%).

"The 006 update for HER2 positive malignancies shows the difference in the number of disease free survival events and breast cancer deaths in favor of [Adriamycin-Cyclophosphamide-Taxotere-Herceptin], neither of which are statistically significant, is now exceeded by the number of critical adverse events," Dr. Slamon said.

He said this should raise the question as to what the role of anthracyclines are in the adjuvant treatment of breast cancer.

However, it may be premature to call for eliminating anthracyclines from the HER2 positive breast cancer armamentarium, said Shail Verma, M.D., of the Ottawa Cancer Center in Ottawa, who was uninvolved in the study.

"They are well on their way out," he said. "The last thing you want to see is a woman die in the adjuvant setting."

The study was sponsored by Sanofi-Aventis and Genentech. Dr. Verma had no relevant financial disclosures.
Primary source: San Antonio Breast Cancer Symposium
Source reference:
Slamon D, et al "BCIRG 006: 2nd interim analysis phase III randomized trial comparing doxorubicin and cyclophosphamide followed by docetaxel (AC&#8594;T) with doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (AC&#8594;TH) with docetaxel, carboplatin and trastuzumab (TCH) in Her2neu positive early breast cancer patients" SABCS 2006; General Session 2: Abstract 52.
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I'm glad I got the AC. I made an informed decision from the
information available at that time. No looking back, nor am
I going to assume that Heart failure will be a problem 20 years from now. If I'm lucky enough to be alive in twenty years, I'm going to assume that they will have new treatments for heart disease.

If I had it to do over again I would have insisted on the
epirubicin but hindsight is always 20/20.

Heart disease is yet another chronic illness in my genetic background. I asked for muga, stress test, nuke stress, sono, etc., and after it's all over and done with, so what?
That was the treatment at the time, and nothing else was available which was as effective. It was tough to decide, and I've had hypertension, strange heart beats, and a heart murmer which has increased since the A/C x 4, then 12 wkly Taxol.

I don't think there is a cancer drug that does not have the possible dangerous side effects. It's what frightened me most about receiving chemo, rads, and anything else.
The docs knew, know, and have every new side effect available to them long before we even hear about it.

Guess I am tired of this entire ordeal. One day there's a promising therapy, next day it's not what they'd all hoped it would be.

I'm depressed today, and the whole chemo experience has made quality of life somewhat unbearable. Especially, the chemobrain!

Numbhead, numbfingers, numbskull...
Indi

Lauralynnie,
I'm with you, and you are not strange to feel that way. Meanwhile, trying to stay healthy, exercised, optomistic, vigorous, vimorous (is that a word?), smiley-faced and ready for a bright tomorrow...are there actually b.c.'s who do this "mission impossible"? Yay, my life is so wonderful because I have cancer...?
Listened to a broadcast about it, and the only thing I got out of it was, exercise, eat like a squirrel, and seek physical therapy and hormone therapy (except we can't take hormone inhibitors since we're triple neg).
I was thinking, not easy these days; that since we are still able to get hormone positive cancers, why are we not given it as a preventative?
Hopelessly confused!!!

Indi

As I sit here thinking (thinking being the operaive word) about going to the gym tonight, the question comes to mind as to whether it is safe to get the heart rate up when our hearts might be damaged.

Should we be concerned?

Jackie

I started with a Personal trainer last night for the very same reason you talked about Cyber Cat. I really didnt know how far I should go. I'm 2 weeks into radiation. Finished 6 rounds of Taxotere, Cytoxan,Adriamycin. They are taking me at a snails pace and dont want my heart rate above 125 for more than 1 minute. I worked up to it slowly then worked back down. If you feel a heaviness in your upper chest, it's your heart telling you, you are going too fast, too soon. All of my muscles are gone so I have to take that slowly too. My goal is to be able to play tennis by fall. (Back in the league I left). A funny thing just started (well not really funny) but 40 days after chemo, I'm losing my left eyebrow! I just dont get this chemo crap! Everywhere else is just starting to grow back!

Good luck and dont over do it!

Julia

Heck they said something about it on NBC tonight, like a chemo treatment that was the standard of care only worked on 8% of breast cancer patients, and the after effects were bad/ but they didnt say anything else/ think he said Adriamycin. Heck I have AC 4 times then Taxatere 4 times. Stage I triple neg, no nodes 1.5 tumor, grade 3. My onc told me I had an 86%, but that she was going for a cure with me?? What the heck, I know there isnt a cure, but I didnt question her. Im 56 now and 1 year out. Other then my thyroid quitting on me last month Im OK. I exercise/ walk/ jog/ ride my bike to work now, eat right lalalalalalal. Some days I want to ask for a total body scan/ other days I dont want to know anything. Whats done is done and I to would rather fall over from a heart attack, then have this fricken cancer get me. I do think if we had AC our oncs should do a follow up mugga. I go back in like 2 months and am going to ask for one since I do some much strenouse activity/my onc knows my exercise level/ wouldnt she have done a mugga by now if that was a concern for us?? "Less side effects like stomatitis
and myelosuppression" ges what are these?
Anyhow I just pray for the best at this point.
Hugs to everyone
Myrna from Oklahoma

Hi all,

It just keeps getting better doesn't it . Anyway you look at it.....we did what we had to do. I guess I was lucky my onc used CEF, but if he had said AC I would have taken it and not looked back.

We are given what is the best available choice at the time...and well if we find out later there is something better...there's nothing we can do. I think you will find there are advances in every disease that changes the standard treatment, yet for many the standard is just fine.

Just keep yourself checked and look for any signs that you might see. We never know with chemo or rads. I got several fields of rads and wonder now if that too was too much. But I could have done what my rad onc said when I asked if it was really necesssary "you can not have it and wait and see if it comes back "....well I did the complete plan and am not looking back. If less rads works now for many women, wonderful...happy for the advancement in treatments for them.

There are going to be a lot of changes in the future...even more that will help us down the road. So don't fret if you had "A"...it did it's job and now just watch for any signs that are out of the ordinary. Don't look back........look ahead, life is good G

Hi All,
Im also triple negative, and have jsut completed my 5th round of TAC - I have one left in 3 weeks time, followed by 6 weeks of rads. Im 31 and have a lumpectomy for a stage 3, 1.8mm , with lypmh nodes affected.
When I met my onc at the chemo daycare last week he said due to "some new data coming to hand that he had been looking at", he was not going to continue my "A" - Adriamycin. Too bad , I said ! I jsut been infused with a bag of the stuff !, so I wont have it for the last chemo session. Like another poster said, on this thread, Id rather die of a heart attack than a long drawn out cancer, so ive no choice but to take my chances with this one. I guess, in another year or so, more research will come to light that will probably blow another of the current treatments out of the water , but that's probably just how it goes. I was a bit annoyed when the onc said he was discontinuing me on "A", as I felt that surely this is not new news to him, he must have had some idea of the usefullness of this drug in relation to my treatment for some time, but I suppose , they like to go in with the big guns and throw everything at the cancer in the hope of eradicating it.

Indi,

YOu hit is rt on the head. These days minimum of 2 months go by by the time they operate. Why can't they put you on hormone therapy as soonas they find out youare er/pr postivie and her2 -ve? I thinks this should be a question to all med oncs