Taxol doesn't treat common breast cancer

fire · October 2007

fire · October 2007

Taxol doesn't treat common breast cancer

By MARILYNN MARCHIONE, AP Medical Writer 21 minutes ago

The widely used chemotherapy drug Taxol does not work for the most common form of breast cancer and helps far fewer patients than has been believed, surprising new research suggests.

If further study bears this out, more than 20,000 women each year in the United States alone might be spared the side effects of this drug or similar ones without significantly raising the risk their cancer will return. That would be roughly half of all breast cancer patients who get chemo now.

"We want to make sure these data are correct before withholding it (Taxol) from some patients ... the stakes are high," said the lead researcher, Dr. Daniel Hayes of the University of Michigan. "On the other hand, we don't want to keep a therapy that doesn't work."

In the study, Taxol did the most good for women who had overactive HER-2 genes - the target of the newer breast cancer drug Herceptin. These women were about 40 percent less likely to have a recurrence if they received Taxol.

Conversely, Taxol did not significantly help women whose tumors were HER-2 negative and were being helped to grow by estrogen. This is the most common form of the disease.

The differences were revealed by a new analysis of a study done in the 1990s, using modern genetic tools that were not available at that time.

"The days of 'one size fits all' therapy for patients with breast cancer are coming to an end," Dr. Anne Moore of Weill Cornell Medical College wrote in an editorial accompanying the study in Thursday's New England Journal of Medicine.

"Oncologists have a responsibility to their patients to be aware of this report."

The original study involved more than 3,000 women whose cancer had spread to nearby lymph nodes but not widely throughout the body. This is the situation of about one-fourth of the 175,000 women diagnosed with breast cancer in the U.S. each year.

Researchers tested adding paclitaxel, sold as Taxol by New York-based Bristol-Myers Squibb Co. and now also in generic form. They gave it after surgery to remove the cancer and treatment with the chemo drugs Adriamycin and Cytoxan.

Taxol improved survival and became a new standard of care. But the drug frequently causes neurological side effects including numbness and tingling in the hands and feet. In the original study, 18 percent of women had this problem months and even years after taking Taxol.

Even more worrisome has been the growing evidence that some women do not benefit as much from chemo as others. Hayes and other researchers wondered whether that was true in their Taxol study.

They retrieved frozen tissue samples from 1,500 of the original participants, did genetic tests to better identify their types of cancer, and discovered big differences in who had responded to the drug.

The study was paid for by grants from the federal government and a breast cancer foundation. Several researchers consult for Bristol-Myers Squibb.

"We should have done this a long time ago," but the tools were lacking and researchers now have the advantage of longer follow-up of these women, said another senior author, Donald Berry. He is biostatistics chief at the University of Texas M.D. Anderson Cancer Center.

Berry is reanalyzing another earlier Taxol study, and Moore urged other scientists to do the same.

With more evidence, "we can begin to use the biology of the cancer to decide whether the chemotherapy will work" before subjecting women to it, Hayes said.

The typical four-cycle treatment with generic paclitaxel costs $7,000 or more, including infusion fees that doctors charge. Insurance typically pays most of this.

For now, many doctors will be reluctant to skip Taxol or other chemo, said Dr. Julie Gralow, a cancer specialist at the University of Washington School of Medicine. Some may fear lawsuits if the cancer recurs and the chemo wasn't given, she said.

"It's just so much easier to give the chemotherapy and know you've been super-aggressive."

However, Kris Miller, a 54-year-old former nurse from Chelsea, Mich., said patients should be given the choice. She has had problems since taking Taxol two years ago for a type of breast cancer that the new research suggests would not respond to the drug.

"Most people recover from it, and I guess I'm one of those unfortunate ones that did not," she said of the side effects. "I have severe numbness and tingling, mostly in my feet. It becomes painful by the end of the day. It never goes away."

"I hope they give people that option," to weigh the risks and benefits and possibly skip Taxol, she said. "If I was going through it now, I would like to have that information."

___

fire · October 2007

It is scary...

I had 4 A/C, 4 Taxol.

A and Taxol doesn't work.

What left?

What all of us have to do?

roseg · October 2007

I think they'd turn around and tell ladies that anti-hormonals are the key to the most common breast cancers.

It would be interesting to see a taxol vs herceptin trial.

I see it as less that Taxol doesn't work, and more that they're giving it to people needlessly. Of course they didn't have to tools at the time to do the genetic analysis.

NoH8 · October 2007

I guess that's the upside of having an "uncommon" breast cancer. My understanding is that taxol still works well with herceptin, or maybe it's that taxol or taxatere makes herceptin work better.

Paulette531 · October 2007

Actually I read an article yesterday about all chemo treatments and that they are being prescribed too much (for certain cancers) considering the side affects they have. And it specifically noted Adriamyican (sp) and how it affects the heart. The new thought is leaning back towards surgery and a hormonal.

I particularly find that interesting because when I was first diagnosed, my onc said that if I had been diagnosed six months earlier my "golden standard" treatment would have been surgery and Tamoxifan but since new research (at that time) had come out, the "golden standard" treatment was 4 a/c and one of the taxannes, mine being Taxol.

abbadoodles · October 2007

Well, doesn't it all just fill you with confidence in medicine? Especially the statement by the doc (Gralow) about it may still be given for fear of lawsuits?

Tina

Anonymous · October 2007

Well I was her+++ so it was a good weapon for me.

I don't think my onc has been prescribing Taxol for her2- women. She didn't rx it for me til after we found out I was her2+

LizM · October 2007

I think it has been the gold standard for a while to prescribe AC plus one of taxanes for high risk node negative and node positive disease, whether you are hormone receptor positive or not. I read this article last night and figured I would rather find out after the fact that I was overtreated than undertreated.

nosurrender · October 2007

My first time I was triple negative and got CMF given in a special study that gave more than normally prescribed.

I had highly aggressive triple neg and have been NED six years from it.

My new cancer is ER/PR+, Her2-. I was given Adriamycin, Abraxane and I am on Xeloda now.

It is my understanding that Abraxane is a superior form of Taxol and that perhaps it doesn't work well because it is so poorly absorbed by the cancer cells. Whereas Abraxane goes right in as Pure Taxol undiluted by any cremephore.

Right now, I am having the worst side effects from the Xeloda. I really don't want to hear next that it doesn't work either.

It all goes back to the surgery I think. 70% of all breast cancers are cured by surgery alone.

I tell every newbie to use an experienced breast surgeon as opposed to a general surgeon for this very reason.

Gee, during BC Awareness Month we sure are getting a lot of bad news!!

nowheregirl · October 2007

Mine was IDC, ER/PR positive and HER2 negative. Pretty common. I did 12 weekly Taxol before I had a lumpectomy and had excellent results with great shrinkage without suffering any major side effects. Maybe I was an exception or just too lucky?

Hugs,

Anonymous · October 2007

Oooops...too late! Wink

I'm glad I did it regardless...it has been and remains what is considered the most aggressive treatment for us 'commoners.' That's good enough for me, but it's encouraging to know that, in the future, if we can't expect a cure, then we can expect more individualized treatments.

~Marin

Member_of_the_Club · October 2007

Aw man . . . so why did I do chemo?

But I have to say, if it only improves chances of survival by a small amount, I'll take it. But this is bumming me out.

AnneW · October 2007

Another reason why I'm glad I didn't do chemo for my Stage 1 cancer, and hoping not to need it this time around. So many folks opt for aggressive treatment, and doctors let them. Nothing wrong with that other than the risks, but women need to be told of the options.

That said, you simply cannot second guess the treatment that you had. It was the best medicine knew at the time. If we didn't keep researching and learning, we'd still be doing water therapy and leeches.

But I still think that many women do needless chemotherapy, out of fear of recurrence that may happen regardless. Oh, to have that crystal ball...

Anne

Member_of_the_Club · October 2007

Anne, I've gotta gently disagree with the words you use in your post. It isn't that we patients "opt" for chemo and our doctors "let" us get it. I think that for most of us who did chemo our doctors strongly recommended it, and we "opted" for it because we wanted to do everything possible to save our lives. Yeah, maybe taxol won't work as well on my kind of tumor as previously thought. Still, I need to raise my children all the way to adulthood and if it only gives me a slight edge, I'll take it.

That "fear of recurrence" you refer to is real, it is a fear of death and chemo is not some random shot in the dark. You make it sound like the possibility of recurrence has no relation to the use of chemo. But chemo will dramatically cut the chances of a recurrence. It has been proven over and over again to save lives.

I guess I am testy about this because I just read a post in the "Just Diagnosed" section from a man whose wife was just diagnosed stage II, triple negative, two positive nodes and she is refusing chemo. I think there is a substantial chance she will die unnecessarily if he doesn't convince her to do the chemo. There are so many myths out there about chemo. It is harsh and has terrible side effects but let us not forget that it saves lives. If this man's wife came on these boards and read your post, I wonder how she would react.

wakebrat7 · October 2007

All I have to say is this. I had absolutely horrible, and I mean horrible vertigo from Taxol and it almost killed me.

When I woke up this morning, it was the first thing I heard on the news. I cried like a baby, because it makes me sick to think I went through a year of spinning and unimaginable vertigo because of Taxol. I think they should do away with it. That stuff is the worst, it almost killed me, literally. Cry

Nancy101 · October 2007

I did not receive taxol as part of my chemo treatment (4 AC). I asked my onc why I wasn't receiving it because I had two tiny positive nodes. I told him that I had read that if you had positive nodes, you should be getting taxol. He told me no taxol for me because I was too ER/PR positive and that it would not do me any good at all. I worried about not getting taxol for a while, but this study now confirms that my onc was right all along with my treatment.

Anonymous · October 2007

i am really pissed about this...

i look forward to reading the study. my understanding was that tripneg pc responds well to taxol. and that has been a positive thought for me.

there was a bit of a security blanket in thinking i had done everything i could by including in it my treatment.

chemo pretty much shut down my life as i knew it, i had a hard time.

i could not work, it was tough on my family.

i have climbed back and moved onward for sure but

not real happy to read this article ...

wish they would just cure the freakin disease already...

sorry, a bit of a rant here.

Anonymous · October 2007

Well, I'm not in the greatest mood, so sure didn't want to read this!

My tumor was 4.5 cm. I had dd AC/Taxol. My tumor shrunk to almost half the size. However, AFTER chemo I still had five out of seven nodes positive. Then on to mast. Then rads. Then six months of Xeloda. I sure hope one of those drugs slapped the you-know-what outta any crappy cells squirming around in my body! Oh, and now I'm on Arimdex. Cry Yell

Shirley

newter · October 2007

I really really do not want to know that the best 5 months of my life (doing chemo) was all for nothing. Losing my hair, putting myself at risk for leukemia and heart problems. My gosh, after treatment there were the reports about A/C only helping a tiny percentage and now this. This is so discouraging.

I realize that research is a necessity but I wish I felt better about the treatment I received. Maybe I should just stay away from reading these reports since I cannot change what I have done. Frown

Sierra · October 2007

I might have already responded to this

but seems many clubs re discussing

the Taxol presently ...

Again, I did it several years

ago and would not change

things, even though side effects

are still with me

I decided, after research and onc

visits to move forward then

There is no looking back now

Feeling very blessed to be

here and, my belief is a combination

of circumstances contribute to this

not just the chemo and rads

Now they do it dose dense, I

had the 4-5 hour infusions

My surgeon said:
Aggressive TX
for Aggressive CA

Best to all

AnneW · October 2007

MOTC,

I totally understand your "testiness" and do not take offense. I did not state my position as clearly as I could have, and for that I apologize.

In further research on this, and in following the same discussion on another board (bclist.org) this seems to be just ONE retrospective study, so while this is an interesting finding, it doesn't mean it's the gospel. I doubt many oncologists will change their way of treating based on this one study.

All said, though, I stand by my contention that not everyone who recieves chemo will benefit from it. And in many types of cancers, meaning Stage 1, it may benefit only 3% of people. And yes, we all live with the fear of recurrence--I'm living it right now--would chem have prevented it? Who knows. And many women who have Stage 2 or 3 get chemo and still get mets and still die.

We do know that chemo saves lives, or it wouldn't be used. We do know that Taxol helps. Afterall, what were those A/C vs TAC trials all about? I just hate seeing women losing sleep and energy over the "what-ifs" --as in what if this didn't work for me?? And was all my suffering through this treatment for nothing?

Again, I truly do not mean to step on anyone's toes with my opinions. They are just that--my opinions.

sam52 · October 2007

I think this one study is making us all scary for no good reason.

As one of the posters above says, there were lots of trials that showed that the taxanes DID improve disease-free survival; look at various SABC reports to that effect.

It has also been shown that chemo works best for ER-/PR- and also for high-grade tumors.

I doubt that one retrograde study will now refute all the evidence of huge trials conducted in the recent past.

LizM · October 2007

I have always known that doing my DD AC/Taxol treatment probably did not provide me that much benefit and that hormone therapy is my biggest weapon hence my aggressive treatment in that area by removing my ovaries to take an AI. One thing to remember for ER/PR positive gals that were premenopausal is that chemo stopped (for some temporarily) your ovaries from producing estrogen which is HUGE. Could we have forgone Taxol maybe but I still prefer to find out I was overtreated as opposed to undertreated.

Paulette531 · October 2007

I think one of the problems with cancer treatments (initially) is that when you first hear the words "you've got cancer", you are scared out of your mind. I know I was and that day is a memory that will never be clouded or go away. The fear that shot through me was beyond comprehension. Taking that into consideration, remembering my first visits with my oncologist were a blur. I would have done probably anything she suggested because of the fear factor. I settled into the treatments and only then when I had the ability to breathe did I start to research and question.

So many statistics and studies are thrown at you that at times it is pure confusion, add that to just coping with daily life and it's a lethal combination. Your illness almost becomes your full time job.

I also believe with the "gold standard" (I don't know how many times I heard that phrase) treatment, you become a statistic. It will be a great day when researchers find more individualized treatments. When you just look at this board and compare your diagnosis to anothers and it has the same TNM qualities and theirs has progressed and yours hasn't or vice/versa, you really have to wonder about treatment. And yet, at the time you did the best you could with the information you had.

I can understand where doctor's are coming from when they cite "fear of a lawsuit" over treatment because in all reality, they too are doing the best they can with the research they have. It's really a catch 22 where this disease is concerned.

I don't regret the chemo but I do think it is a barbaric treatment and research will find better ways to treat the individual instead of the group.

AnneW · October 2007

Here's the NEJM article for those who want to wade through it. I'd post a link, but I got this from another website and I don't want to pay the $$ for a subscription:

New England Journal of Medicine
Volume 357:1547-1549
October 11, 2007 Number 15

Breast-Cancer Therapy - Looking Back to the Future
Anne Moore, M.D.

Adjuvant therapy for breast cancer - treatment
after surgical removal of the tumor - is a major
therapeutic advance that has had a considerable
effect on prolonging disease-free and overall
survival. Not all patients benefit from adjuvant
therapy, however, and certain types of adjuvant
therapy are not appropriate for some patients.
For example, adjuvant treatment with tamoxifen, a
selective estrogen-receptor modulator, has
improved the 15-year survival rate among women
with estrogen-receptor-positive breast cancer by
31%, but it does not benefit women with
estrogen-receptor-negative disease.1 Trastuzumab,
a monoclonal antibody against the human epidermal
growth factor receptor type 2 (HER2), is
associated with an improvement of approximately
50% in disease-free survival among the 15 to 20%
of women with HER2-positive disease.2,3

In addition to these targeted approaches,
adjuvant chemotherapy that includes alkylating
agents, antimetabolites, anthracyclines, and
taxanes in various combinations has contributed
to the overall improvement in outcomes among
women with operable breast cancer. As compared
with women with estrogen-receptor-positive
disease, women with estrogen-receptor-negative
breast cancer benefit more from chemotherapy. A
recent retrospective analysis of three trials by
the Cancer and Leukemia Group B (CALGB) suggests
very little overall benefit of adjuvant
chemotherapy for women with
estrogen-receptor-positive breast cancer who
received tamoxifen for 5 years after receiving chemotherapy.4

Is it possible to define an optimal adjuvant
chemotherapy program for individual patients with
either estrogen-receptor-positive or
estrogen-receptor-negative breast cancer to
maximize the benefit and minimize toxic effects?
The article by Hayes et al.5 in this issue of the
Journal addresses this question.

Hayes et al. report their retrospective analysis
of an adjuvant-chemotherapy trial, CALGB
9344/INT0148 (referred to below as CALGB 9344),
for women with lymph node-positive breast
cancer.6 The trial began in 1994 to test the
benefit of adding four cycles of the taxane
paclitaxel after four cycles of doxorubicin plus
cyclophosphamide. The trial also investigated
whether doxorubicin at higher than standard doses
was beneficial, and the answer was that
escalating the dose of doxorubicin did not
benefit any subgroup of patients. Women with
estrogen-receptor-positive breast cancer received
tamoxifen for 5 years after chemotherapy. When
the results of the trial were first presented at
the American Society of Clinical Oncology meeting
in May 1998, a small but statistically
significant benefit from the addition of four
cycles of paclitaxel every 3 weeks after
doxorubicin plus cyclophosphamide was reported.7
This result changed clinical practice, and the
use of adjuvant paclitaxel rose dramatically well
before the publication of the results in 2003.

The study by Hayes et al.5 was designed to
determine whether paclitaxel administered after
doxorubicin plus cyclophosphamide was equally
beneficial to all subgroups of women enrolled in
the CALGB 9344 trial. New information was added
by testing the tissue blocks from the original
tumors for HER2 positivity with the use of assays
for overexpression and gene amplification. The
results are noteworthy. There was a significant
clinical benefit from the addition of paclitaxel
to the treatment of women with HER2-positive
breast cancer. Most of these women had
HER2-positive, estrogen-receptor-negative breast
cancer, a profile associated with a relatively
poor prognosis, but the small subgroup of women
with HER2-positive, estrogen-receptor-positive
disease also benefited from paclitaxel. However,
women with HER2-negative,
estrogen-receptor-positive breast cancer, the
most common category of the disease, did not
benefit from the addition of paclitaxel to doxorubicin plus
cyclophosphamide.

Why should we spare our patients from paclitaxel?
The toxicity profile of this drug is unique.
Hypersensitivity reactions (including, rarely,
anaphylaxis) occur during the infusion of
paclitaxel, despite premedication with
corticosteroids. Such reactions were reported in
6% of patients in the CALGB 9344 trial. A
transient symptom complex of myalgia, arthralgia,
and neuralgia is common within 2 to 3 days after
the infusion. Neurotoxicity, the predominant side
effect, was reported in 18% of patients in the
CALGB 9344 trial. For some patients, numbness and
tingling in the hands and feet last for months or
even years after treatment is completed.8

Thirteen years have passed since the first
patient was enrolled in the CALGB 9344 trial.
During this time, important changes in practice
may have diminished the value of adding
paclitaxel to chemotherapy for women with
HER2-negative, estrogen-receptor-positive breast
cancer. For instance, advances in adjuvant
endocrine therapy reduce the proportional benefit
of adjuvant chemotherapy for women with
estrogen-receptor-positive breast cancer. In
postmenopausal women, the incorporation of an
aromatase inhibitor (anastrozole, exemestane, or
letrozole) into adjuvant therapy prolongs
disease-free survival more than does treatment with tamoxifen for 5
years.9

Hayes and his coauthors caution us not to change
clinical practice on the basis of their
retrospective analysis, but oncologists have a
responsibility to their patients to be aware of
this report. A similar trial of doxorubicin plus
cyclophosphamide followed by paclitaxel involving
3100 patients was published by the National
Surgical Adjuvant Breast and Bowel Project in
2005. The results showed a small benefit in
5-year disease-free survival but no difference in
overall survival as a result of the addition of
paclitaxel in women with
estrogen-receptor-negative or
estrogen-receptor-positive disease. There was no
analysis of outcome according to HER2 status.10

In the analysis by Hayes et al., women with
HER2-positive breast cancer benefited from
receiving four cycles of paclitaxel every 3 weeks
after receiving doxorubicin plus
cyclophosphamide, regardless of the
estrogen-receptor status of the tumor. How does
this treatment fit into contemporary
adjuvant-chemotherapy programs that incorporate
trastuzumab into the treatment of HER2-positive
breast cancer? Most such programs include a
taxane. However, in a pivotal trial that showed
clinically significant improvement in
disease-free survival from administration of
trastuzumab after adjuvant chemotherapy, 74% of
the patients were treated without a taxane and
still benefited from trastuzumab.3

More difficult to define is the effect of the
report by Hayes and colleagues on the treatment
of women with HER2-negative,
estrogen-receptor-positive breast cancer.
According to this report, the addition of four
cycles of paclitaxel every 3 weeks after
treatment with doxorubicin plus cyclophosphamide
is unlikely to benefit these patients. However,
this is not a call to abandon taxanes for this
group of patients. The 3-week schedule of
treatment with paclitaxel is not the only way to
include a taxane in adjuvant therapy. In more
recent trials, "dose-dense" therapy using the
same doses of doxorubicin plus cyclophosphamide
and paclitaxel every 2 weeks has been shown to be
more effective than the same regimen every 3
weeks.11 Adjuvant trials that use paclitaxel
weekly instead of every 3 weeks and the adoption
of the alternative taxane, docetaxel, for
adjuvant therapy point to more choices.12,13 It
would be of great value if the investigators in
charge of these more recent trials analyzed their
results retrospectively with respect to HER2 and estrogen-receptor
status.

Leaders of clinical trials should continue to
look backward, when appropriate, for data such as
those presented by Hayes et al. In looking to the
future, correlative science must be incorporated
into modern clinical trials in breast cancer. The
days of "one size fits all" therapy for patients
with breast cancer are coming to an end.

References

NOTE: If links do not appear below, full-text and
abstracts can be accessed through searching Medline at
http://pubmed.gov/

1. Early Breast Cancer Trialists' Collaborative
Group (EBCTCG). Effects of chemotherapy and
hormonal therapy for early breast cancer on
recurrence and 15-year survival. Lancet
2005;365:1687-1717. [CrossRef][ISI][Medline]
2. Romond EH, Perez EA, Bryant J, et al.
Trastuzumab plus adjuvant chemotherapy for
operable HER2-positive breast cancer. N Engl J
Med 2005;353:1673-1684.
[<http://content.nejm.org/cgi/content/abstract/353/16/1673?ijkey=0a481df57148a029fadcecf43f1031231d8fb60cFree

Full Text]
3. Piccart-Gebhart MJ, Procter M, Leyland-Jones
B, et al. Trastuzumab after adjuvant chemotherapy
in HER2-positive breast cancer. N Engl J Med
2005;353:1659-1672.
[<http://content.nejm.org/cgi/content/abstract/353/16/1659?ijkey=ea05299f78ddb0bebf0609baea51de4a67d25eadFree

Full Text]
4. Berry DA, Cirrincione C, Henderson IC, et al.
Estrogen-receptor status and outcomes of modern
chemotherapy for patients with node-positive
breast cancer. JAMA 2006;295:1658-1667. [Erratum,
JAMA 2006;295:2356.]
[<http://jama.ama-assn.org/cgi/content/abstract/295/14/1658?ijkey=1e1f96f9696086cd5dba2258c15e7c1eb7fb3894Free

Full Text]
5. Hayes DF, Thor AD, Dressler LG, et al. HER2
and response to paclitaxel in node-positive
breast cancer. N Engl J Med 2007;357:1496-1506.
[<http://content.nejm.org/cgi/content/abstract/357/15/1496?ijkey=b49f7679538168fb45cb82f6653975e617b15c1dFree

Full Text]
6. Henderson IC, Berry DA, Demetri GD, et al.
Improved outcomes from adding sequential
paclitaxel but not from escalating doxorubicin
dose in an adjuvant chemotherapy regimen for
patients with node-positive primary breast
cancer. J Clin Oncol 2003;21:976-983.
[<http://jco.ascopubs.org/cgi/content/abstract/21/6/976?ijkey=6b634093dfcdcd7d5aea6044d5b0f9ba0009847fFree

Full Text]
7. Henderson IC, Berry D, Demetri GD, et al.
Improved disease-free (DFS) and overall survival
(OS) from the addition of sequential paclitaxel
(T) but not from the escalation of doxorubicin
(A) dose level in the adjuvant chemotherapy of
patients (pts) with node-positive primary breast
cancer (BC). Proc Am Soc Clin Oncol 1998;17:101a.
8. Ocean AJ, Vahdat LT. Chemotherapy-induced
peripheral neuropathy: pathogenesis and emerging
therapies. Support Care Cancer 2004;12:619-625. [ISI][Medline]
9. Lin NU, Winer EP. Optimal use of aromatase
inhibitors: to lead or to follow? J Clin Oncol
2007;25:2639-2641.
[<http://jco.ascopubs.org/cgi/content/full/25/19/2639?ijkey=8836c1e4d782450b4d85daf034ab2565c1546ab9Free

Full Text]
10. Mamounas EP, Bryant J, Lembersky B, et al.
Paclitaxel after doxorubicin plus
cyclophosphamide as adjuvant chemotherapy for
node-positive breast cancer: results from NSABP
B-28. J Clin Oncol 2005;23:3686-3696.
[<http://jco.ascopubs.org/cgi/content/abstract/23/16/3686?ijkey=eb96147a9e6e5e7f87d6df899763cbe9e682274dFree

Full Text]
11. Citron ML, Berry DA, Cirrincione C, et al.
Randomized trial of dose-dense versus
conventionally scheduled and sequential versus
concurrent combination chemotherapy as
postoperative adjuvant treatment of node-positive
primary breast cancer: first report of Intergroup
Trial C9741/Cancer and Leukemia Group B Trial
9741. J Clin Oncol 2003;21:1431-1439. [Erratum, J
Clin Oncol 2003;21:2226.]
[<http://jco.ascopubs.org/cgi/content/abstract/21/8/1431?ijkey=6bee27cea4063860277eec301c04e5387e0617a9Free

Full Text]
12. Sparano JA, Wang M, Martino S, et al. Phase
III study of doxorubicin-cyclophosphamide
followed by paclitaxel or docetaxel given every 3
weeks or weekly in operable breast cancer:
results of Intergroup Trial E1199. J Clin Oncol 2007;25:Suppl:516-516.
13. Martin M, Pienkowski T, Mackey J, et al.
Adjuvant docetaxel for node-positive breast
cancer. N Engl J Med 2005;352:2302-2313.
[<http://content.nejm.org/cgi/content/abstract/352/22/2302?ijkey=748b347e40716539c9f2fb5dae47fd6d156a8e26Free

Diana_B · October 2007

I had a lumpectomy, then they found more cancer in my breast (several spots, multifocal).

I was strongly ER+, although PR-. At first they gave me FEC, but then discovered that the cancer was growing while I was getting it. So they switched me to taxotere (I know it's not the same as taxol, but is in the same family, so I'm assuming there's some relevance).

Even though I'm her2-, the taxane made the cancer invisible on MRI. After the mastectomy they found some cancer cells still in the breast, but my cancer was very responsive to taxotere, which would seem to go against this study.

So it seems to me that some ER+ women are in fact helped by a taxane. It's very confusing and I don't know how they would know who's going to respond or not. I'm really glad I got the taxotere!

Member_of_the_Club · October 2007

Thanks for the article, Ann. What was interesting to me was at the end they said that the study only looked at taxol every three weeks and that it might show more benefit in the newer dose-dense protocols. Thats what I had and I think it will be some time before they know the long-term benefits.

I think Darya's post is interesting because even if there is less benefit than previously thought, clearly some women do benefit from the taxense, including those of us who are er+. If, like me, you are past stage I, any additional benefit is important. if you are stage I, it is definitely something that should be considered.

Here's to the future of more targetted treatments! Here's hoping we won't need them!

AnneW · October 2007

Breast cancer treatment is a work in progress. I'm excited about targetted treatments and women getting just the right "fit" for their cancer. Like designer jeans, sort of.

Which I'd rather have, anyday!!

Anne

Diana_B · October 2007

I think "a work in progress" describes our treatments well, although sometimes crap shoot feels closer to the mark.

Fumi and I are two ER+ women who took a taxane and had some visible cancer in our bodies to watch, so we know for sure that it had an effect.

I think that those of you who received taxol but had no visible cancer left to monitor, you may in fact have responded to it and don't know. It could have killed cells that had metastasized.

So please take heart if you think you may have taken it for nothing - if there are exceptions writing in on this one thread, there must be many more out there. You may be one of them too.

gsg · October 2007

i must be another exception...i'm thinking there's LOTS of exceptions. tomorrow they'll probably publish a study saying that study wasn't conducted properly and it turns out taxol works.

i had all chemo before surgery. IDC, er/pr+ and her2-. Was given 4 DD A/C then 4 DD Taxol. I was able to feel my tumor shrinking with both chemos. by the time i finished with the taxol, the MRI showed no discernible cancer. and the pathology of my lumpectomy showed all cancer cells dead.

14 months later, my toes are still tingly...but i'm okay with that. i feel like it worked.

Taxol doesn't treat common breast cancer

Comments

Categories