Weekly Paclitaxel protocol

[anshul_15]

Dear all,

My mother (post surgery) is on the following adjuvant chemotherapy regimen:

1. Taxol - Paclitaxel (70mg/m2) weekly for 12 week. [This comes out to be paclitaxel 100mg weekly as her BSA is 1.48]

2. Herceptin - Trastuzumab 150mg (weekly) for 52 weeks.

No prior anthracyclin or any other chemotherapy was given to her.

She has completed 1st three chemo sessions (weekly) successfully, but there was drop in WBC count. Prior week 1 chemotherapy, WBC counts were about 7200, which dropped to 6300 (one day before week 2 chemo), which finally dropped to 4500 (one day before week 3 chemo). ANC (Absolute Neutrophil count) calculated prior weeek 3 chemo came out to be approximately 2800.

As we can see she was on the lower range of WBC counts (and hence ANC counts) when she took week 3 chemo-along with trastuzumab.

I am afraid this time (after week 3 chemo) her ANC (Absolute Neutrophil count) may come to its lower limit and she might get drifted towards neutropenia.

Lets now discuss the worst case scenario:

Lets assume she suffered from neutropenia (ANC <=1500) after week 3 chemo, then what is to be done next. Should she skip the 4th chemo ( that is 3 dose of weekly paclitaxel then one week off) or should she continue with the 4th chemo along with Filgrastim support ?

What is correct recommended protocol to give weekly paclitaxel ? Does protocol recommends one week off after 3 weeks of paclitaxel ( given @ 70mg/m2 - weekly, in our case).

Should she consider for dose reduction if she has to continuously take paclitaxel weekly for 12 weeks? (as paclitaxel @ 70mg/m2 is causing neutropenia).

Thank you...

[roxboxfox RadiationOncologist]

Dear Anshul,

I would seek your oncologists advice as its his call and probably he knows best what he is doing.

Anything said, is going to cause a great deal of distress, anxiety and mistrust.

We are by no means a replacement for your oncologist

[anshul_15 in reply to roxboxfox]

Very truly said rohit sir..... I fully trust my mother's medical oncologist and we blindly follow his recommendations.... his capability is unquestionable.....

I just asked as a curosity.... because in our previous discussions i found your suggestions to be very understandable and explained in very beautiful manner. If sometime I get a chance to come to Bombay, I would surely love to meet you...

Still I would love to have your opinion. It will by no means taken as an alternative to any medical opinion. I would love to listen from your side....

[sumeet_shah Administrator in reply to anshul_15]

Even to discuss all that you asked verbally would take 15 to 20 minutes. To pen all possibilities down would amount to writing about 8 to 10 full pages. And that too with lots of ifs and buts and a lot of possibilities.

We need you to understand that this is a support group, where all members are there to share experiences, give moral support and help you with treatment related effects. This is by no means a place for second opinions or discussing intricate medical details; not because we don't want to talk - we would rather love to help even in that; but because you need to understand that cancer treatment is individualised. It means it's important to understand a patient and be aware of the whole history and her behaviour. A cancer patients fate or outcome or issues must NOT be judged by few pieces of paper containing her report. Hence we Just can't give any second opinions. You need to discuss all this with your Oncologist. Your Oncologist is the only person who can help you out with the questions, we can't!

[anshul_15 in reply to sumeet_shah]

Rightly said sumeet sir..... I ll surely take care of that in future......

[previ80]

Anshul - hugs to you and your family during this difficult time. My MIL also went through the same chemo schedule. I cannot comment on the questions you've asked, but do make sure she eats well during this period and drinks plenty of water. My MIL actually commented that her diet had never been so healthy all her life! There is another post with effects of Chemo and how to deal with them. That is also a very useful post that you can refer to.

[previ80]

Forgot to mention, always ensure the environment around her is positive. Don't talk about her disease negatively, talk about things she likes, see movies at home if she is in the mood, google success stories (you'll find many at this site itself) and tell them to her! A positive environment will help her keep her strength during chemo.

[MsLockYourPosts TeamBCI]

Anshul - You have the most important thing in place for your mother - a doctor you trust. Your worst case questions prove how important that is, because the answers would vary from one patient to the next, and we need doctors who "treat the patient", not just the cancer. I know that it's hard not to get ahead of ourselves thinking of all of the "what ifs", but try to focus on how your mother is actually dealing with her treatment. All of the possibilities that you raise are things that her doctor will have seen before and I'm sure he is thinking several steps ahead.

It is, in many ways, harder to be a caregiver than to be a patient, in my opinion. Let us know how your mother is doing. I know that her doctor will have answers should she have any issues that require adjusting her treatment.

Pat

[anshul_15]

Thank u Pkenn and previ80 for ur support n suggestions.....

U people were correct.....and to my surprise the blood counts were stable (as of the previous cycle) and she tolerated this cycle very well....

and from the past 2 cycles, we start the chemo with a pack of multivitamin as it really helps with mouth sores and other eating problems throughout da week..... Other things are fine except for mild alopecia and itching.....