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).