Consequences of Overdose of docetaxal, carboplatin and trstuzumab in TCH chemo regimen due to wrong weight written by nurse.

[Shrutirugani]

Hello,

My mother was diagnosed with triple positive breast cancer. She had MRM on 20th december, 2018 at Aanand hospital, surat, Gujarat. Her weight at the time of mrm was 57.5 kg.

After MRM, we went to Dr. Chirag Desai(Ahemedabad)for chemotherapy planning. She is been recommended 6 cycles of chemotherapy followed by 11 cycles of herceptin.

Above chemotherapy regimn is being executed locally at Anand hospital, surat.

She recently completed 3rd cycle of TCH on last Sunday. After 3rd cycle, for insurance purpose, I took photocopy of indoor case papers of hospital.

While going through it, to my surprise, i came to know that at the time of 1st cycle, nurse mistakenly wrote wrong weight (she wrote 68 weight instead of 58 weight) and accordingly dose of every drug is computed wrong. She is been overdosed. She is given 544 mg(68* 8) of trstuzumab instead of 464 mg(58 *8). Same way for docetaxal and carboplatin. Her hight is 156 cm. So right BSA should be 1.6 and accordingly docetaxal should be 120 mg(75* 1.6) but she is given 130 mg by following wrong weight and accordingly wrong BSA.

I rushed to doctor immediatly and explained him everything. He accepted mistake of hospital and nurse. But he said nothing to worry about it and suggested 2d echo.

Please note that at the time of first cycle my mother gone through many side effects. They are listed below.

- severe acidity-She is also given acidity injection through iv after 4 days of 1st cycle

- severe diarrhea - which lasted for around 20 days.

- Pain in the area of anus

- fatigue and dizziness

- hair loss

Can u all please guide me with the consequences of this overdose. What ateps i should take. Whether there is need of reducing dose in remaining 3 cycles? Whether this overdose can cause permanent hair loss?? Please also suggest some good medical oncologist in surat. We are really worried.

We have not expected this type of carelessness from hospital as it is one of the best in surat.

Thanking you all in advance.

[roxboxfox RadiationOncologist]

Bharat Cancer Hospital, Surat

For Chemotherapy

Dr Tanveer / Dr Ankit / Dr Kaushal

For Radiotherapy Treatment

Dr Nilesh Mahale

[Shrutirugani in reply to roxboxfox]

Thank you so much roxboxfox. I really appreciate you are taking time to read such a big post.

There is one more confusion we have. We consulted total 4 doctors including our surgical oncologist. 2 suggested to have radiation and 2 suggested no need of radiation.

Here is her details.

She had undergone MRM. Stage is T1c pN1, grade 3 , ER - positive , PR - positive , HER 2 - positive score 3, ki-67 30%.

Currently undergoing 6 cycles of TCH chemotherapy followed by 11 herceptin.

Doctors who are suggesting radiation are in the opinion that according to new studies, radiation is required even one lymph node is positive.

It would be good if you can also guide on the requirements of radiation.

Again, Thanks a lot.

[roxboxfox RadiationOncologist in reply to Shrutirugani]

On 21st June 2014, there was a practice changing article published in Lancet which has changed management implications internationally amongst oncology thinkleaders.

This was a Individual Patient data - Meta-analysis (Level 1a Evidence) which is difficult to ignore.

Essentially, this IPD Meta-analysis showed that in women who had 1-3 positive nodes, postmastectomy radiotherapy reduced the recurrence rate by 32% and reduced the breast cancer mortality rate by 20%. The benefit was similar whether women had only 1 positive node or whether they had 2 or 3 positive nodes.

Please find attached The

medscape review

medscape.com/viewarticle/82...

Original Lancet article

thelancet.com/journals/lanc...

Can you please provide the names of Radiation Oncologists who have recommended against Radiation.

[Mamtasharma]

No.. Shruti...these all side effects are absolutely temporary... don't worry....hair loss is also not permanent..... after completing all the chemo cycles.... she will start getting her natural hair