Paclitaxel

Hi, My wife has stage 4 Ovca. Dx was in November 2014. Well on the first cycle of chemo in January they tried to give her Paclitaxel but she reacted to it so they stopped, they ended up just giving her Carbo and Avastin.

Yesterday was her second chemo cycle, again she reacted to the Paclitaxel despite anti-histamins etc. So only Avastin and Carbo was given again.

Are there any alternatives to Paclitaxel? Should we be worried that she is only getting half the chemo drugs that are a standard treatment?. I did a little research lastnight and found nab-paclitaxel. Is that a viable alternative to paclitaxel on the NHS?

She has responded briliantly to the Chemo she has recieved with her CA125 dropping from over 6000 to 3000 already. Shes has lost the fluid in her tummy, shes hardly in any pain anymore and only take maybe 1 pain killer a day.

I am worried its just not enough.

Thanks for reading.

Rich

[kaz14]

Hi Rich,

I was diagnosed stage 3c in Dec 2012, started chemo, was very ill for three weeks after the first paxlitaxol, on the second cycle, went into severe anaphylactic shock within two minutes of the carbo/ taxol. I then had carbo only about three hours after and was told I wouldn't be able to have taxol again. Continued with carboplatin only and worked really well, it shrunk the tumours enough so that I could be operated on, even though at the beginning it was inoperable. Three weeks after surgery I started the first of another three cycles of carboplatin only, at the end of that there was no evidence of disease and I'm still in remission eighteen months later, so carboplatin on its own worked really well for me, I too was very worried it wasn't enough, but it was fine, take care

Love Kaz xx

[Whippit]

Dear Rich

Welcome to the group. It's great news your wife has responded so well to her first 2 chemotherapy treatments with Avastin. Such a dramatic drop in the CA126 is always welcome and encouraging and I'd imagine she's a lot more comfortable getting rid of that ascites.

I can only speak as a patient from what I've experienced or read of others' experience (mostly on this forum) and not in any other capacity. Some patients do have a reaction to one or another chemotherapy drug. When I had a reaction to carbo-platin they gave me a Piriton injection into the cannula which sorted out an itchy rash, and on a second occasion which was a bit more serious the hospital stopped the chemo immediately, gave me a steroid injection and after a couple of hours I continued with the chemo but at a much reduced rate and all was fine.

Oncologists say that carbo-platin does 90% of the job, and the remainder is the taxane. They work by destroying cancer cells at a slightly different point in the development cycle of the cell which is, as I understand it, why a combination is given if patients can absorb them both.

I'm aware there are other taxanes, and I read a report recently that claimed no taxane is any more effective than another but the report suggested they were all generally more effective in early stage treatments and become less and less effective the more patients have. The question as to whether your wife should have an alternative taxane is something to discuss with your oncologist or clinical specialist nurse. Do you have a phone number you can ring to ask them so they can put your mind at rest? You could also ring the Nurse Led line at Ovacome and I'm sure they will give you the theory behind the taxane debate though obviously they wouldn't advise on your wife's specific case. Their number (Office hours) is 0845 371 0554.

It might give you a bit of reassurance to share with you that I only ever had a single-agent chemotherapy at first line due to a hospital error. I was a bit worried about it but had a very good remission for over a year, and another year again before I needed more treatment. Some women actually opt for single-agent carbo-platin.

Wishing you both well on this new voyage together. x Annie

[kazrazmataz]

Hi Riche, I too was diagnosed stage 4 May 2014, I reacted to the Paclitaxol after chemo 2 so the Onc said did not want to give me anymore and recommended carbo alone 'would do the job' plus they could give me a bit more carbo as only having single agent. So for chemo 3 I just had carbo. Had a pre-op scan after chemo 3 which showed I'd had a very good response and 'significant reduction' in disease. However I too kept thinking surely the two types are better than one and had a bit of a heated debate at my post op appointment and he was not impressed that I was reluctant to go with his decision and kept saying carbo alone was just as good. At my pre chemo appointment for chemo 4 it was a different onc and she said she was happy to give me another chemo and recommended caelyx so I went with that for chemo 4,5 and 6. However I did my own research and discovered Paclitaxol is made from the bark of the yew tree but its the stuff they mix it with that causes the allergy not the taxane itself, I also discovered that this chemo is also available under a brand name of Taxotere the only difference being the compounds its mixed with are not allergenic. I phoned and spoke to my Onc and she said I was absolutely right and I could have the Taxotere if I wanted to instead of the caelyx. I thought about it and decided as I had already had one session of carbo/caelyx to stick with it as I did not have any side effects whatsoever plus my hair had started to grow as carbo and caelyx do not usually cause hair loss. Please note there are side effects associated with caelyx but as with all chemos they do not affect everyone and I found it quite gentle.

At the end of the day its the patients decision as its true carbo alone does the job for a lot of people however the large scale trials of carbo/paclitaxol showed in the results of hundreds of patients there was a slight advantage in having that combo and you never know if you would be one of those marginal patients that might not have done as well on carbo alone but the probability is for lots of us carbo would still do the same job. You just don't know so I would rather have two chemos. I am not sure if Caelyx is better than Taxotere but for some reason it was not offered to me but I think when they have to use alternative chemos different oncs have different views. I would recommend you ask questions and then decide. I would also ask if Avastin would be given if she has carbo/taxotere as I was denied that as the trials with Avastin were with standard chemo of carbo /paclitaxel only. So if there is no differentiation made betweed pacli/taxotere then I would go with that as she would get Avastin and the trials proved this has an improved outcome. NB I am pretty sure the new rules around avastin will not affect stage 4 patients but have the discussion as this was not explained to me so I do feel a bit cheated that they did not go into the avastin option for me.

My post treatment scan was NED (No Evidence of Disease). Good luck.

[Hidden]

HI Guys,

Thanks for the replys. Its heart warming to know that there is just as much sucess using just Carbo. I will bring up Taxotere point with our onc and see what he says. At the moment we are happy with the response Carbo has had so I hope it continues for the rest of the cycles.

Wishing you all the best.

Rich.

[kazrazmataz]

Hi Rich, Taxotere is also known as Docetaxol. I think its very important to get the consultants views before deciding on alternative treatment. Good luck.

[Veronique]

Hello, I had one dose of Paclitaxel (with Carbo) but had such bad effects was taken off it. I am now having Carbo with Caelyx and hardly any side effects (which l put down to taking high dose of Vit E and B6. Ask the One about Caelyx.