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Initially diagnosed June 4, 2009 Invasive Ductal Carcinoma Stage II,Grade II tumor size: 2-3 cm node positive ER/PR postive HER2 Neu - negative Current Diagnosis: Metastatic Invasive Ductal Carcinoma Grade 3 Mets: Scalp/skin, Liver, Spine, Bone ER/PR + HER2/NEU -

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Thursday, July 23, 2009

2 Down 10 to Go

Had my 2nd Taxol treatment today. Everything went fine. Only side effect has been that my vision is kind of blurry. The best way I can describe it is the effect they use in movies and tv shows to show someone is dreaming. Blurry... foggy like?

Today the place was like a morgue. Why do chemo treatment centers have to be so dreary? I'll try to take a picture of the room next time I'm there so you can see what I mean. It's a real plain, boring room, with a bunch of cheesy vinyl recliners, two crappy tv's that are crammed into a corner with sleeping old people in front of them(why do they take the 2-3 tv seats if they aren't going to turn the tv on?). No one talks or does anything. Really depressing to have to sit there for 2-3 hours. Jesse and I were discussing bringing a deck of cards or something next week to pass the time.

Oh I've been doing some research on the chemo I'm on. Found a great article that references pubmed.gov research articles. Apparently, there is a newer form of Taxol that is in a better suspension than this one that has less side effects. The older Taxol which they have me on is suspended in castor oil of all things... so no wonder I'm all achy with castor oil being sent straight into my veins. There's a reason they stopped using that nasty stuff back in the 40's and 50's! I think I may call over to the oncologist's office tomorrow and ask why they chose Taxol over Abraxane. I'm guessing it was cost difference, but we've met our max out of pocket for the year, so if that is the only reason, I may ask to switch to that on next treatment to reduce side effects.

Read this and see what you think.. btw my ki-67 is either 30% (according to ProPath Services) or 50% (according to MD Anderson who reviewed the same slides).

An Alternative to Taxol

If Taxol gets down to the point where it’s maybe a 1% survival difference, or maybe half a percent, or maybe none, but you just don’t want to give up that sliver of a chance, how about an alternative that might be just as good, without the toxicity?

The alternative treatment hasn’t been studied as thoroughly as it should be, but there is quite a bit of evidence accumulated about it anyway. Let me quote (with modifications) from a meta-analysis (Chlebowski 2002) :

"Lack of this treatment as a negative influence on prognosis of breast cancer patients has been reported in the vast majority of studies over the past 25 years, with many analyses controlled for recognized prognostic variables. Currently, 34 studies have related this treatment to recurrence risk or survival in early-stage resected breast cancers. A statistically significant association between this treatment and recurrence or survival was seen in 26 reports incorporating 29,460 women (Table 2), whereas eight reports incorporating 3,727 women did not see such associations (Table 3). The positive effects of this treatment on breast cancer recurrence and survival are seen in both pre- and postmenopausal women. …

In a meta-analysis, the hazard ratio (HR) for effect of lack of this treatment on recurrence at 5 years was 1.78 (95% confidence interval [CI], 1.50 to 2.11) and for death at 10 years it was 1.36 (95% CI, 1.19 to 1.55). By another measure, recurrence risk at 5 years without this treatment was 1.91 (95% CI, 1.52 to 2.40) and for death at 10 years it was 1.6 (95% CI, 1.38 to 1.76), suggesting that women without this treatment were significantly more likely to develop recurrence and less likely to survive. Most recently, this treatment was again strongly associated (P _ .005) with disease-free survival and overall survival in a cohort of 535 women (median age, 50 years) with newly diagnosed breast cancer. … These associations of this treatment and positive breast cancer outcome are substantial, with differences comparable in magnitude to those associated with adjuvant hormonal and chemotherapy use and of potentially great clinical importance." [emphasis added]

Neglecting to get this treatment after diagnosis has been frequently reported for breast cancer patients, especially among women receiving systemic adjuvant chemotherapy. In a prospective cohort of 535 newly diagnosed breast cancer patients, use of adjuvant chemotherapy and onset of menopause were the strongest predictors of lack of this treatment. …

So what is this magic treatment that makes more difference than Taxol? I call it the “Tahoe Treatment.” You’ve probably guessed its other names: weight loss, weight control, waist-to-hip ratio...

Though as the authors point out, someone really needs to do a good randomized trial, the accumulated data strongly suggest that two months of bounding through the snow with your dog, and getting trim like you always do when you go to Tahoe, will do just as much good as Taxol—or more. And it’s sure to be a lot more pleasant! Plus, there’s no risk of permanent joint pain, unless you do something really stupid on your skis. (Though to be consistent, we should be clear that that the difference made by carrying or not carrying your 10 extra pounds, and the benefit to be gained from two months of exercise, is certainly smaller than the difference made for a person who carries or doesn’t carry 50-100 extra pounds for a lifetime. However, the benefits seen in these studies are so big that they could be reduced a lot and still be in the realm of any benefit expected from Taxol.)

Here is a summary from an analysis of post breast-cancer exercise to echo what the analysis of weight says: “ Most of the breast cancer survivors were not meeting the physical activity recommendations proposed for the general adult population. Efforts to encourage and facilitate physical activity among these women would be an important tool to decrease obesity, prevent postdiagnosis weight gain, and improve breast cancer prognosis.” (Irwin ML 2004) There’s also an exercise meta-analysis (Thune 2001, pmid 11427781) which says “An observed inverse association with a dose-response relationship between physical activity and breast cancer was also identified in the majority of the 41 studies including 108,031 breast cancer cases.” I also saw something about a steroid administered with chemo possibly being partially responsible for weight gain, but I haven’t pursued it.

If it were me looking at that data, I’d put my money on two months of intensive Tahoe Therapy.

Taxol update 4/2005: In January the FDA approved Abraxane (ABI-007), a new form of paclitaxel using nanotechnology to improve the delivery. Although I am not usually in favor of the latest whizbang variant which just happens to cost more and still be under patent protection, Abraxane seems to be a big improvement.

So far Abraxane is only approved for metastatic breast cancer, but at this point, I wouldn’t accept paclitaxel in any other form—if I couldn’t find a doctor who would give Abraxane off-label, I wouldn’t do taxane treatment. Why? Because Taxol uses the solvent polyoxyethylated castor oil (Cremophor) to get the paclitaxel in, a solvent which likely contributes to the hypersensitivity reactions that often occur with Taxol and are severe in about 3% of patients. Not only are solvents also likely culprits in peripheral neuropathy, but they may actually reduce the effectiveness of the paclitaxel (leading to the rather dismal results we’ve been reading about above). By contrast, Abraxane skips the solvents and uses nanoparticle technology to deliver the paclitaxel. In a study of 460 women, the women given Abraxane had less of a hit to their white blood cells and fewer cases of prolonged neuropathy than with Taxol. Oncologists can deliver a 50% higher dose of the active agent (paclitaxel) and still get fewer side effects (maybe that way one will actually get survival differences greater than 3%!). They also don’t have to give women steroids to prevent hypersensitivity reactions.

K. Garber’s January 2004 editorial in the Journal of the National Cancer Institute provides a helpful overview of the issues (pmid 14734692). Despite the expense, my position at this point would be “either Abraxane taxane or no taxane.”


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