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how important to get all 6 taxol/carboplatin exactly on time to kill cancer cells?

Aeaea
Posts: 8
Joined: Jan 2010

Hello, I'm stage 3A and just finished my 3rd chemo treatment of taxol (Paclitaxel) / carboplatin, with 3 more to go.

My neutrophils and WBC are getting very low, borderline neutropenic, so I'm worried that the 4th, 5th, and 6th cycles will be delayed.

chemocare.com says that chemotherapy treatment is given in cycles.
This allows the cancer cells to be attacked at their most vulnerable times.
Chemotherapy drugs that kill cancer cells only when they are dividing are called cell-cycle specific.

Taxol/Paclitaxel is cell-cycle specific, so a delay in treatment means my odds of being cured go down, because the 3-week cycles were designed to take advantage of when taxol will be most effective.

What can I do to get my WBC & neutrophils up (i.e. exercise, diet) so I nail my 4th, 5th, & 6th appts exactly so the taxol will kill the most remaining cancer cells?

I started chemo 3 weeks after surgery when my WBC, neutrophils, etc were about half the level before surgery -- should I have waited up to 3 weeks to get the blood counts back up before starting chemo so I'd have gotten through more treatments before hitting neutropenia?

Songflower's picture
Songflower
Posts: 632
Joined: Apr 2009

There are drugs that your oncologist can give you to bring up your white count so can get chemotherapy on time. (Neuopogen, neulasta) Sometimes your platelets are low and then they have to delay. I don't know how much difference it really makes if you miss one by a week or two. I would ask my oncologist about that. I know many women and men who have had cancer and had a treatment delayed a week or two and did fine. There are many different regimens for cancer; some types of cancer people take chemo every week, sometimes they take it every four or six weeks. If you are late a week I don't think it means that your chemo won't work. Please talk to your oncologist about your worries. Alot of women also get blood transfusions to help them; I took Aranesp shots to get my hemoglobin up. There are alot of different options. I don't know any tricks to make your white count come up faster. Be sure you are eating three good meals a day.

Write these worries down and talk to your oncologist about this. If you are really worried I would make an extra appointment just to discuss this with him/her.

SI
Posts: 21
Joined: Jan 2010

Hi Aeaea,
We are similar in that I have just finished the 3rd cylce of chemo with 3 more to go and I also have a 3A diagnosis. My last chemo was delayed one week as I did not recover as well from the second treatment. The oncologist suggested that it may be better to go on 4 week cycles rather than 3 week cycles and said that there would not be a difference in effectiveness.
I am sure there must be differing thoughts, however, as there seems to be so many opinions on what is best in cancer treatment.
Best wishes to you!!

norma2's picture
norma2
Posts: 486
Joined: Aug 2009

I am going for my second Taxol/Carbol tomorrow. My diagnosis is Stage2 IIIC Had my first one 3 wks ago. Glad you posted this question. I was wondering the same thing if I had to delay chemo. My gyn/oncologist is only scheduling me for 3 so far. He said he will see how I tolerate it. I told him to be AGGRESIVE!! Give me as much chemo as he can.

I will ask him tomorrow what he thinks if people delay chemo how it affects their prognosis.

Hope all goes well for you.

Aeaea
Posts: 8
Joined: Jan 2010

Hey, thanks for getting a second opinion -- I don't want to upset / anger my oncologist by seeming to doubt his wisdom, and this kind of knowledge isn't my gyn/onc's specialty so I don't think I ought to ask her

norma2's picture
norma2
Posts: 486
Joined: Aug 2009

In my case doc said that I am only to have one more chemo after this one. Then they are going to do more tests to see if there is any reason to do 3 more rounds. I asked him if delaying chemo can cause problems and he said it depends on the person, circumstances, and the type of chemo involved. I have a dear friend who is a 5 yr breast cancer survivor and she had to delay some of her chemo because of low white count and she had been NED for years.
Hope all goes well with you.

Aeaea
Posts: 8
Joined: Jan 2010

I just wrote him and he said a delay if neutrophils less than 1000. I am quite likely to be below this level given my past drops in neutrophils and WBC -- I hope it isn't an issue of money that they're with-holding a shot that might boost my counts and enable me to stay on schedule (the cost appears to be $4000 to $7000).

googling is dangerous and depressing, but it looks like weekly taxol has been extremely successful with breast and ovarian cancers, but they're in clinical trials, not enough people to be sure, and of course, toxicity issues. So maybe even 3 weeks isn't often enough, seems like waiting until the 4th or 5th week can only be worse under most circumstances if the results that taxol administered weekly turn out to be true.

What does NED mean?

Northwoodsgirl
Posts: 201
Joined: Oct 2009

I wanted to get my chemo completed by Dec 30th. My oncologist moved my #5 chemo up by a few days and my last chemo was Dec.30th. I was going to have my last dose moved up a couple days but my oncologist said that I would be less likely to have low counts if I moved my 5th rather than 6th tx up a few days. As it turns out she was correct. My pre chemo counts on the day of my 6th chemo were the lowest ever. The nurse thought I needed Neulasta but the Fellow said since it was my last that it was OK even though my counts were low. I did fine with the chemo and without the neulasta probably because I didn't have to have anymore chemo.
Eat well and get exercise.

yoh_57
Posts: 6
Joined: Jan 2010

im also diagnosed stage IIIa uterine cancer and my my cycle is every 3 weeks. i started my 1st chemo with paclitaxel/carboplatin last jan 11 and the 2nd one was last feb 1 2010. however, i have decided to stop now. is it harmful if i dont continue anymore. has the cancer cells been triggered and will cause more damage? anyone who may know the answer? thanks a lot.

Ro10's picture
Ro10
Posts: 1356
Joined: Jan 2009

Have the side effects been too much for you to handle? Most of us have had 6 rounds of chemo to fight our cancer. Some have had only 4 or 5 rounds of chemo. I would discuss this decision with the onocologist to get their opinion. I would think it would be like not finishing an antibiotic that was ordered for an infection. It helped a little , but did not complete the job of taking care of the infection the antibiotic was prescribed for. Good luck with your decision. In peace and caring.

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

This just came out February, 2010, and I found it fascinating:

Superiority of Weekly Paclitaxel Challenges Ovarian Cancer Treatment Paradigm

Dr. Maurie Markman is Vice President, Clinical Research; Professor, Gynecologic Medical Oncology; and Chair, Gynecologic Medical Oncology; The University of Texas M.D. Anderson Cancer Center.

1. In your view, which development that has occurred since September 2007 could have the most significant impact on gynecologic oncology?

There were several highly meaningful events over the past year in the management of female pelvic malignancies, but, in my opinion, the single most important report came from the Japanese Gynecologic Oncology Group, as presented at the 2008 Annual Meeting of the American Society of Clinical Oncology (ASCO). These investigators presented preliminary data from their randomized phase III trial that compared a regimen of carboplatin (delivered every 3 weeks) plus paclitaxel, administered either on an every-3-weeks schedule (standard approach) or weekly (experimental approach) (J Clin Oncol. 2008;26:294s).
The study revealed a highly statistically significant 11-month improvement in median progression-free survival in favor of the weekly schedule (17.2 vs 28 months; P = .0015; hazard ratio [HR], 0.714), and a more modest improvement in 2-year overall survival (77% vs 83.6%; P = 0.0496; HR, 0.735). Data on median overall survival were not available at the time of the ASCO presentation.

2. What specific changes in oncology have you observed or do you foresee as a result of this development?

This study seriously challenges the current management paradigm for the use of paclitaxel in ovarian cancer, whereby the agent is routinely employed on an every-3-weeks schedule. These data also raise the issue of whether paclitaxel should be delivered on the more frequent schedule in the treatment of endometrial and cervical cancer, for which paclitaxel is a component of several routinely administered treatment programs.
Future studies in ovarian cancer will need to consider employing the weekly approach. In addition, the implications of the new results for any ongoing studies (including those exploring the addition of novel targeted therapies) that are employing an every-3-weeks regimen, rather than weekly administration, will need to be addressed.
I believe that, based on the data from this important Japanese trial, oncologists should consider the use of weekly paclitaxel with carboplatin as primary therapy for advanced ovarian cancer.

3. Could you put this development into historical perspective for the practicing oncologist?

This was the first evidence-based, randomized, phase III trial reported in more than a decade that has revealed an improvement in outcome for a systemically delivered chemotherapy strategy administered as primary treatment of advanced ovarian cancer. (Three randomized trials over this period have shown the superiority of intraperitoneal cisplatin, compared with the systemic delivery of this agent, when employed as front-line therapy for small-volume residual advanced ovarian cancer.)

While the Japanese Gynecologic Oncology Group trial is only a single study, the results are consistent with those from 2 recently reported studies in breast cancer that demonstrated the superiority of weekly scheduling over an every-3-weeks paclitaxel regimen (N Engl J Med 2008;358:1663-1671; J Clin Oncol 2008;26:1642). These data provide important support for the validity of the Japanese phase III trial.

4. Would you sum up, in a single sentence, why you chose this development as the top story of the past year?

I consider this development to be the single most important event in the management of female pelvic malignancies because it challenges the long-standing (>10-year) existing paradigm in the systemic treatment of ovarian cancer, and it represents an approach that may be employed in several settings to improve outcomes in gynecologic malignancies.

Ro10's picture
Ro10
Posts: 1356
Joined: Jan 2009

I am sure this boosts your confidence in your weekly doses of Taxol. It will be interesting to hear if new people signing on the board will be getting the weekly treatments rather than every 3 weeks. Thanks for sharing. In peace and caring.

yoh_57
Posts: 6
Joined: Jan 2010

not really but as i thought im well coz i gained weight and appetite already so i thought not to continue anymore and take alternatives like herbal. my oncologist did not even tell advised me when to have ca-125 even after total hysterectomy.

daisy366's picture
daisy366
Posts: 1493
Joined: Mar 2009

Thanks for the research article. You are right about the info on this site and you have contributed so much to it!!!!

For the person wondering what NED means - stands for "no evidence of disease" - a state we all strive for!!

sandrawall
Posts: 2
Joined: Apr 2010

Paclitaxel was really effective one. Only thing was little expensive, so got it online at discount from International Drug Mart.

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