Interesting Study re Sequence of Chemo
Chemotherapy Sequence Affects Early Breast Cancer Outcomes
"Chemotherapy Sequence Affects Early Breast Cancer Outcomes
Elsevier Global Medical News. 2011 Jan 7, B Jancin
SAN ANTONIO (EGMN) — The sequence in which paclitaxel (taxol) and anthracyclines (such as adriamycin) are given for treatment of early breast cancer makes a big difference in long-term outcomes.
That's the conclusion reached in what is believed to be the largest-ever retrospective study of the clinical impact of the sequencing of taxanes and anthracyclines. The study involved 3,010 early breast cancer patients who were treated during 1994-2009 and entered into the prospective online database at the University of Texas M.D. Anderson Cancer Center, Houston.
The clear winner was paclitaxel (taxol), followed by anthracycline-based therapy with 5-fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide or 5-fluorouracil, epirubicin, and cyclophosphamide, Dr. Ricardo H. Alvarez reported at the San Antonio Breast Cancer Symposium.
Starting with paclitaxel rather than an anthracycline-first regimen led to better long-term results in the settings of adjuvant chemotherapy and primary systemic (or neoadjuvant) therapy.
The adjuvant chemotherapy analysis included 1,596 women, three-quarters of whom received paclitaxel followed by anthracyclines. The 5-year relapse-free survival rate with this regimen was 88.8%, compared with 79.5% when anthracyclines were followed by paclitaxel. The 10-year relapse-free survival rates were 81.8% and 73.5%, respectively.
Five-year overall survival was 93.1% with paclitaxel followed by anthracyclines, compared with 83.2% for the reverse. The 10-year overall survival rates were 83.9% and 65.6%, respectively.
In a multivariate analysis that was stratified for potential confounders, including age, clinical stage, hormone receptor status, tumor grade, and era of diagnosis, the anthracyclines-first sequence was associated with a 67% increased risk of relapse (P less than .0001) and a 2.5-fold greater risk of mortality (P = .001), according to Dr. Alvarez, a medical oncologist at M.D. Anderson.
Among 1,414 patients who underwent neoadjuvant therapy, the 5-year relapse-free survival rate was 79.0% with the paclitaxel-first regimen vs. 61.2% with the anthracyclines-first regimen. Ten-year relapse-free survival occurred in 61.7% and 50.5%, respectively, of these patients.
Overall survival was 84.2% and 66.2% at 5 and 10 years, respectively, in patients who received paclitaxel followed by anthracyclines, compared with 71.3% and 53.4% in those who got anthracyclines first.
In a multivariate analysis, the anthracyclines-followed-by-paclitaxel sequence of neoadjuvant chemotherapy was associated with an adjusted 49% higher risk of relapse (P = .01) and a nonsignificant 28% increase in risk of all-cause mortality (P = .17), compared with the paclitaxel-first strategy.
The mechanism that accounts for the increased efficacy of taxane-first regimens for treatment of breast cancer is unclear, according to Dr. Alvarez.
He declared having no relevant financial relationships."
Comments
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taxol followed by FEC
That is so interesting (and encouraging!) as I have just started last week on a 12 week cycle of Taxol, which will be followed by a 12 week cycle of FEC (apparently like AC, but different - don;t know much about it yet).
The doctor recommending this treatment timing is Dr. Christafannelli from FOx Chase Cancer Center in Philadelphia. I was diagnosed with breast cancer on Dec 16 and started my chemo on Fri, Jan 7. I just joined this board.
I;m struggling with a lot of feelings about breast cancer in general and chemo in particular - how "should" I feel? Why am I so hungry when everyone says I "should" lose my appetite? Am I being too optimistic about my chances for recovery? I;m also tired of comforting other people about MY cancer, if that makes any sense to anyone!
Just some random thoughts put out there- it;s been a long day! (and it's not over yet!)
Hoping to find this a good place of support.
Laura Jean0 -
Oh my gosh
...it is like you read my mind. I was just sitting here wondering why my onc. decided on Taxol first when so many others have it last... but I do have early stage node negative ER+ bc and I am going to MD Anderson. I was expecting no chemo until my Oncotype came out so high for reoccurrance last week that my onc. reversed her opinion and wants me to do Taxol first and then the others. Sure makes you wonder how this cancer beast works. This makes me feel a bit better about it all now. Thanks for sharing. What does it mean "he declared no relevent financial relationships"?0 -
Pink PearlPinkPearl said:Oh my gosh
...it is like you read my mind. I was just sitting here wondering why my onc. decided on Taxol first when so many others have it last... but I do have early stage node negative ER+ bc and I am going to MD Anderson. I was expecting no chemo until my Oncotype came out so high for reoccurrance last week that my onc. reversed her opinion and wants me to do Taxol first and then the others. Sure makes you wonder how this cancer beast works. This makes me feel a bit better about it all now. Thanks for sharing. What does it mean "he declared no relevent financial relationships"?
"he declared no relevent financial relationships" means that he doesn't get any financial benefit from any of the companies that manufacture any of the drugs in the study.
I also had the same question that Mimivac had. I have a coworker that is currently receiving TAC, so I'm wondering if this is good news for her or not.
As usual - Thanks so much for sharing Cynthia!0 -
Laura Jean, all of us are sodbhadra said:taxol followed by FEC
That is so interesting (and encouraging!) as I have just started last week on a 12 week cycle of Taxol, which will be followed by a 12 week cycle of FEC (apparently like AC, but different - don;t know much about it yet).
The doctor recommending this treatment timing is Dr. Christafannelli from FOx Chase Cancer Center in Philadelphia. I was diagnosed with breast cancer on Dec 16 and started my chemo on Fri, Jan 7. I just joined this board.
I;m struggling with a lot of feelings about breast cancer in general and chemo in particular - how "should" I feel? Why am I so hungry when everyone says I "should" lose my appetite? Am I being too optimistic about my chances for recovery? I;m also tired of comforting other people about MY cancer, if that makes any sense to anyone!
Just some random thoughts put out there- it;s been a long day! (and it's not over yet!)
Hoping to find this a good place of support.
Laura Jean
Laura Jean, all of us are so very different; each a chemical system with thousands of different pieces and parts to that system. None of will react to a drug the same way. Some of us sail through a therapy. Others may have devastating side effects from the same therapy.
So you may not lose your appetite and that is wonderful--don't begin to second guess it! I lost all of my hair, but a fellow survivor who started the same exact treatment at the same time didn't even have thinner hair.
As to your saying you are tired of comforting others about your cancer--that makes perfect sense to me. As nurturers, we often don't make our needs known. Also, some folks are just less than empathetic--avoid them like the plague.0 -
I honestly don't know, butcindycflynn said:Pink Pearl
"he declared no relevent financial relationships" means that he doesn't get any financial benefit from any of the companies that manufacture any of the drugs in the study.
I also had the same question that Mimivac had. I have a coworker that is currently receiving TAC, so I'm wondering if this is good news for her or not.
As usual - Thanks so much for sharing Cynthia!
I honestly don't know, but remember that this is just one study and don't panic.
I had Stage 3A in Feb 1987. The chemo that was used on me in 1987 was cytoxan, methotrexate and 5 FU (CMF). Of course, this regimen is rarely used anymore. The cytoxan back then was oral, a horse pill, and awful and would not always stay down. Also, I had to skip chemo one month because my WBC bottomed out and there was no neulasta, neupogen, etc back then.
But here I am anyway 23 years later (my 23 year canniversary is next month but I'm celebrating early). So, my message is, have faith and keep fighting!0 -
23 years!CypressCynthia said:I honestly don't know, but
I honestly don't know, but remember that this is just one study and don't panic.
I had Stage 3A in Feb 1987. The chemo that was used on me in 1987 was cytoxan, methotrexate and 5 FU (CMF). Of course, this regimen is rarely used anymore. The cytoxan back then was oral, a horse pill, and awful and would not always stay down. Also, I had to skip chemo one month because my WBC bottomed out and there was no neulasta, neupogen, etc back then.
But here I am anyway 23 years later (my 23 year canniversary is next month but I'm celebrating early). So, my message is, have faith and keep fighting!
Cynthia, I think you're awesome!0 -
Need to remember that this
Need to remember that this is one study dealing with EARLY BC DX. Nor does it state what type of BC 'they' dealt with.
Those of us who are IBC are very seldom (if ever) DX'd in an "early" stage. Any study that is done scientifically is great BUT does not apply to those who do not fall into the limited peramaters of the 'study'.
It's great that it has shown what it has - but does not apply to so many.0 -
That's interesting as in
That's interesting as in Canada they have been using 5FU and I actually tried to avoid it as one onc told me it was an old chemo and I knew they hadn't been using it in the U.S. Thanks for the interesting article.
jan0 -
I had A/C, surgery and thenjamiegww said:Does this mean I'm "screwed"?
I had AC first and then Taxol. If I read this correctly, I have a greater risk of reoccurance and a decreased chance of surving five to ten years.
I had A/C, surgery and then Taxol. Do I think I was "screwed" - NOPE! I wasn't EARLY BC. Operative word - "EARLY"! This study was very limited and even in it's limits does not apply to so many of us. I'm IBC, which doesn't have the best prognosis, but on Jan 28th, I'll be a year out from the last Taxol and I'm "doin' great".
Susan0 -
OMG, OMGmimivac said:23 years!
Cynthia, I think you're awesome!
I just realized it will be 24 years next month--not 23. That's a good thing though that I can no longer keep track and I have gone so long--right?? Not just senility--right?? LOL0 -
Thanks Cynthia for anothercindycflynn said:Pink Pearl
"he declared no relevent financial relationships" means that he doesn't get any financial benefit from any of the companies that manufacture any of the drugs in the study.
I also had the same question that Mimivac had. I have a coworker that is currently receiving TAC, so I'm wondering if this is good news for her or not.
As usual - Thanks so much for sharing Cynthia!
Thanks Cynthia for another great article!
Sue
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nobody is screwed, I had ACphoenixrising said:That's interesting as in
That's interesting as in Canada they have been using 5FU and I actually tried to avoid it as one onc told me it was an old chemo and I knew they hadn't been using it in the U.S. Thanks for the interesting article.
jan
nobody is screwed, I had AC and taxol, unless I want to go and do it over again, there is nothing I can do. good info for people who may wonder why they are getting something different. i too had CMF the first and it seemingly worked. And now they no longer use that treatment.0 -
My chemodbhadra said:taxol followed by FEC
That is so interesting (and encouraging!) as I have just started last week on a 12 week cycle of Taxol, which will be followed by a 12 week cycle of FEC (apparently like AC, but different - don;t know much about it yet).
The doctor recommending this treatment timing is Dr. Christafannelli from FOx Chase Cancer Center in Philadelphia. I was diagnosed with breast cancer on Dec 16 and started my chemo on Fri, Jan 7. I just joined this board.
I;m struggling with a lot of feelings about breast cancer in general and chemo in particular - how "should" I feel? Why am I so hungry when everyone says I "should" lose my appetite? Am I being too optimistic about my chances for recovery? I;m also tired of comforting other people about MY cancer, if that makes any sense to anyone!
Just some random thoughts put out there- it;s been a long day! (and it's not over yet!)
Hoping to find this a good place of support.
Laura Jean
My 1st was nov 5 2010 and I had my last one fri. Jan7 and it was great compared to what I had expected. It was good my only sides effects was I was tried a couple of days and loss of hair . I was scared but everything worked so good. I am so blessed I have found a new person in myself0 -
My chemodbhadra said:taxol followed by FEC
That is so interesting (and encouraging!) as I have just started last week on a 12 week cycle of Taxol, which will be followed by a 12 week cycle of FEC (apparently like AC, but different - don;t know much about it yet).
The doctor recommending this treatment timing is Dr. Christafannelli from FOx Chase Cancer Center in Philadelphia. I was diagnosed with breast cancer on Dec 16 and started my chemo on Fri, Jan 7. I just joined this board.
I;m struggling with a lot of feelings about breast cancer in general and chemo in particular - how "should" I feel? Why am I so hungry when everyone says I "should" lose my appetite? Am I being too optimistic about my chances for recovery? I;m also tired of comforting other people about MY cancer, if that makes any sense to anyone!
Just some random thoughts put out there- it;s been a long day! (and it's not over yet!)
Hoping to find this a good place of support.
Laura Jean
My 1st was nov 5 2010 and I had my last one fri. Jan7 and it was great compared to what I had expected. It was good my only sides effects was I was tried a couple of days and loss of hair . I was scared but everything worked so good. I am so blessed I have found a new person in myself0 -
I may have IBC too - and many questions!carkris said:nobody is screwed, I had AC
nobody is screwed, I had AC and taxol, unless I want to go and do it over again, there is nothing I can do. good info for people who may wonder why they are getting something different. i too had CMF the first and it seemingly worked. And now they no longer use that treatment.
OK, here is my question - how do I actually know if I have IBC? I have one negative skin biopsy, one positive skin biopsy, some swelling, some redness, a 3 by 2 centimeter lump/mass and a cancer with "lobular features"!!!????
My oncologist keeps telling me that IBC is a "clinical diagnosis" meaning, if you are inflamed, you are classified as IBC. But, according to her, it doesn;t matter since I am ER+, PR+ and HER -, so treatment is the same whether it is IBC or "regular" breast cancer. But at the same time, everything I read says IBC has worse prognosis than other types of breast cancer.
IS IBC really worse that other breast cancers???? And WHY???
Also, I hate telling people I am Stage III (which I am classified as, both because of the size of my tumor and the skin inflammation). They look at me as if I am going to die immediately (or maybe I just imagine that they are) and then I end up explaining how even though it's Stage III, it's really not that bad, etc. etc. etc. Why do people even ask what stage I am, anyway? How does anyone else answer that question. Today I found a new way to cut short that discussion by simply saying, "My prognosis is good" (though I have not seen that written down anywhere on my numerous reports (and would like it in writing "excellent prognosis" would be even better!!!) I am still going to say it based on talks with my oncologist!!!"
Thanks ladies for letting me vent here! Until I started writing I didn't realize how much was in there!
2nd round of 12 weekly taxol tomorrow...one down, 11 to go!!!
Wishing everyone a good night,
Laura0 -
Thanks CindyPinkPearl said:Oh my gosh
...it is like you read my mind. I was just sitting here wondering why my onc. decided on Taxol first when so many others have it last... but I do have early stage node negative ER+ bc and I am going to MD Anderson. I was expecting no chemo until my Oncotype came out so high for reoccurrance last week that my onc. reversed her opinion and wants me to do Taxol first and then the others. Sure makes you wonder how this cancer beast works. This makes me feel a bit better about it all now. Thanks for sharing. What does it mean "he declared no relevent financial relationships"?
Thanks Cindy, I guess some doctors receive financial incentives. It is scary that money could influence their recommendations, isn't it?
I just wanted to say that no matter what reports say etc. you still have to discuss it all, reasearch it yourself to some extent and trust your own oncologist who knows you and your cancer type the best. After my discussion with my onc. last week, I asked for a few days to think about it and another appt with her which I had today. We decided for me the best plan with the least bad permanent side effects, best for my gene markers, stage, and tumor size is to go with TC which is Taxotere and Cytoxan for 4 cycles 3 weeks apart. So... being aware of this report or any report is a good thing but don't get worried if your treatment is or was different. There is always some guess work involved; it just goes with the territory. Just try to make the best choices for you at the time you are presented with the data and trust your plan and expect it to work to your benefit!0 -
Good Answer Laura!dbhadra said:I may have IBC too - and many questions!
OK, here is my question - how do I actually know if I have IBC? I have one negative skin biopsy, one positive skin biopsy, some swelling, some redness, a 3 by 2 centimeter lump/mass and a cancer with "lobular features"!!!????
My oncologist keeps telling me that IBC is a "clinical diagnosis" meaning, if you are inflamed, you are classified as IBC. But, according to her, it doesn;t matter since I am ER+, PR+ and HER -, so treatment is the same whether it is IBC or "regular" breast cancer. But at the same time, everything I read says IBC has worse prognosis than other types of breast cancer.
IS IBC really worse that other breast cancers???? And WHY???
Also, I hate telling people I am Stage III (which I am classified as, both because of the size of my tumor and the skin inflammation). They look at me as if I am going to die immediately (or maybe I just imagine that they are) and then I end up explaining how even though it's Stage III, it's really not that bad, etc. etc. etc. Why do people even ask what stage I am, anyway? How does anyone else answer that question. Today I found a new way to cut short that discussion by simply saying, "My prognosis is good" (though I have not seen that written down anywhere on my numerous reports (and would like it in writing "excellent prognosis" would be even better!!!) I am still going to say it based on talks with my oncologist!!!"
Thanks ladies for letting me vent here! Until I started writing I didn't realize how much was in there!
2nd round of 12 weekly taxol tomorrow...one down, 11 to go!!!
Wishing everyone a good night,
Laura
Laura...I 'm. 14 months out of treatment..lumpectomy, chemo,radiation...Triple negative...not a "good"one...no lymph node involvement....Stage II... got the best piece of advice from my surgeon ...he said when people start giving advice, tell them "thank you, but my physician's advice is what I have to listen to."
As far as the staging questions, I think your answer is PERFECT!!! I was stunned by what some people said to me....Mostly I just had to let it go...same with friends who " disappeared"
Hang in there sweetie...it's a long journey but we are stronger than we know!
Nancy0 -
thanks for the reply Nancy/people's random theories on cancerMAJW said:Good Answer Laura!
Laura...I 'm. 14 months out of treatment..lumpectomy, chemo,radiation...Triple negative...not a "good"one...no lymph node involvement....Stage II... got the best piece of advice from my surgeon ...he said when people start giving advice, tell them "thank you, but my physician's advice is what I have to listen to."
As far as the staging questions, I think your answer is PERFECT!!! I was stunned by what some people said to me....Mostly I just had to let it go...same with friends who " disappeared"
Hang in there sweetie...it's a long journey but we are stronger than we know!
Nancy
yes, I have had people tell me not to eat sugar, not to eat chicken, not to eat fruit, to see an accupuncturist, to take homeopathic medicine...I know they mean well, and different things work for different people....but I'm going with what my oncologist tells me as she is actually medically trained in this disease. I try to listen politely and then do what I am going to do anyway.
If we knew exactly what caused cancer and how to cure it, then we would know for sure and not have all these different theories. I also resent the (probably unintentinal) implication that if I had not eaten sugar, fruit, chicken, etc, I would not have cancer, therefore it is somehow "my fault". It's more difficult because I am overweight/obese and that has been shown in some studies to have a link with breast cancer. In 2010 I worked really hard to lose 25 pounds. Now that I started on steriods I am eating like a horse. I;m afraid I;m going to be one of these people that gains on chemo, so then I would be bald AND fat!!!
Thanks for the support, all, and sorry for the bit of negative ranting.
2nd chemo today - 2 down and 10 to go! Bit of nausea/gas tonight and not as much appetite...just took Adivan and probably should go to bed.
Wishing all a good night!
Laura0
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