Study on the effectiveness of adjuvant docetaxel

My wife is having a bit of a hard time with the first dose of docetaxel (Taxotere), so I was trying to find out a bit more and came across this recently reported study:

breastcancer.org/treatment/chemotherapy/new_research/20090515b.jsp

It is saying that there was no difference in 5 year recurrence-free survival for patients who had FEC followed by Tax, against patients who had FEC alone or E-CMF treatments.

It does make me think a bit about whether the risks outweigh the benefits. I wonder whether any others had thoughts on this.

I have got hold of the original research paper, but haven’t been able to read it yet.

Interesting. I had 4 x FEC/4 x Tax in 2007. At the time I looked at a lot of the research, and everything I read then said the opposite! There was a clear advantage to having Taxotere.

Interesting indeed.
I was on TACT trial (4 x FEC and 4 x Docetaxel) in 2002 and like Road Runner, all the evidence at that time pointed to the advantage of having Docetaxel.
I’m still reviewed annually as part of the trial and when last seen in August, I still have no evidence of further disease.
Take care x

Hi, i dont look at facts and figures, to be honest, i am too scared to, but i just wanted to add that i found my first docetaxel (tax) dreadful. There was no way that i was going to do another cycle of it. But i did, and the 2nd dose of it wasnt anywhere near as bad, and i am going for my 3rd dose on wednesday. I hope that your wife finds that it gets easier. I personally will take whatever the hospital will offer me because i know that if i get any spread of this horrible disease, i would feel even worse if i hadnt tried everything offered to me to prevent it.
good luck and take care
anna

I had extreme side effects on Taxotere and during the weekend after the first dose I actually thought I would have a heart attack and die as I found the pain absolutely unbearable. I cried solidly for hours as the pain was so bad and my OH had to lie down on the bed and stroke my head in an attempt to calm me down as I was verging on hysterical (I was convinced I had sparks coming out of my head at one point).It was also a holiday weekend so we could not contact the chemo ward until the Tuesday.

Once they got the pain relief sorted out things got better, but as the only pain relief that worked was Tramadol I spent nearly the entire time I was on Taxotere in bed. I was really relieved when I got the final one, then about 7 days later huge blisters started appearing on the back of my hand, plus my immune system conked out. This meant a week in hospital isolation and they had to try to grow a culture from the blisters as they did not know if it was an infection. As soon as the blisters burst they would fill up again, it was like being in a really bad sci-fi movie. The cultures were clear of infection, so the conclusion was the last dose had punctured the vein and leaked causing a burn, however this was not apparent at the time as the blisters took 7 days to emerge which is practically unheard of (it had to be photographed and I believe they were considering writing a paper on this). I saw a plastic surgeon after being discharged from hospital, but thankfully there was no dead tissue. 2 1/2 years on my hand is blotchy and the skin gets very dry.

Thing is,I had to have it as I needed Herceptin and the two go together. If I had to undergo it again I would, because this time I would know how to cope with it. However, it scared me as this was the first time during my treatment that I had actually looked very ill - I only had minor side effects with FEC and sailed through the 25 rads.

At the same time as me another patient had a very bad weekend after the first dose and she told the chemo ward she wasn’t going back. Apparently this other patient had to be talked into having the rest of the cycles by the oncologists.

Can I just point out, I was a very extreme case. Other people I’ve met have sailed through it with just a little fatigue and joint pain. I wasn’t really affected by FEC aside of a couple of days fatigue on each cycle; my oncologist told me they find that people who do well on FEC sometimes have a hard time on Taxotere and vice versa. It took me a while to get my energy back as it also left me out of breath when out walking, I felt like a 70 year old 40 a day smoker.

Thanks for the replies.

It is encouraging to hear from Anna that the second Tax was much less bad. Fingers crossed, and I hope your’s continues to be not so bad for the remaining ones.

There are a couple of studies published in 2000 which are quoted in the introduction of recent research paper (which is actually reporting the TACT trial - perhaps you realised the already doxey.) According to this paper, those studies showed a “modest benefit”, and “no significant difference” respectively.

Anna, I think your way of looking at it is right. Janet is pretty resilient, and she wants everything they can throw at her if there is a chance of it benefitting her. I think we will probably discuss it with the onc, though (providing Janet is happy with that, of course).

Good luck to all.

(Hadn’t seen cherub’s comment when I wrote this.)

Hi, i know what cherub means about the sparks flying out of the head, i described it as giant pins and needles all over, it was a nasty, nasty time, although i think cherub you had a worse time of it. My 1st docetaxel was by far the worst ever, I have had 4x Ec before that, i went to bed on the saturday convinced that was it, but by sunday night was feeling better. There was also the pain from the bone marrow boosting injection. For the 2nd docetaxel i got armed with codeine and waited. I never had to use it, because although i still felt rough, the side effects for me were only a fraction of what they were like on the 1st one. Maybe my body got used to it? i hope so, heres hoping the next 2 go so well. Good luck with the rest of chemo, i hope it gets easier for everyone.

Very interesting. I too had 4 FEC/4 taxotere and was told we have to get as much into you as we can. It was in my lymph nodes and I was HER2. So i didnt want to take any chances. But i found the taxotere dreadful. FEC no real problems. But everything kicked in on taxotere. It was this time last year and I spent most of the three months or so i was having it in bed, exhausted, not eating much as sense of taste was dreadful. Actually lost weight because in the end i couldnt be bothered to cook anything as there was no point everything tasted awful. Had some peripheral neuropathy but slight. Running nose and eyes. Very embarrassing. Would be in supermarket and then nose would just run. Had to have tissues to hand all the time. But the worst was hair and skin. Hair is still thin in places one year on. Skin reacted very very badly. Like a bad attack of eczema which came on after the last three doses approximately one week after infusion and gradually got worse. Then when was improving it was time for next dose. Skin on hands and arms peeled off in sheets and there was nothing for it. Aqueous cream did nothing and it itched and was very sore. The only good thing? was it was winter so could cover it up. In fact I blame taxotere for the start of lymphoedema. I have never understood why some people in some areas get 3 each and some get 4 each of regime.

Starfish, I think the total dosage is usually the same but spread out over different timescales. They take the patient’s age, height/weight and previous medical history into account when calculating the regime.

Jansman, thanks for bringing this to our attention. It is interesting to see how research is developing. If it results in some women getting less invasive treatment it can only be good.

I too had 3 FEC and 3 Tax. My tumour failed to respond to FEC so although the Tax was harder going I was glad of it. I also found the first dose to be the worst and it got easier. I hope your wife is the same.

Jan xx

You may be right about Taxotere and your lymphoedema, Starfish.

I have just discovered that having Taxane chemotherapy (presumably Taxotere or Taxol) is a recognised risk factor for developing it.

I had lymphoedema before I had either of the Taxanes. Both have definitely aggravated it.

Taxotere is a toughie for many people, I reckon. It certainly was for me! Altho’ I don’t think I suffered as badly as many on here. For me the difference was that while FEC was like being hit by a bus every three weeks, Taxotere was a case of being continually dragged along behind one, if that makes sense…

Hope your wife is feeling a bit better at the moment, jansman.

X

S

The Registrar who works under my oncologist told me after I finished Taxotere that I had done really, really well as many patients don’t manage the last dose. He is specialising in skin reactions related to chemo treatment and my oncologist dispatched him to the hospital where I was being kept in isolation. He came to see me twice and I was really glad to see a friendly face; he is Sri Lankan, wears really bright silk shirts and is very cheery! The Consultants at this particular hospital kept reminding me “we’re haematologists, NOT oncologists!” and they made me feel like I was just a nuisance to them; the nurses were sanctimonious bitches as well, no bedside manner at all sadly. None of them would work nights, so it was always different agency nurses.I used to want to scream when the consultants kept saying “aside of your breast cancer issues” every time they spoke to me.

The consultants would talk over my head when I was sitting on the bed and they tore the junior doc who was looking after me off a strip for helping me with a wound dressing problem (“that’s what the nurses are here for!”). That kind boy was only 23 and he used to come into talk when it was quiet as he was a bit down after splitting with his GF - he was about to move to Australia because he couldn’t get a post in the UK and I have often hoped he is doing well in his new life. He was a really lovely chap, a credit to the medical profession in his manner.

It was all quite a depressing experience really.

Hi Jansman,

I have read that article. It is available on the web as Sequential docetaxel as adjuvant chemotherapy for early breast cancer (TACT): an open-label, phase III, randomised controlled trial.

You might want to ask your oncologist for their interpretation of the article, since article’s argument seems different from the press interpretation. The authors note “We postulate that patients with ER-positive and HER2-negative cancers might not gain a clinically worthwhile benefit from taxanes; however, long-term follow-up is needed to confirm this hypothesis.” Since this is the most common type, it is an important finding, but it may not be generalizable to all subtypes. The authors suggest that the possible benefits of taxanes may vary considerably by subtype (see figure 7): her2positive, er-negative, node-positive women seem to get the most benefit (possibly reducing recurrences by a quarter), followed by triple negative, then women who are both er-positive and her2-positive.

Best wishes,

Christine

Ever wish you hadn’t read something? I am booked to have Docetaxel on Weds or Thurs depending on whether I am having Herceptin or Lapatinib (going on a trial). In fact wish I wasn’t in this position at all after 10 years of all clear. Mets in Lungs and Chest Glands so guess have to follow Onc recomm. Anyone heard of PDT by the way? Fran

Thanks all for the responses. It is helpful to hear so many views.

Thanks also for the good wishes. Janet went through what I can only describe as hell for about 72 hours. She seemed to turn a corner yesterday afternoon and now it’s just the abdominal pain that is quite bad (“just”!). Fingers/toes/nails are quite sore as well. Some of the advice in the “Advice on Taxotere” thread has been very useful. Especially advice to keep moving and to take plenty of fluids.

@Christine. Thanks for the analysis. I have the article, but haven’t had chance to study it thoroughly yet. There’s a lot of information there, and you are right that the news article over-simplifies things greatly. Janet’s BC is positive for HER2, ER and PR, so I guess she falls into the third category.

@Fran. Sorry to hear what you are now going through. The study that I mentioned at the start of this thread is about the effectiveness for early stage BC. I don’t think there is any doubt about its effectiveness against secondaries.

Glad to hear Janet is feeling better.

Has she been offfered the ice mitts and slippers to help her nails at your hospital?

Or some little bowls of chilled water to put her fingers in during the infusion? (If not, you can always take your own along).

X to all

S

Maybe I am well in the minority but I sailed through chemo(4xfec,4x taxol)I certainly wasn’t looking forward to it after all the horror stories I’d heard, but apart from the night of my first fec when I felt as if I had the mother of all hangovers and could hardly stagger to the bathroom unaided,the rest of it was fine!!
I did get more and more tired on the taxol and don’t know how I would have coped with another one,but all in all I cant complain.
By far the worst bit for me was loseing my beautiful waist length hair which I’d managed to hang on to while on fec by cutting it mid length and using the cold cap…alas on the taxol I ended up as bald as a coot!
I’m now six years down the line and still ok. I have peripheral neuropathy in my toes and a condition called ‘wet eye’ which is very probably a result of the taxol. Being triple neg and node pos I’ve another 2yrs of checkups.I was told when on the taxol trial that it would only increase my chanches of survival by a few percent but hey even 1% is quite a few of us!!
Wishing you all the same luck as I’ve had,
Josie x