“The addition of new chemotherapy drugs has not improved outcomes. Thus, we need to give the active drugs in the best way,” says G. Thomas Budd MD of the Cleveland Clinic. Dr. Budd reported a very interesting study comparing two dosing regimens of Taxol (paclitaxel) at ASCO 2013, this year’s annual meeting of the American Society of Clinical Oncology, which took place from May 31st to June 4th.
I was particularly drawn to this abstract because Taxol caused what was probably the most unpleasant experience I have had to date on chemotherapy. Oh, I lost four kilos a treatment on the AC schedule, but vomiting could be controlled. But Taxol… Taxol quite literally took my breath away. My chest hurt and I was coughing and gasping for air. The friend who had accompanied me to that first dose, a nurse herself, started me on oxygen and went for the chemo nurse. They put me on steroids and something else that made me sleep. From then and for the rest of the series of Taxol treatments, I received a bag of IV steroids before the treatment, then something that made me sleep, then finally the Taxol. It was not fun.
So it was interesting to read this abstract. I won’t go into the details of the protocol, but you can read about it at the links I’ve provided below. The part that concerns us was the comparison of two dosing regimens for Taxol: the traditional “dose-dense approach” given every two weeks that was developed at Sloan-Kettering, and a lower dose given weekly.
Discussing the conclusions of the survey, Dr. Budd said: “Either regimen can be selected on the basis of efficacy. So in practice, treatment can be selected based on other considerations, such as toxicity.”
Toxicity of cancer drugs is graded on a scale called the Common Terminology Criteria for Adverse Events (see National Cancer Institute Wiki FAQ on the CTCAE) that ranges from 0 (no adverse effect to 4 (life-threatening adverse effect). (Grade 5, death, does exist on the scale, but was not a factor in this study). The study found that both regimens had grade 3/4 toxicity, but that the “toxicity profile” differed between the two. The dose-dense protocol led to more allergic-type reactions, whereas the lower weekly dose showed more hematological toxicity.
The study concluded that 12 weeks of low-dose Taxol produces less overall toxicity than six cycles of dose-dense treatment (one cycle every two weeks).
What are the implications for me? If my oncologist should suggest putting me back on Taxol (it has been shown to have some efficacy in stage IV breast cancer), I would definitely ask about the weekly schedule. (It may not be possible in my case due to chronic neutropenia, but it’s worth investigating.)
It should be remembered that these findings were presented orally at ASCO and have not yet been published in a peer-reviewed journal.
The study was funded by the (American) National Institute of Health and Amgen.