Weekly Taxane Chemotherapy for Metastatic Breast Cancer

By Edith Pituskin RN BScN

In spite of many advances in cancer treatment, when a breast cancer comes back and has spread to other parts of the body (metastasize) there is no known cure. If this happens, the treatment plan changes: to control problems or symptoms caused by the tumor growth, and to prolong survival.

Surgery and radiation are used when possible to remove or shrink tumors. However, a systemic treatment is often necessary when tumor cells have spread in different areas of the body. Chemotherapy is called a 'systemic' treatment because the medications are carried by the bloodstream through the entire body. Chemotherapy can often relieve symptoms like pain, shortness of breath, or weakness by shrinking the tumor causing these symptoms.

Many people worry about receiving chemotherapy and the side effects they could experience, especially if they are not feeling well. The most problematic and frequent side effect of chemotherapy is on the bone marrow, causing low levels of red blood cells, white blood cells, and platelets. Without enough of thse cells people are at high risk of infection and bleeding. Nausea and vomiting, fatigue, and hair loss are other side effects that also cause concern.

For people who are considering chemotherapy treatment for metastatic breast cancer, it is very important that the treatment has been shown to be effective and also have few side effects. New information and study results are available showing benefit for women who receive weekly treatments with chemotherapy medications called 'taxanes".

Weekly Taxane Chemotherapy

Chemotherapy medications are generally given every three weeks to allow the bone marrow to recover between treatments. New information from studies with taxane chemotherapy medications suggest that weekly treatment could have benefits:

• less toxicity to the bone marrow, decreasing the chance of bleeding or infection
• cancer cells are exposed more frequently to chemotherapy medications
• higher total doses can be given safely over a long period of time

Taxol

• the major problem with weekly Taxol infusions has been the eventual damage to peripheral nerves (neuropathy)
• response rates from studies of weekly Taxol are, on average, about 30%

Taxotere

• data from six studies of weekly Taxotere has shown an average response rate of 38%
• neuropathy has not been found to be a problem
• although the minority of people develop changes in fingernails and some fatigue while receiving this chemotherapy treatment, it is generally well tolerated
• dexamethasone is also given before and after Taxotere infusions for nausea control and prevention of fluid retention or sensitivity reaction

Weekly Taxotere Treatment at the Cross Cancer Institute

At the Cross Cancer Institute, we routinely give Taxotere at 36 mg/m2 intravenously over 30 minutes each week. This dose has been shown in studies to be effective, without significant side effects. If you would like more information about this topic or would like to know if this treatment would be helpful for you, talk to your doctor at the next clinic visit.

Sources

Hainsworth JD Burris HA 3rd Greco FA. Weekly administration of docetaxel (Taxotere): Summary of clinical data. Seminars in Oncology 26(3 Suppl 10:19 - 24, 1999 June.

Hortobagyi GN. Recent progress in the clinical development of docetaxel (Taxotere). Seminars in Oncology 25(5 Suppl 9):32 - 36, 1999 June.

Loffler TM. Is there a place for 'dose-dense' weekly schedules of the taxoids? Seminars in Oncology 25(5 Suppl 12):32 - 34, 1998 October.

Love SM. Dr. Susan Love's Breast Book. 2nd ed. 1995 Addison Wesley.