Taxotere v. Abraxane - 1250159

They really haven't been compared head to head in NSCLC. There's far more evidence to support Taxotere (docetaxel) in previously treated advanced NSCLC, and Taxotere but not Abraxane has an established survival benefit in this setting.

-Dr. West

Is there any reason not to give one then the other in the same manner as you can give taxol in one line then taxotere in another line and expect to have efficacy in both?

The limited evidence available demonstrates that people who have received prior Taxol (paclitaxel) followed by Taxotere do as well as the people who don't receive Taxol and then receive Taxotere.

To be honest, I haven't given Abraxane enough to have a sense of how it compares with Taxotere. Historically, I haven't felt that the data have been there to support it, and I still don't think the data are there to support it as a clear alternative to Taxotere. It may have fewer side effects than Taxotere, and being able to give it weekly means that it can be monitored and adjusted closely, but I'm not a big fan of giving a treatment just because it's easier if there aren't good data for it. To me, that's like looking on the brightly lit street for the keys you lost in the dark alley, just because the light is better there.

-Dr. West

Dr West recently wrote a post about abraxane:
http://cancergrace.org/lung/tag/abraxane/
I know some people do well on Taxotere, but my understanding was that it can be quite tough. It would be interesting to hear Dr West's opinion on its side-effects relative to other chemotherapies.

I wouldn't want to minimize the toxicity issues, but in the actual clinical trials, it's not appreciably worse than other agents we'd typically use, including even Alimta (pemetrexed), which is a darling of oncologists for it's perceived minimal side effect profile. But when you actually put Taxotere head to head against Alimta, the non-lab-related side effects are very comparable: it was only with regard to a bigger drop in blood counts that Taxotere fared worse, and we can largely limit that by giving Neulasta (peg-filgrastim) or G-CSF (filgrastim) if we need to.

My sense is that people's tolerance of Taxotere is quite variable: some patients definitely have a very hard time, but others really do fine. The evidence to support its efficacy in advanced NSCLC is pretty strong. It is widely perceived as being very tough, while Alimta is widely perceived as being easy, but when you actually measure them against each other carefully, the differences are far smaller than our informal assessments would lead us to believe.

-Dr. West

That's useful to hear, thank you Dr West.

As someone who just finished with taxotere, I'll add my two cents worth. Monday I had a CT scan after my 6th taxotere infusion. (I'm one who asks for and gets her scan results before seeing my oncologist. I meet with her later this week.) The results were stable as far as the pleural and pericardial effusions, the left lung and the bone areas; there was shrinkage in the right lung's biggest nodule and the disappearance of some of the smaller nodules. In other words, good news----

The first four infusions were no harder than Alimta while the last two gave me the chance to realize what cancer treatment fatigue is! It is passing. I also have the first hints of neuropathy in one hand and my feet. Nothing I can't live with if it doesn't go away. I had no problem with blood counts and certainly had better results with taxotere than with Alimta.

Hi Judy, glad the Taxotere has worked for you. I'm especially interested to hear about the blood counts - I had a lot of problems on first-line chemotherapy (transfusions, infection), but perhaps that was because it was a platinum doublet. Hope your fatigue passes swiftly. All best.

My husband did 2 rounds of Taxotere. For him, it was wicked. He would be fine the first few days then he would have steroid crash around day four. By day six, he didn't get out of bed much - only to go to the bathroom. I had fluids brought in and my son (a nurse) would hook him up. He just did not tolerate it well at all. He says he's not doing it again so we are looking for other options. Local Dr. mentioned Abraxane and Carbo but will talk with our Dr. from MDAnderson first. I was hoping he could try Afatinib but we found out today that he is EGFR negative. If he tries the Abraxane, I'll let you know if it was any better for him.

Layla,
Though you don't know me, I am so sorry to read about your loss. I wrote the above response before I read about your mother. I know your heart hurts right now but hope that the kind words of all the friends you've made on here bring you some comfort. I've lost a father, mother-in-law, father-in-law, numerous friends and one of my students to cancer and with each loss, the sting of the pain is ever present. From what I've read, you were an awesome daughter - one that walked each step with her in her journey. Please take gentle care of yourself and allow yourself time to grieve yet remember to smile at the many wonderful memories I'm sure you have of your mother. I hate this disease.

Kate