Taxol/joint and muscle pain
I am new to this forum, and am seeking others who have experience with Taxol when used as a single agent.
My husband was given his first dose of this a week ago today....his only side effect so far has been debilitating muscle aches and joint pains. This started Saturday night and has only begun to subside today. He has been taking Oxycodone, sometimes along with Tylenol Arthritis, as well as Celebrex. This regimen only dulled the pain, never fully relieving it.
I spoke with the clinic pharmacist today regarding this, and she will be working with the oncologist to devise a med plan that will make him more comfortable when he takes the next dose in a couple of weeks. If anyone has any experience with this, I would like to know how you coped with the pain.
A bit of background on him: He was diagnosed with thymic carcinoma in April of '96. It recurred in '01, was stabilized; then recurred again in June of this year. Over the years, he has had single agent Cisplatin, 6 doses; Carboplatin, 2 doses in '01, followed by 4 doses of a "cocktail" consisting of Cisplatin, Adriamycin, and Cytoxan, which stabilized the tumors again; this past August, 3 doses of Carboplatin (did not respond), followed by 2 doses of the "cocktail" again (now stabilized); our oncologists are following up with the single agent Taxol in hopes of shrinking some of the tumors again. (The thymoma was already metastatic when it was first diagnosed, but all visible cancerous growths were surgically removed in '96.) He has also had bladder cancer since 1991, but it has been in complete remission for over 2 years.
Any ideas or help concerning the Taxol would be appreciated. We must be careful with most NSAIDS, as he is also recovering from massive PEs, including a saddle PE, and must limit his meds because of the Coumadin therapy.
Thanks for your input.
Tonky (Jane in GA)
All things happen for a reason; our job is to search for it.
Thanks for posting. All these side-effects from Taxol can be terrible, and the pain certainly can be a big issue. I am glad you/he will speak to the oncologist and adjust the analgesic treatment. Oxycodone is a good drug, but if it does not cut the pain there are alternatives to improve that.
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.
Neuropathy, a problem that sometimes occurs with chemotherapy treatment. It's not all that rare, especially frequent in patients older than 65 years of age. It is damage to the nerves. It can occur from some chemotherapy drugs used in conventional cancer treatment.
There are three major goups of nerves in the human body, the peripheral nerves that carry information to and from the limbs, the nerves that supply the bowels and other internal organs, and the nerves of the head which connect to the ears, eyes, taste buds, etc. Nerves in any or all of these major groups can be affected by certain chemotherapy drugs.
Nerves are vulnerable to many kinds of damage. They can be damaged by certain cancers. This may be caused by the cancer cells producing a particular kind of biological agent that interferes with the function of the nerves. Sometimes, they can be damged by drugs used in chemotherapy treatment. The chemotherapy drugs that most likely cause nerve damage are the vinca alkaloids(vincristine, vindesine and vinblastine), platinum drugs(cisplatinum, carboplatinum) and the taxanes(taxol, taxotere). These drugs have the potential of interfering with nerve function.
You may notice symptoms in different areas of your body depending on which groups of nerves are affected. Symptoms in the hands and feet happen when peripheral nerve damage happens and are not rare with vinca alkaloids. The first sign of nerve damage is usually a feeling of tingling and numbness like what you experience when your foot goes to sleep after you've been sitting for a long time in an uncomfortable position. If the problem progresses further, it often produces weakness of the muscles, resulting in loss of strength at the wrist or the ankle. You will notice difficulty in doing up buttons and picking up coins. You may notice that you will tend to trip while walking up stairs or dragging your feet and tend to have a wide-based gait. In severe cases, the weakness may be so severe that you will need a wheelchair.
When the nerves in the bowel are affected, constipation is the earliest sign. In a few people, the abdomen becomes bloated with a distended bowel that is basically paralyzed. Some of the nerves in the head can also be affected. Platinum drugs can affect the auditory nerve and cause loss of hearing and tinnitus(ringing in the ears). Vision can very occasionally be affected.
A lot depends on how quickly your cancer treatment can be stopped. Sometimes the need for treatment is more urgent then the residual nerve damage. Sometimes, the balance between benefit from the drug and the side effect of nerve damage is more finely balanced.
Once treatment has been stopped, recovery is usually slow. It may take months to get even partial improvement and often there will be some residual impairment, either a motor weakness or a sensory numbness or both. Recovery is slower in the feet and legs than in the hands and arms.
There is no specific treatment that enhances nerve recovery. There are no drugs that will directly stimulate nerve regeneration or recovery. If you have severe and prolonged pain, then the pain may require narcotics often combined with antidepressants. In some cases, certain types of anticonvulsants would be helpful. Treatment options are subjects that you should discuss with your doctor, so you have accurate expectations of potential benefits and side effects.
Chemotherapy drugs that can cause neuropathy. NCI lists these as most likely to do so:
Cytarabine (Cytosar, Ara-C)
Paclitaxel (Taxol) and Docetaxel (Taxotere)
Other medications reported to contribute to neuropathy include oxaliplatin (Eloxatin), gemcitibine (Gemzar) and thalidomide (Thalomid).
Thank you so much for your reply. I went to your website and read the sad account of your late wife's battle with OV Cancer. Of course, it reinforces my reservations about all of the chemo that my husband is having. We are lucky that our oncologists do involve us completely in the decisions concerning the drugs, and are careful to point out that chemo can oftentimes be as damaging as the cancer itself. They reassess his condition after every chemo dose. So far, we have been fortunate that there seems to be no permanent damage to his body.
As to my question about Taxol and pain, he has not experienced any neuropathy at all..just transient muscle and joint aches, for about 4 days. After they stop, they are completely gone until another dose. Since he is allergic to morphine, and taking a synthetic drug like hydromorphone could be risky, we are relying on the condone drugs, which do a less than perfect job of giving him relief. If his upcoming PET/CT shows continuing stability or shrinkage, he will be given 3 more doses of Taxol, then will have a holiday, until another recurrence. (Currently, there is no clinically proven single-action protocol for Thymic Carcinoma, since it is such a rare cancer....recurrences are almost a given with this disease.)
Your experiences with your wife's chemo ordeals lead me to question whether or not we are taking a big chance with all the Taxol. In carefully studying your story, I came away with the idea that a lot of the things that happened were related to the fact that OV cancer was the disease. In your opinion, is there an across- the -board tendency for Taxol to cause the same problems that your wife had, regardless of the type of cancer? I would appreciate your ideas about this.
Jane B. (Tonkyii)
All things happen for a reason; our job is to search for it.
Taxol/joint and muscle pain
I enjoy reading when a new drug or procedure comes out, and the people writing the report or article then badmouth the previous drug or procedure in explaining it. It is usually possible to get very interesting information on company's products from various company websites. They are competitors of course.
Taxol is given into a vein, but in order for the body to absorb the drug, it must first be dissolved in a solution. Taxol's history began fourty-three years ago. It was found to be virtually insoluble in water. It had the solubility of a brick. The compound wouldn't dissolve very much in any solution. Without a way to get it into a cancer patient, what good was it? It was discovered that something Taxol would dissove in that "might" work in a reasonably "safe" intravenous solution in humans. It was an elixir made of castor oil and marketed as Cremophor EL. It was the "only" answer (until synthetic compounds were introduced like Taxotere). However, this castor-oil carrier is suspected as the culprit behind the misery which includes nausea, vomiting, joint pain, appetite loss, brittle hair and tingling sensations in hands and feet (neuropathy). The much ballyhooed drug was no panacea.
The American Cancer Society, in its press release about a new breast cancer drug approved, mentioned that the solution can cause dangerous allergic reactions in many people, so patients "must" first take other drugs like steroids and antihistamines in "hopes" to prevent a bad reaction. The solution can also leach chemicals from regular plastic tubes used to deliver medication, so Taxol must be given through special tubing.
The new drug for breast cancer (Abraxane) is a new form of Taxol (Paclitaxel), which is also a widely used breast cancer drug. So, no, Taxol side effects can happen in any cancer, not just ovarian. Abraxane does not need to be dissolved in the castor oil solution and does not require special equipment to be given to patients. However, more of the women on Abraxane had numbness and tingling in their hands and feet. And more suffered nausea and vomiting, diarrhea, muscle and joint pain and anemia.
The percentage of patients that must respond to a drug before it is approved by the FDA varies as high as 80% to as low as 20%. Thereafter, it is used routinely for all patients with the same form of cancer, though unfortunately, a drug that helps one person does not necessarily mean it will help all patients with the same diagnosis. Taxol was approved by the FDA with a 30% efficacy (not accuracy).
Now, Bionumerik, in boosting its new drug Tavocept, that is aimed at preventing or reducing common and serious side effects, particularly nerve and kidney damage, associated with taxane (Taxol) and platinum (Carboplatin) drugs, talks about in their literature that chemotherapy-induced toxicities are common and serious clinical problems that adversely impact both the quality of life of cancer patients and the ability of patients to continue treatment for their cancer. Very little has been accomplished to prevent or reduce chemotherapy-induced toxicities such as nerve damage (neurotoxicity), kidney damage (nephrotoxicity) and hearing impairment (ototoxicity). But now they have another new product.
Thanks for your reply. My husband will have a PET/CT in a couple of weeks, and my question may be a moot point, if the Taxol is not being effective. (They will discontinue if the cancer has regressed.)
I do have a lot of faith in our oncologists....they work in a cancer clinic in a good teaching hospital, the Medical College of Georgia, to be precise. They are also getting input from the leading thymic carcinoma doctor, who is at Indiana Medical College. He sees several thymic patients a month, whereas most oncologists do not see a case in their lifetime. He suggested that Taxol be given instead of additional Cisplatin, Adriamycin, and Cytoxan cocktail. I know that our doctors are well aware of the many undesired side effects of all chemos, and are very pleased with how well my husband recuperates after each series, also the fact that he has always gotten several years' stability and well-being each time he undergoes treatment. It is a bit scary this time, though....when he finishes this series, he will have taken 11 doses total, using 5 different chemos. He has bounced back remarkably after each dose, though, and 2 of the 3 weeks beween dose, he usually feels quite good. A lot of Taxol is being given in our clinic, too, for many different cancers.....it will be a shame of many of these patients go on to develop further illness as a result of the drugs.
Thank your for your interest. The nurses had mentioned that Taxol was given in an oil, but did not specify what kind 9Neither did I ask!)
All things happen for a reason; our job is to search for it.
Gee. I hope the cancer hasn't regressed. And I hope that they would not discontinue if it has. Has any tumor or fluid specimens been retained at pathology? Take a look at postings for chemosensitivity testing at either the breast or ovarian cancer subjects on this web site. This technology excels in refractory cancer.
It's interesting that your doctors at Medical College of Georgia are getting input from a leading thymic carcinoma doctor at Indiana Medical College. I am certainly happy for that. It IS usual. Your in good hands. It reminds me of a form of what once was a very rare form of cancer (Leptomingeal Carcinomatous or Carcinomatous Meningitis). For ovarian cancer, up until 1994, there was only 14 well documented cases on record. What was so unusual is that about 50% of this type of cancer was diagnosed "post-mortum." Only after the patient died had they discovered it.
There are two ways to get this cancer, and my wife (unfortunately by bad oncologists at our local community hospital) got it from one of those ways (direct extension from a spinal tumor left unevaluated). My oldest brother was an associate clinical professor at Penn State Hershey Medical School and I used his connections to have my wife operated for a brain met in 1998. Because of the unevaluated spinal lesion at our local community (so-called community cancer center) hospital, I took her back up there to conclusively find out what was happening and how to get some additional life for my wife.
Like that Indiana Medical College doctor, Penn State Hershey Medical Hospital is a leading institution on lymphomas. And because of their knowledge of advanced lymphomas (carcinomatous meningitis from lymphomas) they were instrumental in helping my wife's carcinomatous meningitis from ovarian. I posted what information I saved from that experience on "other cancers" subjects on this site.
That "oil" is something that my mother remembers that doctors gave patients, way, way back then.
Yep, Castor oil was a renowned treatment for many children in my childhood....some parents gave periodic doses of it to their offspring, just to give them a good "cleaning out". Fortunately, my mother was not one of them..her remedy was "Castoria", which was more than likely a small amount of the oil camouflaged with sweet syrup. I was given a dose of the genuine article as a prep-step to inducing labor with my first child...ugh!!
As to what our doctors will do if my husband's cancer isn't behaving..they have told us that there are several other drugs that have worked for some with Thymic carcinoma.....the oral drug Iressa has been used in clinical trial.....only about 20% of patients have positive response, but in that group, the response was good. The Indiana doctor (Dr. Loehrer) is starting new trials soon for thymic carcinoma....I am not sure yet what the regimens will be, but my husband might not qualify because he has had continuing stability success with other agents for almost 9 years.
What concerned me most was the fact that when I read your wife's story, it seemed that the Taxol was directly responsible for her brain metatisis, but in your last post, some of the info leads me to believe that had she gotten proper treatment at every step, she might not have presented with the brain involvement. Am I still misconstruing exactly what happened?
Thank you for all the research...I plan to carefully study a lot of info on this site. Incidentally, my husband seems to be tolerating the treatment he had on 1/20 somewhat better than the last time.....we are using a combo of Oxycontin, 10 mg, Tylenol Arthritis, and Benadryl. He has also resumed his minuim-dose Celebrex. He had Oxycontin last year when he had knee replacements, and he has no problems with it for a short treatment period.
All things happen for a reason; our job is to search for it.
Boy! Your information about Castoria really poked the mind of my 90 year old mother (in a NH) when I told her about it. She does remember Castoria was a better tasting substance that came later because no one like the taste of Castor oil. It brought back memories of her mother, who had a mom & pop grocery store. Remember those? There was one on just about every corner of any city, and many people came to the store to buy Castor oil for whatever ailed them (probably, as you said, a prep-step to inducing labor when a lot of child birth was done at home). This was over a hundred years ago.
I had always thought that the postoperative whole brain radiation was the one and only thing that caused the demise of my wife. It still was the primary morbidity, however, from numerous response letters I received from scientists, I came to understand that her Taxol had a contributing factor. Leukoencephalopathy (basically brain damage) results from structural alterations of cerebral white matter, characterized by cerebral edema and can occur in patients of any age (but particularly more often in those over 65). Cranial irradiation and/or chemotherapy agents, especially those used in high-dose protocols, are causal agents. The prevalence of toxic leukoencephalopathy is unknown. Because this syndrome alters neurobehavioral function, patients may present in a confused state (I believe they call it chemobrain or chemofog). When my medical expert perused her medical records, he confirmed the pathology of her leukoencephalopathy.
The other part of Taxol, on my wife, was chemo-resistance. The effectiveness of taxane/platin combination is limited because of the late stages of a lot of cancer and most patients develop resistance. Most cancer patients have the drug bounce off their tumors, doing little if any good. Because of the "dose-intense" nature of the treatment, it also suppresses the immune system, making it possible new tumors to grow because the patient has been rendered unable to resist them (this would be more pronounced in those over 65). And the taxanes and platins do permeate (pass through) the blood brain barrier (the system that protects the brain from foreign substances by blocking their passage from the blood).
In my wife's case, in regards to ovarian cancer, a NCI observational study in 1995 reported experience in their clinic where recurrent systemic disease occurred in all ovarian patients for which they received dose-intense Paclitaxel (Taxol) therapy. Brain metastasis was the only site of disease recurrence. I've had numerous cancer patients or the loved ones of cancer patients who have written to me with their experience with brain mets after dose-intense taxol/carboplatin regimens. These patients had either ovarian, breast or lung cancers. Never had any from "rare cancers." Another scientist from a major lab had told me that platins can make a patient less resistant to radiation treatments, making the side-effects more pronounced.
I sincerely hope the Iressa helps out. I've read a lot of pros and cons about it, but one must research it for themselves. There is not a "right" or "wrong decision", just an "informed" decision.
Taxol treatment for Node Negitive, Her2Neu Positive BC
Hello, This is my first posting to your forum on Taxol. I would like to give you some information of myself. I am 50, female, with stage IIA BC. There are no lymph knodes involved, the margins are clear, and the infiltrated ductual carsinoma size was 3cm. It was removed Dec. 1, 2004. I started chemo on Jan. 10, 2005 with Cytoxin and Adromiacyn (sp) dose dense of every 14 days. I am also Estrogen Receptor and Progesteron Receptor negitive and HER2NEU positive. Premenapausal. Altho now with chemo I was told I will be going through menapause. My hot flashes back this up. Now here is the new news. My oncologist would like me to take Taxol or taxene's, he feels the HER2NEU positive is a reason to do this even with all the GOOD things I have going on for myself. This I believe will also be for dose dense 4 sessions. (My last session of A & C will be Feb. 21, 2005 with 14 days later starting the Taxol's) I am truly having a struggle to decide if I even should take this next set of sessions. I have been told by other Taxol users that they needed liquid morphine to get thru this. Even my Oncol. says that his colleges would say he is treating me OVER AGGRESSIVELY. But he also states that this is the first time out and although there there is not much information out there with regards to Node neg. women that this is the time for the "BIG GUNS". I am also suppose to do the radiation for 6 weeks 5 x's weekly and currently looking in to seeing if I would be a canidate for Mammosite Rad. instead.
I look forward to any information or links that can help me make an educated decision.