Chemotherapy taxol herseptin and perjumab 3 weekly side effects

Hi Blueflower,

I have had two three-weekly cycles of docetaxel, herceptin and perjeta, and in fact will have my third treatment tomorrow (with one final cycle after that).  Before that, I had two cycles of EC, which is similar to FEC.  I have found that the side effects of the second regime are different to the first one, although I have been managing fairly well with both and have been able to keep on doing most normal things so far.

With the docetaxel/herceptin/perjeta, I have to take a high steroid dose (four 2mg tablets twice daily) for three days starting with the day before treatment, which my chemo nurse says is to counteract the potentially quite harsh side effects of docetaxel around the time of treatment.  I find that this works well, and that I feel absolutely fine for Days 1-4 although I do get a hot rash on the cheeks from the steroids on Day 2.  I also have to do filgrastim injections for 7 days from the day after treatment, and as these do cause side effects such as bone pain, it is sometimes difficult to tell whether it is the docetaxel or the filgrastim that is having an effect.  It is unlikely to be the herceptin or perjeta, as these apparently do not usually cause immediate side effects (although herceptin can affect heart function - I have an echocardiogram every 6 weeks to check this).

On Day 5 after the steroids are out of my system, I have found that I definitely feel worse (in fact, Days 5 to 8 seem to the worst for me in terms of the taxane side effects).  I have not had any queasiness as sometimes happened on EC, but I have had bone pain in the hips and lower back (where the injections create new bone marrow cells), plus digestive problems (looser stools and speeded up digestive transit) for which my unit provided loperamide.  I have also had taste changes and a metallic/bitter taste in the mouth which are more marked than on EC.  I have not had any mouth ulcers or problems with my nails (I am using Evonail), but another lady in my unit on the same regime is finding that her nails are painful, blackened and some are beginning to detach from the nail bed.  I also have not had any problems with peripheral neuropathy so far. 

I understand from my oncologist that all the taxanes have similar side effects and that the three-weekly cycle is regarded as quite challenging, but if you have a taxane together with herceptin/perjeta, the taxane dose is lower than if you were having it alone.  My side effects have certainly been milder than those of other people in my unit on docetaxel alone.  I would say that they are perfectly manageable.

One thing you may find is that the first treatment on the new regime will be lengthy because it is necessary to check for side effects from each of the drugs, particularly the herceptin.  My first treatment for the herceptin/perjeta took 9 hours because patients have to be observed for 4.5 hours after the last infusion, and then I had to go back for 5 hours the next day for the docetaxel.  After the first treatment, the drugs are given in one session, so it only takes about 4 hours in total now

I hope that your remaining FEC treatment goes well, and that the change to the new regime does not cause you any problems.   A lot of us post mostly on the monthly chemo threads (currently October, but we will shortly move on the November one), so do come and join us  - it’s a fantastic place for support.

Blackcat xx

Good Morning Blackcat,

Thank you for this update it is reassuring to hear of your experience. I have unfortunately developed thrombophlebitis after second FEC and I am also on clexane. I am seeing oncologist today re third FEC dose and ? If I need PICC line . I find thinking about side effects and chemo all consuming at times but it is supportive to have this forum. I hope your treatment tomorrow goes well and thanks again fir your advice.

Blueflower x