Adjuvant And Neoadjuvant Therapy Side Effects-Dr. David Margileth

Uploaded by drjayharness on 20.12.2011

>>> DR. DAVID MARGILETH: I like to tell my patients in great detail about the side effects
of the chemotherapy. In general, the same drugs are used in the neoadjuvant setting,
as the adjuvant setting, and we can divide the toxicity of these chemotherapies into
two major groups: one would be the problems that occurred during the chemotherapy or the
acute toxicities; and the other would be the late toxicities, that is, those things that
we might need to worry about shortly after or maybe long after the chemotherapy has been
The acute toxicities most people are fairly familiar with, the one that we do the worst
job with still, is hair loss. We still really don’t have any modality that will prevent
hair loss. Many of the best breast cancer chemotherapy drugs are unfortunately those
that pretty much routinely cause hair loss, on a positive note that hair loss is totally
reversible. Once that chemotherapy is completed, patient’s hair grows back. Most of my patients
feel comfortable at about four to five months without a wig and ultimately their hair looks
exactly the same as it did pre-treatment.
Two of the major acute side effects that used to be huge issues in chemotherapy are now,
if not completely solved, certainly mostly solved, and the most important of those would
be nausea and vomiting.
Nausea and vomiting used to be a huge part of my life. In that many patients had a lot
of dry heaving, I’d get calls from patient’s husbands in the middle of the night, my wife
has thrown up 25 times… what do I do? Now we have several new classes of anti-nausea
drugs and I would say that at least in the breast cancer world, nausea and vomiting is
about 90% better.
I am almost surprised when somebody throws up, they may have two or three days of queasiness
around the chemotherapy but rarely if ever, do they have this persistent dry heaving or
vomiting that was a common accompaniment of chemotherapy in the past.
The other major toxicity that was a huge issue in the past was infectious complications.
When chemotherapy is given, especially of higher doses, there is an unexpected decrease
in the white blood count about 10 to 14 days after the chemotherapy has been given. When
that happens that patient is more susceptible to infection, and sometimes serious infection,
and in the past all oncologists would have a number of patients in the hospital with
what’s called neutropenic fever, or infections that occur during a time when the white count
was very low, when those infections might become quite serious.
There was a drug developed called Neupogen, and now a newer drug called Neulasta, as a
single intramuscular injection that stimulates the bone marrow to make more white cells such
that patient’s white counts are often relatively normal during the entire chemotherapy, meaning
that serious infections are very uncommon and equally importantly, these people can
live a normal life. They don’t have to worry about going out in public. I have had several
kindergarten teachers on major chemotherapy and never had any infectious complications.
So those two things are much, much better. People get through the chemotherapy easier.
Other complications that we watch for acutely, some of the drugs, namely the taxanes, may
cause a peripheral neuropathy, that is some numbness and tingling of the hands and feet.
We will put up with some minor neuropathy, but if we are in a longer chemotherapy and
that neuropathy becomes more of an issue, we don’t want to push that drug to a point
where they have a permanent neuropathy and we’ll switch to some other chemotherapy.
Other problems that we watch for other GI side effects such as diarrhea - not a huge
issue anymore. Mal sores, which used to be a major issue, now I think because of Neulasta
and the white count remaining normal, are not nearly the problem they used to be.
Hi, I am Dr. Jay Harness and I want to share with you important information that I believe
that every newly diagnosed patient with breast cancer needs to know.
Susan Denver: I am a breast cancer survivor.
Katherine Stockton: I am a breast cancer survivor.
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