DEAR DR. ROACH: One of my relatives has been diagnosed with stage 2 or 3 triple-negative breast cancer. Her death sentence is chemotherapy every two weeks for eight weeks, and then every week for 20 weeks! What is your opinion on this kind of chemotherapy? Isn’t there some therapy safer than this? — R.I.

ANSWER: Before I answer your question about chemotherapy risks, let me explain what is meant by ”triple-negative” breast cancer. Breast cancer cells often have receptors on their surface, which regulate growth in normal breast cells. Three of these are estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2. If they don’t express these in high numbers, they are called ”triple negative.” These kinds tend to behave more aggressively than other cancers.

Any diagnosis of breast cancer must be taken seriously. It must be evaluated, ideally by an expert team including an oncologist, breast surgeon, pathologist and radiation oncologist, in order to decide the optimal treatment. There is hope for every breast cancer patient. What often is done in triple-negative breast cancer is chemotherapy followed by surgery (this is called neoadjuvant chemotherapy), but sometimes the surgery comes first, followed by chemotherapy (called adjuvant chemotherapy).

Chemotherapy improves that hope, particularly in triple-negative breast cancer, where there are no options to block the hormone receptors. Yes, chemotherapy can be difficult, but an oncologist chooses a chemotherapy regimen that is designed to best treat the cancer while minimizing toxicity. It is unfair (and possibly harmful to your relative) to call a chemotherapy regimen a ”death sentence.” There may certainly be safer therapies, but neither you nor I have enough information to evaluate her regimen. Regimens using weekly chemotherapy are well-tolerated and improve the chances for a cure.

Questions about breast cancer and its treatment are found in the booklet on that subject. To obtain a copy, write: Dr. Roach Book No. 1101, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I am taking Eliquis and need to know what are some safe herbs and herbal teas. I have problems with anxiety. I was looking on the Internet and found a site that says chamomile tea, garlic and ginger (among others things) are not safe to take with Eliquis. Do you have a list of or can you tell me where to find information about what herbal products and teas are safe to take with Eliquis? — D.C.

ANSWER: I wish I could give you an easy answer, but I can’t give you a way of reliably getting information about drug-drug, drug-food and drug-supplement interactions that is both accurate and easily understandable. It took me close to an hour of searching and reading sites available to the public as well as those available to a physician with the resources of a major research institution to feel like I could begin to answer your question on apixaban (Eliquis).

For example, chamomile contains compounds that have anticoagulant properties, and a case report in 2006 from Montreal showed that a person using chamomile lotion and drinking chamomile tea while taking warfarin had a life-threatening case of internal bleeding due to the interaction. This is why you were cautioned against chamomile with Eliquis. Similarly, many supplements, including turmeric, garlic, ginger and green tea, have antiplatelet effects, which can act synergistically with the effect of Eliquis on clotting factors to increase bleeding risk. It is hard to estimate the magnitude of this risk.

Although a grapefruit or a glass of grapefruit juice probably is safe, large amounts of grapefruit juice may increase toxicity of Eliquis.

I could not find a list of ”safe” supplements, since proving perfect safety is impossible. Your best sources of information are your Eliquis prescriber and your pharmacist.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.


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