Node positive chemotherapy...CEF vs AC/T

Carmelle

Differences emerge in chemo success
HELEN BRANSWELL

Canadian Press

TORONTO — A chemotherapy regime commonly used in breast cancer patients is significantly less successful at preventing cancer from recurring than another, Canadian-developed regime, researchers reported Sunday.

While the findings will serve to fine tune treatment rather than stake out new ground, they should help lead to more women being offered the more effective combination of chemo drugs, oncologists said.

“It's going to have a big impact (on treatment). I won't be using it, as (formulated) in the trial,” Dr. Mark Levine, one of two lead researchers on the study, said of the less effective chemo regime.

The researchers, from Canada and the United States, reported their findings Sunday at a major breast cancer conference in San Antonio, Tex.

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The study set out to test an experimental chemo regime against two established chemo combinations, as well as assessing the two commonly used treatments against each other.

After an average of only 30 months follow up, a difference was already clear.

If 100 women were on each of the three regimes, 10 women who received the experimental combination and 10 women who got the Canadian-developed regime would have had a recurrence. But 15 on the less effective chemo cocktail would have seen their cancer come back.

“The difference in the early going is impressive,” Dr. Steven Narod, a leading breast cancer researcher based at Toronto's Women's College Hospital, said via e-mail.

But Dr. Narod, who was not involved in the trial, said it will be important to follow the women to see if there is a difference in death rates due to breast cancer among the three groups.

The women being studied — 2,104 in Canada and the U.S. — had undergone surgery to remove a breast cancer tumour and were getting chemotherapy to lower the risk their cancer would come back. The women, aged 60 and younger, all had cancer that had spread into their lymph nodes or tumours that had characteristics suggesting the cancer would likely spread.

About 22 per cent of invasive breast cancer cases in Canada fall into this category, called node-positive or high-risk node negative, according to the Canadian Cancer Society.

Kristina Cusack of Summerville, N.B., was one of them.

Ms. Cusack, 34, was diagnosed with breast cancer two years ago, when her only child, a daughter, was 18 months old. Her oncologist, Dr. Margot Burnell of Saint John Regional Hospital — the other lead researcher on the trial — asked if Ms. Cusack would be willing to take part in a study.

“I didn't even hesitate,” Ms. Cusack said. “It was the easiest question throughout the whole, whole thing to answer....

“I just thought: if there was something I could do to make it easier for people down the road, even if this didn't work for me, if it made a difference later on, why not?”

Women in the trial were randomized to receive one of the three treatments. Ms. Cusack was given the Canadian-developed regime. Two years out, she has not had a recurrence.

The less effective regime is called AC/T and is made up of the drugs doxorubicin and cyclophosphamide followed by paclitaxel. This combination is commonly used in the United States but is less frequently used in Canada.

The Canadian-developed regime is called CEF, short for cyclophosphamide, epirubicin and fluorouracil. It is commonly used in this country.

The experimental combination, called EC/T, involved a shorter, concentrated course of epirubicin and cyclophosphamide followed by paclitaxel.

At the 30-month follow up, 70 women on EC/T and 79 on CEF had had a recurrence and 112 on AC/T saw their cancer return.

It is too soon to say if EC/T or CEF is more effective, said Dr. Burnell, interviewed from San Antonio. She said the researchers will continue to follow the study participants to try to tease out an answer to that question as well as to see if there was a survival advantage to either combination.

Unlike Dr. Levine, Dr. Burnell didn't believe the study will mean a wide-scale phasing out of the AC/T regime — which of the three is the combination with the fewest side-effects.

“You may see that this regime decreases in its ... frequency of use, but . . . it is still a good regime for many women,” Dr. Burnell said.

Dr. Michael Pollak, a clinical oncologist at McGill University in Montreal, welcomed the findings as a step towards clarifying which of the existing treatments works best in most women. But he said he looks forward to a day when medicine can tell which treatment is best for each individual woman, based on the characteristics of her cancer.

“But that's not yet here. And in the absence of that, it's very useful to know the best sort of average responses,” Dr. Pollak said.

This slow, methodical accumulation of knowledge is the way cancer science evolves, suggested Dr. Levine, an oncologist at McMaster University in Hamilton.

“We don't hit home runs. We hit singles. We move incrementally,” he said.

The study was funded by the Canadian Cancer Society, the Canadian and American National Cancer Institutes and drug makers Pfizer, Bristol-Myers Squibb, Amgen, Janssen Ortho and Ortho Biotech.

Ainslee

Hi Michelle,

I read this article in today's Calgary Herald. I know that you did the same regimen as me.

Makes me hope that the "chemo" hell I lived through wasn't all for not.

Encouraging news for all of us CEF girls, that's for sure.

Hugs,

Ainslee

yowyow

Hi, I was still in so much shock when I started my chemo that I never even asked what I was having. It took until my last treatment to even think of asking as all along I just did what I was told and took every extreme option available. So fairly happy to read this now I know I had FEC

Thanks

cbr2004

The Edmonton Sun said:
"The three-year recurrence-free survival rate was 85% for the patients on AC/T, compared to 90.1% for patients on CEF and 89.5% for those on EC/T."

I was on the MA21 trial, which this one sound like. I did EC/T arm, which was virtually as good as CEF, so I'm happy to hear this news.

I am a little confused, though, because I though E had fewer heart-related side effects than A. But the news reports suggest otherwise.

Clare

linny

Hi, I had chemo last year at Princess Margaret Hospital in Toronto - I had 6 treatments of FEC, which is NOT the same as CEF - it is the same drugs, but given in a different way, and is not considered to be the same chemotherapy regimen as CEF. I never understood why so few women on these boards that live in the US have either CEF or FEC.

Linda

Ainslee

Hi Linny,

Thanks for clarifying that.

FEC is usually given in 6 doses, like you said, whereas I had 12 treatments of CEF (over six months), given in a different format.

In my journey with breast cancer, I have met quite a few women who did the FEC regimen but less than a handful who did CEF. I think it's a more aggressive treatment but will be curious to see if we hear about more women being given it now that the early results of the trial are showing the benefits.

Cheers,

Ainslee

wallan

I had the AC/T arm on this trial. I was considered quite high risk when I started the trial. So now I am a little nervous. More nervous than usual. And to top it all, the dang adriamycin may have damaged my heart.

Last night I told my hubby I thought I was doomed. I haven't thought that for awhile. I go see my oncologist on Thursday and will be asking lots of questions.

Wendy A

cbr2004

You know, that difference between 85% and 89-90% is not huge. They are both very good survival rates! When I started chemo I was told that either chemo regime would reduce my changes of recurrence from about 50% to 25%. So all 3 arms of the trial are showing better results than the expectations of only 2 years ago.

I suspect that the 'T' has particular benefits for some patients, and the news report suggests that 'E' might have been harder on your heart.

When I first heard the news report, I realized that what seems good news for some patients would seem like bad news for others.

So I hope that your oncologist can help lift your sense of doom.

Clare

Carmelle

Wendy...it does not mean that your treatment will not benefit you 100%. you are doing great.
the study was to compare and i have felt the CEF was so old an outdated and worried as i read so many posts saying canadian medical system is so behind because of budget and meds and worried as to why women were being swtitched to AC/T. so to me to know CEF regimen was as good as the others was a relief. that's why i posted it. not to worry the AC/T women. i have a friend who did AC/T in 2000 (35 with 4 kids) with stage 3C...still doing great.
as to hardest or worst...they all stink.
Michelle

raluca63

Wendy, I don't think that you have to worry about doing the AC/T chemo, everybody is so different so you might have had excelent results from the AC/T. I can tell you from my own experience, AC/T worked great. I had a 13 cm tumor and many swollen lymph nodes and I had neoadjuvant AC/T. I can tell you that I had a complete pathologic response, no cancer found in either my breast tissue or nodes.
Regards,

Calipso

wallan

Thanks everyone for your kind words. Calipso, way to go!!
A 13 cm tumor is huge... mine was 7.5 cm and 2 positive nodes that were big with extracapsular extension. Grade 3.
So your story is really really encouraging. And I hope and know you will continue to do well...

The letter I got was just so negative. It said 5% difference in treatment response may not look huge, but it is "statistically significant". There is that dang "statistical" word again. And I know better. I work in science!! And then the letter warned me I may be upset by this. And, that the results were not anticipated and that AC/T was widely used at the time of the letter. It sounded like someone was trying to cover their butts!
So, maybe I am overreacting, as I tend to do with this stuff.
But I have put it in perspective too. I don't have mets; its been almost 3 years now and Carmelle is right, I am doing well. So really.... what's the dif if AC/T is 5% less effective? And I didn't know that it was previously thought response to chemo was only 30-50% before this study. So there you go.

Thanks ladies... as always, you cheer me and are there for me.

Merry Christmas everyone!!

Wendy A

sunshine2003

Wow, I miss you guys!
Now I know why I connected with you....both Wallan and Carmelle!!!!- what incredibly intelligent and sensitive women you are.
I was also glad to read the article you posted - as a 3 1/2 year CEF graduate....also believing Canada was in the "Dark Ages" of chemo - compared to the U.S.
You know, from the newspaper I read,they didn't mention which regiems - so it wasn't until just now I realized - that CEF showed up as doing alright. It was a little scary because everyone I ran into was getting AC/T - so I felt like it was being dropped for lack of success. Carmelle is right - for us, including you Wallan!, it's working 100%!!!
Anyway - we're still going - and life's quite good.
I hope you all have a Merry Christmas and a very Happy New Year!
Janet

LizM

I read this article when it first came out and I believe if I am correct that the AC/T regimen was not given in dose dense (every two weeks) like it is normally given here in the US. I do believe that dose dense has been proven to add a few percentage points to recurrence/survival. Can anyone clarify who was in the trial as to whether they received dose dense AC/T?

cbr2004

Liz

I can answer that question. I was in the MA21 trial, on the EC/T arm. I just looked up the information I was given before I decided to do it. The AC/T group got AC every 3 weeks for 4 cycles, then Taxol every 3 weeks for 4 cycles.

medinorth

Did a search for AC/T vs. FEC and came across this topic. They are both anthracycline-based chemotherapy regimens. I don't know whether to stay away from the chemo forum or read every topic in my results. It all makes me nervous.

flannelette

Interesting. I had 6 tx FEC in 2008 - it was not chemo hell, IMHO. I knew nothing, asked nothing except - is my chemo in the low, med or strong range? and my onc said med. anyway - 3 years down the road NED (Knock on wood - always!) I had no nodes positive, but did have a whopper tumour.