Anyone doing TCH chemo, er-pr-her+ Node +

tomatojuice

Anyone doing TCH chemo, er-pr-her+ Node +

tomatojuice

Haven't seen anyone else on the board with node positive, who will be doing TCH chemo. After reading and listening to BCU-update-Dr.Stephen Jones-It seems as though TCH is being done around the country mostly for node negative, but he gives it for 1-3 node positive pts. Also some other doctors will give it to pt. with up to 5 nodes positive. From what I could understand-they are doing studies now-they want to see if they can eliminate the anthracyclines for her 2 because of the cardiotoxicity, and they say you really only need either the adriamyicin or herceptin. So some dr. feel six cycles of Tc and Herceptin. Anyways I am not real scientific, so to understand all of this is not easy. Don't really know if I am interperting it right. So if anyone is interested go to 'breastcancerupdate"-dr. Jones. Would love to hear from anyone doing TCH-node positive. Trying to make a decision before next week.

nagem

One thing that's important to remember is that at this moment there is no single right answer, and as a lay person, you don't have the background to do much more than try to grasp what the issue is--which you seem to do quite well. The drug-regimen question for her2neu+++ is still in flux, so there is no way to know for sure the most advantageous drug combination for your particular situation. At this juncture, you really have to put your faith in your oncologist's instincts.

TenderIsOurMight

Just to help by clarifying the "C" in TCH and TC&H:



TCH: Docetaxel, Carboplatin, Herceptin



TC&H: Docetaxel, Cytoxan, Herceptin

Written as Adjuvant TC and Herceptin

an adjuvant stage II safety trial headed up by Dr. Jones which opened in June 2007 at 68 sites



link:http://www.clinicaltrials.gov/ct2/show/NCT00493649?term=Phase+II+TC+with+H&recr=Open&rank=1&show_locs=Y#locn

tomatojuice

Thank you TenderisOurMight. I spent all day thinking Dr.Jones was talking about Doxetaxel,Carboplatin,Herceptin. Oh well,totally confused again. Back to not knowing what to do. nagem -I wish that I could put my faith in my Oncologist. He is compassionate, and seems to be a nice enough doctor, but he is a new doctor(just finishing up his fellowship). I am a Medicaid patient, and I think my experience is somewhat different than non-medicaid. For instance- I met my surgeon at a clinic-she spoke to me for all of 3 min. After surgery-she spoke to me for 5 min. I will not see her again til June. When I was under-I don't really know who did the surgery, could have been a student. Same thing on Tuesday- I go for port to be put in-have no idea who's going to do it. I am grateful for medicaid, because I know some people have no insurance. But ideally I would like to find another Oncologist and get a second opinion. The cardiotoxity of Adriamycin scares me to no end. Right now everthing scares me. My mom had two heart attacks and passed away at 56. My baby sister passed from bc at 50. At least though, the onc did give me the choice to either have ACTH or TCHI am agonizing over this. Monday will roll around and I will just decide.

TenderIsOurMight

Tomatojuice,



Dr. Jones does also speak of TCH (Docextaxol, Carboplatin and Herceptin).



I just clarified the TC & H incase you were thinking of trying that phase II study.



But now I understand your delimma is whether to do dose dense ACTH or TCH.



I had a couple of questions. Do you have any history of heart disease, hypertesion, long standing high cholesterol yourself? You're in your 50's. Most dramatic effects of Adriamycin have been newly reported in women over age 65 but not all. Do you know what your Muga scan showed?



I understand your concern about the cardiotoxicity of Adriamycin. I did receive that as chemotherapy, and now doubt that I would given what is known about it's heart effects and ER+ tumors. But Adriamycin has saved many a women in breast cancer, and it's possible the full story of its efficacy is not written in the cards as yet.



Yet your tumor is HER+, and HER overexpression genetically is close to the topoisomerase gene, felt needed to be present for optimum effect of adriamycin. So in this case, if you omit Adriamycin you may omit a chemotherapy which in retrospect may best work in situations like yours. Please note, of late there has been some question of the toperisomerase/adriamycin relationship. As yet, most breast tumors are not tested directly for topoisomerase amplification.



I suspect that is why 5 out 6 oncologists recommended ACTH in the presence of your tumor profile, markers and other information you were given.



It is a very difficult decision which only you can make and I'm sorry for your quandery. In adjuvant therapy the goal is to attempt a cure with treatments, although such is really known only in retrospect.



Good wishes going your way.

Tender

tomatojuice

Hi tender. Thank you so much for your response. I do not have any heart problems. I had an echo done yesterday-have not gotten the results yet. I am 58 1/2 . I have had high cholesterol for the past 20 yrs. Tryed very hard through diet and exxercise to remedy it, but was never successful-had to take lipitor. Been taking it for past 10 years.

suemed8749

Tomato: Did you check on the ACT vs TCH thread to see if any of those women are node positive? I'm doing Taxol/Carboplatin/Herceptin, but I'm node negative, so can't help you. One thing I was NOT expecting was having these decisions to make - life-affecting decisions, required to be made quickly. I wish you all the best as you are deciding this.

Sue

tomatojuice

Before I conk out for the night. Can't wait to hit the pillow, all this decision making is more exhausting to, than running a marathon. Really want to do Tch-afraid of adriamyicin. Getting the port on tuesday. Wed is chemo day-don't want to postpone it.

MaryAnn-CA

Hi tomatojuice - I am considered node positive because I had one node (of six removed) that had a micrometastasis.  The other five nodes were negative.  I chose TCH and will have my last treatment (of six) this coming Thursday.  I can appreciate your dilemma.  I agonized, and I mean agonized over whether to to ACTH or TCH.  I went to three different oncologists:  one said do ACTH, the other said do TCH, and the third said do either one.  The day I had to decide, I was almost paralyzed with indecision.  The truth is there is no cut and dried correct answer.  Even the oncologists do not agree.  In the end, my husband helped me to list the pros and cons and I decided on TCH.  One reason was that I did not want to risk doing adriamycin and have it cause my ejection fraction to drop and then be denied herceptin (which all three of my oncologists agreed is the most important drug for us Her2+ patients.)  Also, I am overweight and the oncologists said it is difficult with an overweight patient to determine the correct dose of adriamycin to give ... I did not want to risk either being under-dosed and therefore limiting the effectiveness of the treatment or being over-dosed and upping the risk for heart damage.  Also, I liked the idea that with the TCH program, I could start herceptin right away unlike ACTH where you need to wait until you have taken four treatments of AC.  There really is no right or wrong answer.  When you decide, just go with it and believe that you have made a good choice.  I felt so much better once the decision was behind me.  Good luck to you and know that you are not alone and whatever you decide will be an excellent treatment.

tomatojuice

Well spoke on the phone to my Oncologist. My echo came back normal (I guess)61%. Told him I was going to do TCH. I really like my oncologist alot. From the beginning, I have noticed, that he always had time for me-you know to discuss things etc. And he is a very compassionate person-I know this because I broke down in his office-when I was first diagnosed. So having to tell him that I was not going to do what he thought was best for me, was very difficult. Tomorrow after I get the port, I will go to see him to finalize everything. Start chemo wed.Tnank you Maryann-Ca, Tender, suemed, nagemand everyone who has responded to my threads. Feel so much better, now that I have made my decision. I chose TCH, because of the long term possible side effects from Adriamyicin.Although everyone keeps saying "you are young enough" in 1 1/2 years I will be 60.To me it is not young-both parents died from heart desease at 55-56. Also I went to this site http://www.breastcancerupdate.com/download-audio/bcu/20   On track #9-the roundtable discussion-Dr. Miller say she is increasingly giving Tch to her her2 pts. even with 5 nodes positive. Also since one of the dr. on the team discussing my case wanted to give me TCH-was convincing to me. Anyway I'm hopeful and confident. For me it is the only way to go.

TenderIsOurMight

Truly pleased to read you've made your decision. You bring many valid points to the table, and your decision was not an easy one.



Wishing you all the best and a safe time through chemotherapy.



Tender

Cathy-CA

Tomatojuice -- glad to hear you made your decision and your onc is comfortable with it.  My father is currently sitting in the hospital awaiting by-pass surgery, which is why -- like you -- I ultimately chose TCH.  I felt I have too much family history of heart disease to risk adriamycin.

Here's hoping you have few side effects.  I have had so few problems with TCH that I almost feel guilty when I read some of the other stories on this site.

mary6204

Tomatojuice,  Glad you made your decision and I hope it goes well for you.  I was not node-positive, so I didn't offer any advice before, by my oncologist told me that their office was slowly getting away from using adriamycin unless it was the only option.  He told me he wanted to free me from Cancer and yet at age 53 he didn't want it to cause heart problems in a few years down the road. 

Good luck, if you have any questions, just private message me.  I have 2 treatments out of 6 done and really looking forward to the end.  Mary

KristyAnn

I am starting TCH this Friday April 25.

DOUGHY100

4/25/08 I'll have my second TCH treatment. May 14th I have a second opinion scheduled at Dana Faber Breast Cancer Center. Just want some piece of mind re: the correct Chemo.

Today was a good day, tomorrow will be even better!

tomatojuice

Hi suzanne Good to hear from you. Maybe you could update us on the second opinion. Hope all goes really well for you with the second chemo.

suemed8749

tomatojuice: Good for you for making a decision and taking an active role in your treatment!!

Sue

DOUGHY100

Just heard today from my PCP. My health insurance has denied my

2nd opinion at Dana Faber. Boy, I'm peeved. They want me to go to New England Medical Center and see some doctor I have never heard of. NE Med Center is on the Insurance plan of course. I appealed their decision this afternoon. It will be Dana Faber, I will appeal as many times as I have too! Let's hope I won't be paying out of pocket in the end.

DOUGHY100

Thank Goodness!

An update, my appeal was excepted- my health insurance has agreed to my 2nd opinion at Dana Faber Cancer Insitiute, Boston. I've been very lucky and have my appointment with a leading MD.

Doing the appeal was easy. I called the appeal department and they typed my appeal letter right over the phone- painless. Just goes to show if you want something bad enough, all you have to do is exert alittle effort.

Today is a good day. Tomorrow promises to be even better!

MaryAnn-CA

Doughy100 - Congratulations on your appeal being accepted!  You are truly an example of how being your own advocate works!  Are you planning to ask Dana Farber if they agree with your doing the TCH program and/or if they recommend any changes or follow-on chemo?  I am very interested because I just finished TCH and have an appt this week to talk to my oncologist about where to go from here.  Since I am also ER/PR negative and have a profile very much like yours, I plan to ask if I should have any more (supplemental) chemo or just depend on the Herceptin to prevent a recurrence.  So, I'm really interested in what Dana Farber tells you.

rdg_runner

I finished neo-adj last Aug and had my masc. in the end of Sept. Because I did my chemo first it is unkown how many lymph nodes where positive as there was enlargement under the arm and possibly above the collar bone but PET scan was unresponsive to my cancer. But mostly I want you to know I researched alot before my chemo and had alot of different opinions given. I finally decided on chemo first and my onc and I saw I felt was the best even though he was a fairly small town local. Very up to date on the latest of research. I was impressed with his knowledge of options and the latest test results, we chose TCH and my cancer was extremely responsive to that program. The benefit was we could see how responsive it was. My tumor shrank by almost 1/2 within the first three weeks. It was awesome. I still feel very comfortable with that choice. After surgery there was very little scatter cancer cells left in my breast and none left in my lymph nodes just atrophied ones. Just finished my 1 yr Herceptin last month. Things are good. Most important to me was finding a Dr. who's opinion and knowledge I felt comfortable with and trusted. Good luck to you. My heart is with you.

Boo307

I get my porta-a-cath next week and start TCH (Taxotere, Cytoxan, Herceptin) the week after.  Any words of wisdom from those who have gone before me?  I am very nervous about all the side effects of chemo.

Does everyone get a porta-a-cath?

 Dx 3-18-08, left IDC, 1.8cm, stage 1tc, node negative, grade 3, ER-/PR-/HER2+, right DCIS, ER+/PR-  3-30-08, 4-9-08 Bilateral partial masectomy and re-excision a week later.   

mary6204

I have a port and I'm thankful it makes things so much easier.  I'm not sure what a porta-a-cath is exactly?

I'm had 3 out of 6 TCH treatments, halfway done.  Good Luck, Mary

texasmom

I am new to this board and recently diagnosed. Had two surgeries in April. I am getting my portacath next week too. I don't know when I will start chemo and am a little overwhelmed. I see that many people have gotten 2 & 3 opinions and wonder if I should. I had two cancers in the same breast...one was high grade DCIS and one was invasive stage 1, grade 2, e/p -, her2+. Not really sure of the details because I didn't get a copy of the report. I guess the her2+ thing is the worst in conjunction with being hormone negative. Chemo was recommended and I don't want to take a chance on it coming back so I'm starting that soon. Looking at all the side affects mentioned on this sight really scares me. I went to look at wigs and scarves this past weekend. Does everyone lose their hair with chemo?

KristyAnn

Texas Mom,

I have almost the same diagnosis- two spots in my left breast- one was DCIS and the other was Grade 3 IDC. Where in Texas are you- I am in East Texas (Tyler/Lindale area)- we need to stay in touch through this journey- looks like we are on the same path!

Kristy

texasmom

I live in a small town just south of Houston (a suburb basically). Yes, we will need to keep in touch. I hang out alot on the June chemo board.

sekar_n

Mammogram was done for my wife at Chennai, India and there was calcification besides some symptoms of breast cancer.  We got biopsy done and the results were negative.  We had paid to Apollo Specialty for ER. PR & Her 2 Neu also but the hospital informed that this test is not necessary since the biopsy result is negative

kathleen1966

Though this seems like an old thread, I had the TCH chemo combo with four positive nodes.  I was never given a choice.  Due to the heart aspects of the A chemo and the possible heart effects of herceptin, they are leaning on the TCH now.  I hope it works!

CarylC

Kathleen,

I will also be doing TCH, with 3 positive nodes.  Then radiation as well, and I've already had a bi-mx.  This chemo was the only type the oncologist even discussed.  I'm hoping they've got it right!!!!! 

KitCat1

Hi Everyone,

I am node positive, ER-, Pr-. Her2 pos.... I did TCH last year. I was given no other options. My Oncologist beleives this is the way to go. I know of one gal that met Dr. Slamon... ( the inventor of Hercepton) and TCH is the top and only chemo he gives to his patients. That should make your decsion to have TCH ..... make you feel confident. Good luck to you and all of my sistas! If you have not seen the movie Living Proof you should. It is about the making of Hercepton and Harry Conick Jr. stars in it. We have so much to be thankful for Hercepton and Dr. Slamon who pushed for it! All the best and for waht it's worth TCH was not so bad and i got through it ok..... afew days after each infusion was the rough time. i am on Hecepton nly now and will finish in May. All the best! Sending huge hugs to all! xoxo