AC versus TC - how to decide?

newmex1598

hi all, my girlfriend has seen three oncologists in two days - two of them recommended 4 cycles of TC. one doctor recommended 4 cycles of AC or 6 cycles of TC. these were based on her oncotype score of 26. how do we go about making a decision? is the AC worth the small percentage benefit at RS 26? we are so confused!!

thanks,

josé

mybeautifulsister

 My sisters oncotype score was 21 and her onc said tc but she was very allergic and couldn`t finish  with that so she now  has 1 treatment out of 4 left of AC. As I understand AC is really aggresive treatment, usually given through a chest port. a score of 26  is pretty high risk so Iwould think a more aggressive approach, but what ever your girfriend is comfortable with. My sister has a LOT of side effects from AC but I am sure there are lots from tc. Maybe the type of cancer your friend has should also be taken into consideration. The onc we went to said every percentage you eliminate for possible reoccurance is worth it! Hope this helps good luck and keep us posted

Deb

revkat

There is recent research that showed TC to be slightly more effective than AC. Dr.Slamon at UCLA has analyzed a huge batch of long term data and he strongly suggests that A not be used for Her2-- cancers. I would not say that AC is more aggressive than TC, it is just different. That said AC has been the standard for a long time. There are plenty of side effects from either one, but they are managable.

wishiwere

Revkat? Do you know why dr. Slamon says not to use A/C for neg Her2 cancers?  Interested in that.  IF you don't mind me asking?

revkat

It has to do with the overexpression of a gene that only seems to be present in Her2 positive cancers. The study was presented at the San Antonio Breast Cancer Symposium last year. I couldn't find a direct link to the study, but it is the first presentation reported at this summary of the symposium. I, personally, was persuaded not to do AC based on this, but as others have mentioned here, it was a retrospective meta-analysis so many oncologists would not recommend changing treatment based soley on this type of a study.

 http://www.nosurrenderbreastcancerhelp.com/2007_SABCS_NEWS.html

mybeautifulsister

Very interesting Revkat, thank you, certainly the more knowledge we all have the more power  we gain. I am going to mention this to my sisters onc.

thanks for the info

Deb

Anonymous

Most of the oncs who don't like Adriamycin question its ability to kill the tumor cells and don't believe its efficacy outweights the cardio risks. Not saying this is Slaymon's position, but it's not uncommon.

Does Dense AC was very effective for me. 

revkat

Like I said, I made the decision from reading studies.

But then I came on here and found Her2 neg. women who were given AC as neoadjuvant treatment and their tumors shrank to nothing! So what does that mean? It sure seems like that is a sign of effectiveness! On the other hand, what does it mean for chemo to be effective in early stange breast cancer? Is 10 year disease free survival the only legitimate measure, or does what we see happening in our breasts count too? We are trying to kill cells that may be lurking around our bodies but there's no way of knowing if they are there or if we go them all. The whole chemo decision thing made me nuts.

Bottom line though, I think either AC or TC will do the job for early stage. (Since I secretly believe that for ER+ Her2neg the real benefit of chemo is that it shuts down your ovaries not that it kills loose cells. Which could be done in less nasty ways, like they often do in Europe -- surgery, radiation, lupron shots. This is only my personal belief based on my non-scientific reading of some studies, so I may be missing something, and probably am missing some really important scientific information.)

otter

Here's an example of the information revkat was talking about:  http://www.curetoday.com/sabcs2007/thurs/feature.php

That site discusses reports at the San Antonio Breast Cancer Symposium from Dennis Slamon's group at UCLA and also from Stephen Jones at Baylor.  Both oncologists believe anthracyclines (e.g., Adriamycin) are over-used.  Even more important, they have reported clinical trial results that show Adriamycin is probably not necessary, and possibly not even effective, in HER2-negative BC.  Here's some of what is in the article I cited above--

"As far back as 2003, data began to hint that an alternative non-anthracycline regimen, using Taxotere (docetaxel) and Cytoxan (cyclophosphamide), might offer as good or better disease-free survival for early-stage breast cancer. That year at SABCS, Dr. Jones and colleagues reported that, among more than 1,000 women, those who took a Taxotere/Cytoxan combination had a lower rate of relapse than those on the standard treatment. ...

The favorable trend toward a non-anthracycline alternative has continued in 2007. This year, Dr. Jones, based at the Baylor University Medical Center in Dallas, and colleagues reported that seven years after treatment, women who received the non-anthracyline treatment have a better survival rate in general, as well as survival without cancer recurrence, something that has not been found in previous studies. At the end of this analysis, 87 percent of women who took the non-anthracycline regimen were alive, compared with 82 percent of those receiving the standard treatment. ...

Meanwhile, further studies described during the [2007 SABCS] meeting are trying to determine which women should remain with anthracyclines, and which could use an alternative. Anthracyclines target a particular enzyme, called topoisomerase, or TOPO II. Therefore, if a tumor isn't drawing on this enzyme for growth, there would be little need for an anthracycline drug.

This may be the case for the vast majority of breast cancers, says Dennis Slamon, MD, PhD, of UCLA's Jonsson Comprehensive Cancer Center. During the meeting, he described studies that tried to tease out the influence of HER2 status in cancer treatment. They found that in some women the HER2 overexpression works in tandem with TOPO II leaving the tumor extremely vulnerable to the anthracycline drug. However, they did not find any instance of a HER2-negative tumor that also relied on TOPO II. If this analysis holds, Dr. Slamon argues, it would mean that more than 90 percent of breast cancers have no target for anthracycline drugs. He also believes the studies that have found a benefit for anthracyclines have not accounted for whether the benefit is confined to those tumors that are HER2 positive, enlisting TOPO II as an accomplice. ..."

+++++++

I've read some of the original papers to which the "Cure Today" article refers.  I didn't find them until after my onco had approved TC and I had started chemo.  They make me glad I chose that option.

otter 

oldladyblue

I was given a choice of AC or TC by my oncologist/hematologist. She felt AC would be better, but just because it was "the standard of care" for a longer time. I ended up going with TC after having a second opinion from the lead doctor who found an article on UpToDate that said TC was better for post menopausal women.

Sun-Shine

I am 59 yr, post menopause. My oncotype score is 28. I just completed TC x 4. My doctor did not even give me the AC option when I started the chemo.

jhl

oldladyblue and sun-shine,

This thread is 14 years old. The references and guidance is probably a bit out of date. I would encourage you to start a new thread on this topic to get more up to date information.

oldladyblue

Hi sun_shine. I was glad I chose the TC. I am 65, with Onco score of 28 too. How are you doing on the hormone pills? I hate the SEs.