TCH or ACT chemo for Her2+

aris

I am still trying to sort out all of this information about what it means to be HER2+.   I have read people who have TCH protocol and then others who have ACT with Herceptin. Where can I get reliable information on what the current recommended protocol is?

 I just got my path report with clear margins, no node activity and a 1cm tumor. I wll be on chemo because of my HER2 status, however. At least that is my understanding. 

 Pam

orange1

The presentation detaining the results of the study that compared the regimins can be found by googling BCIRG 006 (thats the study number)  Click "Second analysis presented at SABCS 2006" This will take you to the presentation slides.  Also you can go to the Herceptin website (just google herceptin), click on the links that say you are a health care provider.  From there so can see results from the studies. 

To summarize:  Both are effective.  At first it looked like AC to TH was more effective, but with the updated data, it looks like they are equivalent. 

TCH: less nausea, less chance of leukemia, less chance of heart damage.

AC-TH, some think might be very slightly more effective, there is not enough data to say..

If you have heart issues, or are looking for a less harsh chemo regimen, consider TCH.

I did TCH, it wasn't nearly as bad as I had feared chemo would be.

Good luck with your decision and treatment.

Estepp

I did the ACT... My 3cm tumor was almost gone at the end of 4 dd AC....

I am not sure... they are doing a lot more TCH. I think... if you are node involved and a larger tumor.. they give you ACTH... is smaller tumor... and no nodes... TCH..

This is what I have seen.

Good luck and if needed, get a second opinion.

my2boys

I just finished TCH.  Now I'm on Herceptin only.  I think it is a regional thing.  On the west coast, TCH is more widely used.  On the east coast, they are just starting to come around to using TCH.  That is what I was told by an oncologist here on the east coast.

I requested the TCH because I was fearful of heart damage.  I knew that no matter what I was going to have to do the Herceptin and that drug is hard on the heart, so I didn't want to couple it with AC.  I was also hopeful that the TCH would have better SE than the AC T.  I did have node involvement and the oncologists I consulted told me that it was a personal choice......neither regimen was considered better.

The AC has been around longer and the TCH is newer.  Both regimens are good.

Good luck.....I think the key is having confidence in your doctor and going with his/her recommendation. 

JeninMichigan

I was on TCH.   Since I am stage IV, my oncologist said I will likely be on Herceptin for life and TCH is easier on the heart.    She also said if your cancer is on your right side, it is less risky for cardiac issues.     I did OK on the TCH.  Taxotere isn't easy for sure but their was not much nausea but I had a problem with  diarrhea and fatigue.   Carboplatin makes your mouth taste like metal for a good week afterward.    Even water tastes like pennies.  I am in the midwest.  My doctor studies in Calfornia so I think it might be true and East / West thing.  My first oncolcogist wanted to do AC/TH.  

Jennifer

Navalex

I chose TCH after getting a second opinion about my BC, talking with a volunteer from the ACS, and educating myself about the chemo drugs. My oncologist originally suggested Adriamycin and Cytoxin.  When I researched these two drugs and discovered statements that they have been implicated in secondary cancers and caused permanent heart damage, I decided on the Taxol, Carboplatin and Herceptin because there was less damage to the heart and I was more likely to regain my heart function. I had dd treatments every 3 weeks and had my last Herceptin dose in May of 2008. I have since regained most of my energy and my heart function has returned to what it was pre-cancer treatment. The doctors where I sought my second opinion stated that TCH was just as effective as A/C and does less damage.

talbrig13

I did TCH because of the heart issues too.  My dad died of heart disease at age 42..so I wanted to be cautious.  I did okay, it wasn't easy, but I did manage to work and take care of my family while they took care of me!  Does that make sense?

Good Luck to you.

Brenda_R

I did A/C then Herceptin alone.  Now I wonder why my Onc didn't offer a taxane with Herceptin. But I was very sick with the A/C chemo. Maybe he was giving me a break?

lexislove

AC x4 & Tx4......

My tumor was not palpable after 3 treatments, and I started out with a 8cm tumor!

Her2+ BC responds very well to AC, so I've read

bluedasher

I did TCH. My tumor was just under 1 cm.

In addition to what others have mentioned about heart effects, in the BCIRG 006 study about 2.5% of the patients in the AC-TH arm had bad enough heart damage from the Adriamycin that they weren't able to receive Herceptin after the AC part of the treatment.

Towards the end of the slide presentation on BCIRG 006 (orange gave instructions for finding it), there is a slide (page 29) with a graph of LVEF (left ventricle ejection fraction, a measure of how well the heart is functioning) for the three arms from the start of treatment to 3 years later. In the TCH arm, the score at the end is almost back up to where it started showing that the heart recovers from the effect of Herceptin.  People on the AC-TH arm have LVEF go lower (worse) than the bottome in TCH and it doesn't recover much. 

In my opinion, the possible slight benefit in recurrence stats for AC-TH isn't worth the heart risks. For node negative folks in the study, disease free survival (DFS) after 4 years was 94% for AC-TH and 93% for TCH (page 16) and overall survival was 98% vs 97% - differences which their analysis says wasn't statistically significant (i.e. they may be just due to random variation).

The overall side effects also looked lower in the TCH arm (pages 21-23).

kimbly

I had TCH as well. My dr at the time had just returned from the symposium in San Diego (dec 2007) and said it was exactly the right thing for me.  She did explain the ACT + H to me as well.  I had two tumors just over 1 cm and no nodes.  TCH was very doable and have to agree about the metal taste thing, and I was very sensitive to certian smells.  I had muga scans to monitor and never had any issues.  I am in the midwest too Jen and from your name it seems you are in michigan which is where I am as well. 

overall from all I have talked to TCH has less severe side effects all around.  

robyn33

Hi there...  I had multifocal tumors--1 cm and 2.1 cm-- with 5/15 positive nodes.  I was given the option of TCH by my oncologist with the understanding that the difference between the two in effectiveness is negligible.  However, the risk for heart damage is greatly diminished with TCH.  It wasn't pleasant, but I got through it.  You will, too...  I wish you well with your decision making process.  I know it can be agonizing.

Tracy01

One of my closest friends was just diagnosed as a Stage II, Her2+ and starts chemo today.  I had 4/4 dd of ACT and her chemo treatment is TCH.  I had not heard of the TC combo until this thread, so thank you for posting it.  It makes me realize how much further we've come in treatments in just a year and a half.  I'm also happy to hear that TCH can be less harsh with the SE than ACT.  She watched me suffer through ACT and was really dreading the chemo SE.

pameliza

I had a small 1 cm, Stage 1, high grade tumor in 2007.  I had a mastectomy and then 12 weeks of Taxol with Herceptin.  Then I continued the Herceptin every three weeks for an additional 9 months.  I think the Taxol/Herceptin combo is a fairly new protocol. I don't find many other gals who have had this treatment though and I'm not sure why.  Anybody have any thoughts on that? 

bluedasher

Pameliza, I don't think there have been any studies on using Taxol with Herceptin. That is probably why not many others are using it. Herceptin, in my understanding, is only on label when used with some chemo. So for some very small tumors, some oncs use just Taxol to be giving some type of chemo with Herceptin. Other oncs use Taxotere, Carboplatin and Herceptin even in that kind of case to stay with a chemo that has been proven in a trial.

Tracy01, there is a thread on the chemo forum titled taxotere, carboplatin and herceptin. It has people in various stages of that chemo. The ones just through stay on to help those taking the chemo now. It was a big supportl to me during chemo and it might help your friend.

pameliza

Thank you bluedasher for the info.  That makes sense. But it is kind of scary to think that that Taxol/Herceptin combo hasn't been studied much yet. I am getting my treatment at a research facility - I wonder if that explains that protocol?  hmmm?  I do feel that I have a very good oncologist so I'll rest on that.  Any thoughts?  

Pam

WLL

Hello new to the forum. I was taking TC chemo, but had a reaction to taxotere. They want to try me on ACT. Anyone taking this? would appreciate freeback on side effects. I had stage II A breast cancer.

WLL

hello, so you took ACT? I am very scared about starting. I was on TC until I had a reaction to taxotere ( bad rash). Any input on side effects would be appreicative.

Dolores81035

I had 4 treatments of Chemotherapy for Her-2 postive Breast Cancer.

 I started the Taxol/Heceptin combo today. How did this combo work for you Pameliza?
Dx 11/20/2008, , Stage IIb, / nodes, PR-, HER2+

Dolores81035

Lexistove. I had TA chemo x 4 for Her-2 postive breast cancer. My tumor was not palpable after 4 treatments.  Now I'm starting on the combo Taxol and Heceptin. Did You require a masectomy? 

ipursuit

Aris and Pameliza - Bluedasher, as always, has given a terrific summary of the trial that is driving the switch from AC=>TH to TCH as a protocol for early stage HER2+.  (Blue thank you so much for all the info over past months).  

A couple of additional thoughts for you.  Just scanning the "NEW Who's starting chemo in March?" thread you will see in the top posting the protocols that each "camper" is on.  By looking at which include H you'll see who is HER2+ and what chemo they are getting.  I think *most* are on TCH.   I see A LOT of TCs and not many ACs, which makes me wonder if even for non-HER2 BC the great minds are shifting from A to T(axotere or Taxol). 

Second thing - was reading yesterday (skimming so can't remember details sorry) articles in past issues of Cure magasine and recall an article on this issue. I don't think the following link is the most on point article, but look around on the site and you'll find it.  I don't think the article name was totally indicative of what you are seeking, so may take a bit of reading to find.  http://www.curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/41

Lastly, I did read something somewhere about Taxol/Herceptin as an alternate treatment - will keep my eye open for this.  Maybe someone on the HER2+ thread?  You might search on the combin on this site.

All the best with your treatment.  E

tulipbebe

Majority of my oncos recommended AC-TH and most of them told me it's a preference thing being that AC-TH has been proven in history to be more effective against the HER2+.

However, what one onco said struck me.  He said, in the world, there is only ONE, emphasis on ONE, clinical trial (BCIRG) proving that TCH is as effective as AC-TH.   My next question to myself was....do I want to do something that's already proven multiple times or embrace the new technology since it's cutting edge and has far less side effects like cancer and heart problems?

I'm still struggling with the answer.

giglgrl

I am so very confused by all of this. I just found out I am HER2 this week. I was originally going to do the TCH, but I am now going to do a trial before surgery and then AC with Herceptin after. After reading this, I am wondering if I am doing the right thing. It is so hard....I wish they just had one good thing that they told you to take. My BS said with the trial I will be getting the benefits of two drugs that have been proven to slow or completely stop HER2....I can't think of the names at the moment A something and L something. But I think because of the study I have to do the AC. Geez, I really hope I made the right choice.

tulipbebe

Just go with the choice that makes you feel most comfortable.  Don't rush and seek a second opinion. 

A lot of it has to do with your age as well.  If you're younger, the changes of recurrence is much higher.  Then it's better to go with something proven.  Also if you're younger, the side effects like cardiac problems etc is not so great because your heart is gonna be much healthier/younger than someone older.  Also it depends on your risk tolerance.  At the end of the day, you have to live with the choice and risks assoc with it.

CandraLM

I'm new here and found the forums last night when i searched TCH. I love this, lots of info.

I start my treatments Fri. I too am getting TCH. I am 42 and have fear of needles. I am so scared of all this. I want to make the right choices for my cure. I had surgery 2/26 and lived thru it. Now after finding i'm her2+ have to have a longer treatment. I read somewhere that chemo only makes the %s 1-3% higher. I don't think the side effects are worth it. I am having chemo w/herceptin for 270 min. fri, 60 min the next fri, then 60 min again the following fri. Is this a cycle? Will I be getting this every week for a year? I'm curious about just getting Herceptin then radiation. it's all so confusing. 

my2boys

CandraLM...It sounds like you will be getting your chemo with herceptin the first week and then herceptin only for the following two weeks.  There is a thread called Taxotere, Carboplatin and Herceptin in the"Chemotherapy, Before, During and After" Section of this website.  Please stop over and visit.  There are 125 pages of women who are going through the same regimen as yourself. 

I went through six cycles of TCH and it wasn't as bad as I thought it would be.  I think the worst part of it was just before the first cycle when I was scared of the whole thing.

Best wishes for an easy time of it.

Anne

CandraLM

   Anne, thank you for the reply and information on the before during and after i'm going to look for it now. It sure helps talking to others who are doing the same treatment. I'm calming down alittle, reading the forums help alot  Thanx    

bluedasher

Candra, usually the taxotere and carboplatin is given once every 3 weeks. The three weeks is a cycle. Some of us get the herceptin once every three weeks along with the taxotere and carboplatin and sometimes a smaller dose is given once every week. It sounds like your oncologist is doing the latter.  The chemo usually takes longer on the first time because they start the taxotere slowly in case you have a reaction to it. If there is a reaction they can give Benedryl.

Usually the taxotere and caboplatin is given for 6 cycles (though some early stage women get 4). After that, usually herceptin is given once every 3 weeks though sometimes they stay at once a week. Radiation is usually done after chemo (the taxotere and carboplatin) is finished. Usually, you keep getting herceptin during radiation though sometimes they stop the herceptin during radiation. 

I'm not sure where you read about the benefit of chemo. For early HER2- cancers, the benefit of chemo is sometimes just a few % in survival and recurrence figures, but for HER2+ or more advanced cancers it can help a lot. 

In December, a study by MD Anderson was released. They looked at women diagnosed between 1990 and 2002 with node-negative cancers less than 1 cm. For HER2+ cancer, the 5 year disease-free survival was 77% and distant recurrence free survival (mets) was about 85%. That is much worse than HER2- cancer (about 94% and 97% respectively). On the other hand, for node negative women in BCIRG 006 (the study that tested TCH vs AC-TH and ACT therapy), at 4 years the disease-free survival was 93% and those women had cancers greater than 2 cm. The TCH therapy made a big difference.

I don't know the numbers for stage III without chemo but recurrence risk has to be higher than for stage Ib. Chemo and herceptin will attack the cancer cells that might have gotten out of the breast.  Since at stage III the cancer is already in the nodes, there is more likelihood that that is necessary. For node-positive cancer in the BCIRG 006 study, 4-year disease free survival after TCH was 82%.

This is a very doable chemo. It wasn't comfortable (my2boys and I were getting it at the same time) but it has a lower rate of side effects than some of the other chemos. One of the reasons my onc and I chose it was to avoid the long term risks of Adriamycin-based chemo. 

The taxotere, carboplatin and herceptin thread that my2boys mentions was very helpful to me too. Please join us over there.

lexislove

Sorry Dolores..for not reponding sooner. Some how I kept missing this thread..lol

Yes I did do a mastectomy afterwards. My tumor was large so I just didn't want to risk any cells still lurking in the breast. But to be honest.....even if my tumor was a lot smaller, I would have still gone the mastectomy route.

This again..is what I feel is best for me.

MRSROCKYTOP55

Any of you ladies fly while on chemo.  I am wanting to go back to the states for two weeks after my third AC and also anyone wear contacts during chemo?  These may be silly questions but being out of the country limits the info I get.  Thanks for all the help.  Kathy

MRSROCKYTOP55

Any of you ladies fly while on chemo.  I am wanting to go back to the states for two weeks after my third AC and also anyone wear contacts during chemo?  These may be silly questions but being out of the country limits the info I get.  Thanks for all the help.  Kathy