4 rounds of chemo or 8

emmaB

Hi,

I'm a 43 year old mom who was diagnosed with bc in August.  Had a bilateral mastectomy.  Tests came back that it was stage 2 node negative, er positive.  Doc wants me to do chemo.  Had oncotype done and results were 19.  She wants to still do 8 rounds because of my age.  I was hoping for only 4 treatments because I was wondering is the chemo beneficial.  I will go on tamoxifen for 5 years as well.  Any advice?  I start next week and not sure what to do. 

ScienceGirl

Dear Emma, 

I was 44 when diagnosed last year.  My advice to you would be to get a second opinion!  I got 3 opinions, 2 said do TCx4 and one said do AC+T dose dense (=8).  I find that oncologists tend to have their favorite regimes.  There is not one agreed upon 'right' chemo.  I was very frustrated at this.  My oncotype was 25, my ONC took my case to the tumor board and they were about 80% do chemo and 20% no chemo.  So it seemed like the real decision was chemo or no, not what type or course.  Try to get another opinion before you start chemo, then it might be too late to change your course.  Good Luck to you!  what is your tumor grade and HER2 status? 

emmaB

is the tumor grade the modified bloom-richard grade.  If so I am a 2 and my her2 is 1+.  To be honest i have know idea what that means.  Can you explain this to me?

ScienceGirl

Hi Emma,

 Tumor grade is a measure of how fast the cancer cells are growing:

A pathologist looks at the tumor cells and checks for three microscopic features:

• degree of tumor tubule formation (percentage of cancer composed of tubular structures)
• tumor mitotic activity (rate of cell division)
• nuclear grade (cell size and uniformity)

Each feature is scored on a scale of 1 - 3.

Cell Feature Scoring

Feature Score 1: Slow cell growth rate
Feature Score 2: Intermediate cell growth rate

Feature Score 3: Fast cell growth rate

HER2 of 0-1 are considered 'negative' and 2-3 are 'positive'.  HER2+ tend to be more aggressive (although there are good drugs against this type of tumor) 

Chemotherapy is most effective against fast growing cells.  Does this make sense to you? 

AnnetteS

Everyone is different.  I had 6 rounds of TC. My ONC told me that only 50% of the women who get chemo actually need it.  The problem is, so he says, is that we do not know which 50% need it and which do not.

I am a bit older than you (47 at diagnosis) and for me, I wanted to know that I did EVERYTHING I could to be and stay cancer free.  I will never know if I needed it or not......

Best of luck to you.

Racy

I agree with ScienceGirl that you should get more than one opinion on chemo. I had two opinions, one being 8 treatments, I think it was AC x 4 and T x 4, and the second TAC x 6. I was told it was the same drugs, just administered differently. I chose the second option as it was only 6 treatments, and am glad I did.



From what I have read, there are dose dense options that can condense treatment duration too but, as with my option, the side effects might be accentuated. Your onc/s should be able to advise you on this.



I was also hoping for a lesser number of cycles but I think the size of my tumour - 2.2 cm - indicated more were needed. There are a lot of ladies here who had 4 treatments but I think they had smaller tumours.



What size was your tumour?

momand2kids

I had 4 treatments of A/C over 8 weeks followed by radiation and hormonal therapy.... it was the standard recommndation by my onc and surgeon--- two different hospitals.... strong stuff, but I am thinking it worked!!!

Racy

Ditto what AnnetteS said. I had isolated tumour cells in 2 nodes but no oncotype test.



If you are HER2, I think chemo is mandatory with the HER2 med Herceptin.



If you don't understand your path report, there is info on this site (check menu options at top of screen) to help you interpret it. You can also ask your onc to explain it.

Racy

It would be a good idea for you to post your question in the HER2 forum, where others with that pathology can advise you.

sweetbean

My initial diagnosis for HER2 was 1+, but when they ran the FISH test it came back at 2+, so I am considered positive, although not highly so.  Make sure you get the FISH test.

mdg

I was 45 at diagnosis and Stage 1, clear nodes, grade 2 with an oncotype of 17.  One med onc said no to chemo but if I felt I needed it for insurance they would do TC x 4.  The other med onc at another hospital said I would benefit from chemo and also suggested TC x 4.  I had to decide.  I chose chemo.....my son was only 4 and I wanted to do everything I could.  I also chose to do cold caps to keep my hair through chemo.  I had a BMX and am on tamoxifen for 5 years. 

Sheypres

I am 40 and was found out July 2011.  The first MO talked about 4x TC before we got the oncotype results back.  When I asked questions about the Ki-67 and medullary features he kind of brushed them off then when I got my score back he was not really concerned. It was a 48!   My 2nd opinion doctor was somebody that was recommended to me by 3 people and he mentioned everything I had questioned the first one about and said we he did not think the first MO was aggressive enough.  It was everything I was thinking and was more in line with all my research. He wanted to do  4x AC and 4x T.  Then the rads(I had a lumpectomy) and then oomp.  I have a 2 1/2 year old and a 9month old and never want to look back and ask what if?  So I went for the more aggressive route. Tomorrow is chemo #3 and it really sucks but it can be done and I will do whatever I can to be around for my girls.  

luckyjnjmom

I am starting 4 rounds of TC next week - then one year of herceptin -

Can you tell me how the TC was? Also - no one told me of the cold cap option - though I have heard of it - how did that work out? Also, did you keep your eyebrows?

I've got so much on my mind I can't see straight - and if they told me that sacrificing a goat would help my prognosis - I would. I've got a 5 year old daughter and a 7 year old son who need me to stick around as long as possible. But if there's a way to get through this without going bald - which is going to freak my kids out a little - I woudl like to understand that option better. Please advise.

thanks,

Lucky

KatheW

There was a Texas study published this year concerning the number of rounds of chemo for BC. THe conclusion was that for early stage breast cancer with 1 to 3 positive nodes: 4 rounds is as good as 6. I was very happy when I read the study abstract as I had just finished my 4th round, and was able to skip my last two rounds.

Different types of chemo were studied, but results did not vary depending on tumor grade or status:

"subset analyses showed no differential impact for chemotherapy duration based on tumor estrogen receptor or Her2 status." This excerpt from Internal Medicine News 1/06/11. I wish I could copy the link here!

Whatashocker3

Can anyone who has used the cold cap comment on it's efficiency?

Ang7

Hi,

I used Penguin Cold Caps for 6 rounds of TCH.  They worked very well for me.  I lost a bit of hair by my ears but that is all.  My oncologist researched them thoroughly before allowing me to use them.  She believes they will be offered with all chemo in the future...