Stage IIIa: Chemo regime question - AC+T? Or are there options?

e-kat

I haven't started treatment yet - but it's pending. I have to decide soon what to do. My Onc says I should get the "gold standard" chemo and get 4 doses of AC over 2 months, then 12 weekly doses of Taxol for 3 months. I am concerned about the Adriamycine and heart risks/side effects and so is my mom who is a doc. The Onc says that I should get this since I have so much node involvement (6 of 30 nodes) on right side. However the tumor was a grade 1 tumor and smallish. Why isn't TC an option for me? I don't get it. On other threads I've read some patients getting TC as option. Also I've seen postings about "Judging from what I'm reading, that can make a great difference in the efficacy of anathracycline-based treatments like AC-T, which seem to be most effective against HER2 positive cancer." I have HER2 Negative Grade 1 cancer. with 6 nodes where the the cancer is visiable on the surface of a couple of them, which puts me at stage 3, per the Onc. So she said since I'm stage 3 "there are less options". She said if I was a stage 2 with less node involvement, I would have more options of types of chemo. Is this right? That's the only course I have open to me: AC + T?

MaxineO

e-kat - your diagnosis is very similar to mine. I had the AC+T, but both were given dose-dense (every two weeks for both sets of treatments).  I don't know why this was the only one offered to me, but over time, I have been trying to work it out in my mind.  You don't say how old you are. I was 38 at diagnosis and premenopausal, so I suspect that had something to do with the treatment choice, perhaps more aggressive? I also wondered if the low grade, slow growth (i.e., grade 1) had something to do with it. Frankly, if it's in your nodes, I think they treat it very aggressively.

I was concerned about the heart issues, too. But they did an echocardiogram, and I have been following up with a cardiologist, especially now that I am in chemically-induced menopause. 

I hope someone else who understands all of these chemo differences comes along. There are a lot of wise women around here.  Hoping the best for your treatments!

TectonicShift

I was originally told I was grade 1. But I had a lot of nodes too. Those two things don't usually go together. So a very good oncologist (the third one I consulted) took a closer look at my path slides. He figured out that the main tumor in the breast was MOSTLY grade 1, but there were some areas of grade 2 cancer mixed in. And then he took a new, clean slide of one of the lymph node tumors and did a new path report on it from scratch. Turns out it was the grade 2 material that made its way to the lymph nodes and kind of exploded in terms of growth.

I think more oncs and pathologists should focus on the pathology of the underarm tumors, since it is the part of the cancer that has spread that can kill us. Believe it or not, it is possible for the breast tumor to be ER and PR positive but the node tumor(s) to be ER and PR negative. Or the breast tumor to be HER2 negative but the node tumor(s) to be HER2 positive. It only takes a few cells to move to the underarm and start to grow and it is the pathology of those few cells that is the key.

I was worried that the AC+T wasn't going to help my grade 1 cancer. Now I am so happy I did it. I'm hoping it killed the grade 2 cancer that traveled to my underarm. I strongly urge you to do every treatment your onc offers. Ask for a new path report on just one of the lymph node tumors. And/or get a second opinion if it would make you feel better. But to be honest, most oncs within one geographic area seem to offer the same standard of care.

By the way, grade 1 tumors definitely do recur as distant mets sometimes, only they tend to recur later than higher grade tumors do. Even after ten years there is risk of recurrence. Makes sense.

lanagraves

I was 38 at dx as well and was treated with dose dense AC and Taxol. My MO said it was the most aggressive treatment available and he thought it was very important to treat my cancer as aggressively as possible. I was very worried about the side effects, and I was very sick, but no major SEs. I know they can happen, but most of the time, people come through it fine, and I was more worried about killing the cancer. It's a personal decision, of course, and I'm sure you will make the right choice for you.

kathleen1966

AC is the most aggressive chemo to get. If I had been part of a clinical trial, it is the one I would have gotten.  But they gave me taxotere due to the heart issues that AC can cause combined with the heart issues Herceptin can cause and this is the chemo that is mostly used for Her2+ cancer now. But, it is slightly less effective ( I looked at the numbers and the difference is small).  I think you do have choices.  If you are very concerned about the heart issues that AC can cause (but not always cause), you could ask for another chemo. IS the T Taxotere for you?  I would say that is a very effective chemo combination.  I received TCH, Taxotere, carboplatin and Herceptin. 

jennyboog

I don't know if there is other tx and I don't know if I'm much help, I can only tell you that that tx worked for me.  I felt my tumor shrink and my inflammatory breast cancer fade away.  At surgery I had only residuel cancer left in my 5 of 16 lymph nodes.  I was told it is the gold standard, it is not an easy tx but is managable with meds.  I was scared of the long term SE as well but in my opinion and what I told myself is...I have to get to that point.  I have to live to even see if it will effect me and I will deal with it when & if the time comes, if BC takes me first who cares if my heart is damaged.  My heart got zapped during rads too due to +intermammary LN that they had to get.  I am damaged, I do have aches and pains and I'm not the same as I was before BC but I'm here.  I saw my baby turn 4 this past weekend and my oldest go to 1st grade last week.  I would do it all again just to be here and see that, I have no regrets.  Best wishes and I hope tx goes well. 

jenni__ca

e-kat ... there are so many variables (size, type, grade, location, nodes and whatnot) that if you are concerned about this onc's recommended regime you might want to consider a second opinion ...

i had dose dense but i had adriamycin for 4 rounds, then taxol for 4 rounds, then cytoxin for 4 rounds ....

best of luck !

p.s. my onc nurse recommended keeping a file with all your stage info, blood test results, tx dosage, etc in it so that if you have to go to another doctor, new hospital, ER, that you can just grab it and not rely on memory .... when i traveled i took that file with me too ...

e-kat

Thanks everyone for posting your treatments. I am pre-menopausal in my 40s, so I think that's why the doc wants to be aggresive with the AC for 4 times over 2 months followed by the Taxol for 12 doses or 3 months. I think that the feedback about getting the nodes re-examined in path for what kind of cancer they had was good advice. My mom is actually a pathologist and also wants to rexamine the slides - maybe she can tell me more about the node sections as well and the cancer there in the macrometastatis that they saw. I am seeing that the AC would probably be managable if my Muga/heart scan comes back clear. I think the SEs sound manageable however the long term SEs are not clear-could be dangerous. However, I agree following up with cardiologist after AC is completed is also a good idea to continue monitoring in following months/yr. I think i am generally very nervous about chemo starting in a week, port going in on Monday... so it's nice to hear you have all survived it and are moving on. I appreciate your time and responses so much.