Differences between ACT and CT?

gildedcage

I'm looking for some imput and I thank you in advance. I was diagnosed w/ IDC in May 2013. I'm ER+/PR+ and HER2-, grade 3, stage 1a. My onc has suggested ACx4 and Taxol x12. I've noticed that ACT is a less common treatment these days and I've read online that UCLA, amongst other hospitals, have eliminated it completely from their treatment options. CT seems to be the standard treatment. Before I jump in and start w/ ACT, I want to be sure that it is necessary for the level of risk I have. Can anyone illuminate me further on why ACT might be the best choice? I've talked to two doctors about it and got unsatisfactory answers that left me with more questions, frankly. Thank you!

puppymama09

Hi Gildedcage, your stats are the same as mine.  I am getting just CT for 4 to 6 treatments.  My Onco told me that was the standard of care for my cancer.  It seems like a lot of people still get ACT, personally I really did not want to have the adriamycan (sp?) because of the luekemia and possible haeart side effects.  It seems to me that ACT is a much stronger treatment.  Do you have a high oncotype score?  Are you real young?  These things may determine a stronger regiment.  Definitely keep asking questions until you feel comfortable with the answers.  Let me know what happens, btw  I start treatment tomorrow.

MsPharoah

I'm surprised that 2 doctors can't explain why this treatment is best for your cancer and leaves you so unsatisfied. The treatment that is recommended for you is not obsolete...there are lots of bc patients who receive this treatment and it is a good treatment. It is an agressive chemo! The following is my opinion only. You don't say what your age is or if you had the oncotype dx test done. I assume you are node negative since you are 1a. Many oncologists will take your age into consideration, your overall health and the grade of the tumor into consideration. If you are young, that may be the reason they are throwing the book at your cancer. Get the oncotype test done...then make your decision with a doctor who can explain the reason they have selected your chemo.

Best of luck in making your decision.

puppymama09

MsPharoah,  lol we must have commented at the sametime, glad to see we are in agreement!

gildedcage

Thank you for your answers. I am 38, node negative and my Octotype score was 34. I am assuming that Adriamyacin is being suggested because I am young and in good health and can handle a lot of treatment. The issue I am having is that when I asked for a second opinion today from another oncologist, he was very wishy-washy and was only willing to say that ACT was a "good standard treatment..but all the standard treatments are good". I felt like he didn't want to deviate from what the original oncologist said. My first oncologist mentioned that she wanted to use ACT because she felt I could tolerate it and it was the standard of care for my situation. However, she also mentioned that she tends to "overtreat" just to be safe and when I brought up what I had read online about Adriamyacin not being used at all hospitals she said that there was not enough evidence either way regarding Adriamyacin so it was just best to go with what has always worked until other evidence changes that. I'm with Kaiser and while I am getting good care, I feel that they are not on the "cutting edge", so to speak. If anything, they are slow to change course and less likely to try things that a research based hospital like a university hospital would do. Perhaps I'm wrong, but this is my impression. It's a hard situation because clearly, I'm not a doctor and didn't spend years in medical school like my oncologist did but I also have to live with the long term effects of the chemo. I just want to really be sure that I'm making the right choice. It sounds like, based on what you two have said, that it is a good one. Thank you for the input. 

gildedcage

Oh, and Puppymama - Good Luck tomorrow!

Mellie289

My first oncologist told me AC+T and my second oncologist told me TC because they are equally effective, but TC doesn't have the heart toxicity issues (adriamycin is the culprit there). I chose to go with her and the TC treatment instead of DD AC+T because of that.

jbsmom

Hi Gildedcage, 

I had to face the same decision you did when it came to chemo regimen.  My onco was more in favor of the AC + T because I was 46 and premenopausal.  I did my research on the two and asked a good friend (we are medicinal chemists and somewhat practiced at reading the drug inserts and evaluating the original literature in cancer journals etc). Anyway, the cardiotox from adriamycin is real and non reversible. I believe that your tumor was a grade 3 where as mine was a grade 2 but I was stage IIa since mine had reached 1 of 2 nodes. The suggestion above to get the oncotype score before making a decision is a good one. When I did my evaluation of the two treatment paths, I came away thinking that had I been HER2+, or had my tumor been grade 3 (and in my nodes) I would have chosen AC + T. For my case, I could not find convincing data in the literature that the outcome would be different if I did CT or AC + T.  Keep in mind that the two T's are different.  In AC +T my onco was using Taxol and the CT they use Taxotere.  The molecules are very similar, but I believe the findings are that the Taxotere is better tolerated and equally as effective.

The cardiotox was my main concern, and I believe that my onco said that there is a lifetime exposure limit for the adriamycin.  Be sure to ask is this means that God forbid, you should get a second cancer that is more aggressive that you would not be able to use the adriamycin if you already had.

One other thing that I did was to use the ask an expert board at Johns Hopkins.  A nurse responded promptly. They still do the AC + T and she recommended one additional tumor marker (I can't remember what) that they don't seem to do around here. The link is bleow, and remember, the more details regarding your numbers and family history you give in your question to them the better.

http://www.hopkinsbreastcenter.org/services/ask_expert/

Good luck with the decision!

gildedcage

Went for a third opinion today with a major university and was told they would recommend TC instead of ACT. Now I'm even more confused. I've decided to schedule an additional consult with a major hospital that only treats cancer. Whichever of the two treatments that doctor supports will help me to make a final decision. I guess there is no "wrong answer" here and I just want to be done with it.  The oncologist I saw today suggested I frame it this way: Would I be more upset if the cancer came back and I didn't do everything I could to hit it hard when I had the chance or would I be more upset if I had to live with lifelong cardio issues? Talk about a Sophie's choice moment. Anyone else facing this dilemma?

JellyK

Gildedcage you're not alone.  Unfortunately I have nothing to add medically speaking - the other ladies on this thread have a wealth of information I'm going to take with me to my next onco appt actually - but I can chime in with how I make crazy hard impossible decisions like this.  I believe very strongly that we know in our hearts the answer, and just have to find a way to quiet our minds and listen.  Sometimes that's first thing in the morning before I'm completely awake, or if I get the chance to sit outside and just close my eyes.  Other times I literally flip a coin - sounds crazy I know - but if I flip a coin and once I have the answer I'm like, "Ok, 2 out of 3", then that tells me a bit where my heart is too.  One other kinda weird way is to imagine yourself telling the story years later - usually one version "feels" right to tell in the story.

A question you might ask is, how did you feel when this last facility said they'd use TC instead of ACT?  Was it relief?  Fear?

Either way we're going to have a monster behind us - it will be fear of not having done enough and having a recurrence, or fear of heart failure.  Or both.  I'm 38 too, and I don't want to spend the next 50 years constantly looking over my shoulder.  I wish you the best in your decision - hopefully something will give you an Ah-ha moment and the confidence you're seeking.

gildedcage

Thanks, JellyK. I have to admit to being totally on the fence about the treatments until I finally got my last opinon the other day. I got a "gut feeling" that this guy was the one to listen to and he suggested TCx6, which seems to be a nice compromise between TCx4 and the ACT option. This has been a hard decision but I finally feel at peace with it. 

SpecialK

Just wanted to add that there is absolutely no predicting how one will physically respond to chemo - I am not referencing the effectiveness - just the side effects.  Physical condition and age are not good predictors of how you will tolerate either drug regimen.  I have seen very fit people have cardiac damage and people over 70 sail through with virtually no side effects other than hair loss.  I certainly hope that you will have no problems, but don't asume age and fitness have any bearing on side effect tolerance.  The decision regarding use of ACT or TC can also be regional - there can be a west coast bias toward TC, east coast favors ACT, or it can be based on the age of your oncologist and their personal preference based on patient outcomes with both regimens in their practice.  My oncologist uses both regimens but does not use ACT for Her2+ patients because because both Adriamycin and Herceptin are cardiotoxic.