Chemo choices: A+C vs T+C

Swami7774

My wife's oncologist just called with news we didn't want to hear--her oncotype test came back high (41), so she needs chemo. Two courses are available: Acriamycin + Cytoxan, or Taxotere + Cytoxin. A+C is the recommended choice by the Farber people, but T+C seems to have fewer long-term risks.

Does anyone here have experience with either? Both courses would include Neulastra; T+C would also require Dexamethasone(not sure of any of these spellings, btw). Donna is freaking out about long-term effects either one could have.

Another thing: the oncologist said there is a 26% chance of recurrence without chemo, and a 16% chance of recurrence WITH chemo. I'd have thought chemo would lower the chances more than that.

BarredOwl

Hi Swami:

I am sorry to hear that. There is a lot of experience here on getting through chemotherapy and endocrine therapy.

"TC" is docetaxel and cyclophosphamide.

"AC" is included in a variety of different regimens (see some examples below). Are you sure the recommendation was for "AC" alone?

• Dose-dense AC (doxorubicin/cyclophosphamide) followed by paclitaxel every 2 weeks

• Dose-dense AC (doxorubicin/cyclophosphamide) followed by weekly paclitaxel

Others:

• Dose-dense AC (doxorubicin/cyclophosphamide)

• AC (doxorubicin/cyclophosphamide) every 3 weeks (category 2B)

• AC followed by docetaxel every 3 weeks

• AC followed by weekly paclitaxel

Do you have an appointment scheduled with the MO to discuss the nature of the risk estimates from the Oncotype report in more detail, get a copy of it, and discuss the treatment options further? If not, please request an in-person appointment.

You need to be clear on the details of the regimens, and obtain a reasoned explanation of the basis for why the MO prefers one regimen over the other in your wife's particular case. A phone call is not adequate.

BarredOwl

Swami7774

BarredOwl, as I understand it both courses include Cytoxan. My "A+C" meant Acriamycin and Cytoxen(the course you listed third as Dose-dense AC (doxorubicin/cyclophosphamide)The phone call was pretty involved. The stated reason for the preferred course (Dose-dense AC) was that it's Dana Farber's preferred course--but the oncologist stressed that BOTH courses are equally effective. My wife is leaning toward the T+C course because of the stated side effects (less with T+C, apparently). We're meeting with the oncologist next Tuesday and then starting the first (of 4) chemo treatments Wednesday. My wife has already cut her beautiful hair very short to ease the transition to a wig.

Jennie93

When my MO floored me with the news that I would need chemo after all, she did not describe the different regimens or offer me any choice. In fact I had to ask for the names of the drugs, she was not offering that info. Anyway, she said that there are two kinds that are equally effective, and the only reason for choosing the one for me (TC) was because the other one is higher risk for heart damage, and I have a strong family history of heart disease. After researching it myself, I presume the "other one" she was referring to was adriamycin.

Jennie93

Oh and no one told me about the small, but very real, risk with taxotere that your hair may never grow back at all. If I had known that, I would've insisted on taxol instead. Thankfully it did grow back.

Jiffrig

seems strange that an MO would even give you a choice. Isn't that what they went to med school for? Puts a big burden on the patient to choose. You don't say what diagnosis she has but with that high of a number she must have nodes involved. The Dex is a steroid, I believe, to counteract reactions to chemo

Logang

My oncotype was 57 with no node involvement. My MO recommended AC+T. I did dose dense, so I had chemo every other week. Four rounds of Adriamycin and Cytoxan followed by 4 rounds of Taxol. I didn't have a choice on which agents.

Artista928

Strange an MO would offer a choice. She should have an echo done before starting chemo to make sure her heart is good as chemo like Adriamycin can affect the heart. Had I been given the choice I have no idea what I would have said so I'm glad my MO looked at my #s and said no choice but do chemo and rads and she had me do Adriamycin/Cytoxan and then Taxotere. I asked why Taxotere instead of Taxol and she said in her busy practice, Taxotere SEs are less dibilitating than Taxol. For me I had hardly any SEs on Taxotere and my hair did come back. As stated already, ask MO details. It's so individual as they look at your age and overall health as well and not just the tumour alone.

If your wife is ER+ then she'll likely be offered hormonal therapy which brings down the recurrence chances. Unfortunately there is no such thing really as low chance because many of us who had a low chance of getting cancer anyway are here on this board. Make decisions the best you can and all you can hope for is NED forever. GL

mike3121

You will see in my wife's BC "adventure" below she's had a severe allergic reaction to both Taxol and NeuLasta.

My wife's BC history. My wife refuses to use the internet, well except for Amazon and Ebay.

My wife, back in Dec of 2012 was diagnosed with Stage 4 ER+ PR+ HER2-breast cancer. One node and a small spot on the spine. After 3 infusions of AC she was clean except for the 6 cm tumor in her breast. The oncologist said since the cancer was responding well to estrogen blocker (aromasin) it was best to leave it be. Ops forgot to mention in the midst of all this cancer stuff she had to have removed a grapefruit sized and very painful non-cancerous ovarian cyst.

A little over a year later, Nov 2014, the cancer morphed and went crazy. She had a radical mastectomy and breast removal. A biopsy showed it to be ER+ and the oncologist prescribed tamoxifen. 19 lymph nodes were removed and 9 of the 19 had triple negative Metaplastic keratinized squamous carcinoma. A PET scan done after the surgery showed some cancer still in her armpit, probably spill over from the nodes. She has two cancers, one ER+ PR+ HER2- and another triple negative. She went back on A-C (lifetime amount), no Taxol as she almost died from it earlier. Almost died from NeuLasta too. Also 7 weeks of radiation.

After all that she had to have major surgery to remove a tumor from her kidney. Eighty five percent were cancerous but hers was benign. Happy dance, she's NED and back on tamoxifen.

Experiencing pain in her "good" breast. PET scan in mid-October.

Prayers and fingers crossed.

DoubleWhammy

I had T/C for the same reasons as Jennie93 describes.  It made perfect sense to me.  However, I was not warned about the possibility of permanent hairloss from Taxotere and I'm one of those women who have permanent hairloss.  This is a big deal.  You should ask about it.  Of course, you may be told that your oncologist has never seen it happen in all of his/her years of practice (because that is what they all say).  Well, they sure seem to be seeing it more and more now!  Anyway, IF I had been warned and IF I had known that Taxol was another option, I would have chosen Taxol.  Beats being bald forever, believe me.  No matter what chemotherapy is offered, they all come with their own set of side effects, both long and short term.  I would likely not have taken the risk of heart disease from A/C because of my family history and blood pressure and cholesterols issues.   I probably have taken the risk of permanent hairloss from T/C, but I feel strongly that the options should have been described to me and that the decision should have been mine.  We are given all this information at a time when we are vulnerable and frightened, so it is always good to have a fresh set of ears and the ability to ask questions and get honest answers.

 

tshire

you can always cold cap if worried about permanent hair loss..

ruthbru

I did dose dense AC with Neulasta shots. Everyone's experience is totally different, but I did okay during treatment. I took the anti-nausea medication religiously, felt like I had a slight case of the flu but was able to work full time, do everything I had to do & most of the things I wanted to do too. If she can exercise (at any level, even if it's just walking around the house in a circle) that will help her feel better. I did not have any permanent long term after-effects.

Artista928

Agree with the cold cap option. You shouldn't base your decision on whether you will be bald or not if it is better for you to go the Taxotere route. My MO did mention it to me but fear of permanent hair loss was down my list of other fears. It seems from reading these boards that what my MO said she sees in her practice is true.. Taxol is big on neuropathy and many don't get rid of it later on. More cases on Taxol than Taxotere, that and se's not being as bad I didn't think twice when she said Taxotere for me.

My hair has grown out but I choose to keep it buzzed so actually I still look chemo-y. But it's easy and I have my self esteem and confidence coming through in my actions/words and so the looks don't matter so much now. What I thought oh hell no years ago is now, so? I'm coming off of a baby girl 3 mo old who fought for her life and just died of a rare disease. Puts things into perspective.

Meow13

Yes my oncodx was 34 and i was offered ac & taxol or doctor said we could do longer cmf. There are choices but to get the risk reduced it requires strong chemo. CMF is the easier chemo. My chances were 23% vs 15% with chemo. But those risks are using tamoxifen. If your wife can get on AI drugs the risks are lower to start with.

I chose no chemo against my mo wishes and took anastrozole then exemestane it has been 5 years and I havent had a reoccurrence. I wasnt willing to take chemo, the risk to my health was unacceptable. But chemo does kill cancer cells but so do AI drugs.

superius

I had TC.  MO mentioned it would be either AC+T or TC. Then she chose 4 rounds of TC, 3 week cycle. Interesting comparison information. I didn't know TC has "lesser" side effects. I didn't ask why she chose TC. but I know many people in the field of oncology & they all agreed it's the right course. Anyway, I think my side effects were pretty minimum

Swami7774

Thanks, superious. Good to hear.

Hopeful82014

Swami, you and your wife may want to review the following; I'm not certain how well it applies to your situation but hope it is helpful.

http://www.breastcancer.org/research-news/chemo-w-anthracycline-better-for-some

badger

hi Swami7774, I was offered a choice of chemotherapy: TC or AC+T

TC chemo was taxotere and cytoxan, 6 infusions, three weeks apart.

AC+T chemo was adriamycin and cytoxan, 4 infusions (I think), then 12 weekly infusions of taxol.

Everyone's situations are different. I have a family history of heart disease so went with the TC chemo.

In my cocktail was the dexamethasone, a steroid to prevent allergic reaction, and an anti-nausea drug.

My blood counts stayed high enough I didn't need Neulasta. Yes, I lost my hair but it came back.

There's no doubt that chemo sucks but it may not be as bad as you fear. Best wishes! ((Donna))

Sjacobs146

Hopeful, thanks for that link! My doc did not recommend Adriamycin for me because of the risk of developing leukemia. BecauseI was relatively young a diagnosis (48), more chance of developing leukemia before dying of something else. After reading that article, I'm guessing that my high blood pressure likely played a factor as well

Hopeful82014

You're welcome, Sjacobs. I'm glad it was helpful. Have a good weekend!

NancyHB

Swami, my Oncotype score came back at 42, so I had almost the exact same stats as your wife (28% recurrence without chemo / 18% recurrence with chemo and Tamoxifen).

Prior to Oncotype, my oncologist recommended TC x 4, but after they saw the score of 42 said AC+T was the best weapon in my arsenal. I had 4 dose-dense AC followed by 6 dose-dense Taxol. I also had a Neulasta shot after each round of chemo (10 in all). Most people told me that Taxol would be a "walk in the park" compared to AC, but I found Taxol to be more difficult (muscle and bone pain, and mild neuropathy in a couple of fingers), but it was manageable.

Eight months ago I had a local recurrence that is now triple negative, so no Oncotype test (chemo is a given with TN). The preferred treatment for TN is AC-T but I've already had a lifetime maximum of Adriamycin, so instead I completed 6 rounds of Taxotere and Cytoxan. I found TC to be much more difficult than AC-T, not easier. I developed folliculitis on my scalp after my hair fell out; I had more bone and muscle pain than with Taxol (my MO says I have a sensitivity to the taxanes), I was anemic to the point of almost needing a transfusion, had significant GI problems and mouth sores, and I have neuropathy in my both my hands and feet. Again, I had Neulasta after each treatment (this time it was the onboard "button" instead of a shot the following day).

Also remember that the Oncotype recurrence rates also includes 5 years of either Tamoxifen or an aromatase inhibitor. My MO says those are almost more important than chemo in ER+ breast cancer.

Chemo is tough, and some of the side effects can be long-lasting and even permanent. But it's manageable and doable, even if it's difficult.

Good luck to you and your wife as you decide which path to take.

Nulyte

Hi

I wasn't offered a choice either but I started doing my own research and I am pushing for the T-C regimen , since I have a strong family history of heart disease. I have heard oh it's fine , no it's not they can't predict who will have cardiac issues from A-C. One doctor finally said its the standard regimen and that's what we do.

Have you gone for a second opinion? We are currently on our third and they are more upfront and patient involving than the other two I saw.

I saw someone mentioned a cold cap. The one opinion we went to said they would absolutely refuse to allow their patients to wear one so please ask that also if she is interested. As the nurse told me if they aren't use to using it they will just say not allowed

KBeee

A recent study showed that TC was not non-inferior to AC-T, meaning that AC-T may be more effective for some. I have done both TC and AC-T and I also found TC more challenging even though it is considered the "easier" regimen. I found both doable though. Best wishes. These are tough decisions

Artista928

My labs were good thru chemo as well. The thing is though you don't know if it'll suddenly plumet, causing delay in your next round. So you have to weigh the plusses and minusses of Neulasta, even if you've had good #s so far..

Trvler

I never knew the difference between TC and AC+T but I got the AC+T.

I would say if you go with AC+T, gt weekly Taxol. It is shown to have fewer permanent neuropathy issues and the outcomes are the same. I did very well on it and have no issues at all with neuropathy now. I had some slight tingling in my arms during treatment.

There is a lawsuit going on right now over the hair loss thing on Taxotere. Apparently some doctors did not tell their patients and it does happen. I know you are supposed to be not thinking about your appearance but being bald temporarily was difficult. Permanent? I don't want to think about it. There are many women on here that it happened to.

Artista928

On the other hand, the group I was in for chemo experienced a lot of issues with neuropathy on Taxol. Taxotere tends to have less severe side effects over all, which I what I did. And all my hair is coming back. There is no one way to go be all as everyone is different. It's about like a coin toss this Taxol v Taxotere.