How to choose chemo AC+T or TC?

retrobutton

Age 48. Early stage IDC TNBC, no nodes.

I simply cannot decide. This week I got two opinions with very different approaches. Both are NCCN standard treatments. I spend all day searching the internet, reading studies and articles and I go back and forth between the two options. I'm taking too long but how do I decide? How do you weigh the options and their risks/benefits?

1. TCx6 every 3 weeks- my own medical group -

"softer" approach - prefers TC to avoid the risk of heart damage and leukemia from AC- Says UCLA (not my medical group) is phasing out AC in favor of TCx6

2. Dose Dense ACx4 every two weeks +Tx8 weekly - a National Cancer Institute designated cancer center has an office in my town -

This doctor emphasized concern for the future. Says I have one chance so "throw the book at it" and give it everything we've got to prevent this from popping up somewhere else. He says the AC risks are very low and because I'm young and that I'll be fine. They check out your heart before and monitor during. (He says this despite the fact that I had a stroke 7 years ago from a Carrotid Artery Dissection, an occasional arrhythmia, and family history of heart disease.)

For option 1- After hearing #2 I'm scared this it won't be enough and it will metastasize to my brain or lungs and kill me. Or will it be enough?

For option 2 - it sounds good to "throw the book at it" and I like the idea of taking the T in smaller doses weekly to lessen side effects BUT I'm scared of future heart problems and heart attack.

A third oncologist who I saw first and didn't like said that AC is preferred on the East Coast (where opinion#2 doctor is from) and TC is preferred in Texas.

Cathytoo

retrobutton....I'm considerably older than you...75 when I was diagnosed TN. However, I am a VERY YOUNG woman considering that I am very healthy. No other current health problems and nothing serious in the past. After my diagnosis I consulted with three top oncologists. Two said ACT (one wanted to do Carboplatin also). I chose the doctor who said A was being phased out because of residual serious health problems. Remember Robin Roberts who was cured of TNBC but then had life threatening leukemia which was caused by A. The third oncologist preferred 6 infusions of TC. I did some research and discovered that they have documentation that TC might be as effective than ACT or better. My thinking was that I wanted to come out of treatment as healthy as I began. I went with 6x TC. You have a harder decision than I had because you are so much younger. BUT...we both want to live‼️ Unfortunately, I've read all kinds of stories. Recurrences do happen and women do die regardless of their treatment. I have a friend who has a recurrence of a tiny ER+ tumor less than two years ago. I have another friend who is 15 years out from TN, 6cm tumor with lymph node involvement. I think it's the most serious decision we have to make. THE outcome is unknown and all we can do is hope for the best. I wish you well. If you want to PM me...do so. ❤️❤️

retrobutton

Thank-you. I got tired of trying to decide and finally just decided TC and sent a message to my doctor. However he just called, said my echocardiogram looked good and that he ran my case by the tumor board this week. Everyone on the board recommended some combination with the A. He told me to make my decision and see him on Monday. Sigh. Just when I thought I had decided.

anotherNYCGirl

retro, - i have a congenital heart murmur from pulmonic stenosis but was still advised to go with AC/T. I, do, live on the east coast, so it may be true that is the favored way to go here. Good luck with your decision!

(PS After my first round of AC, the treatments were divided so that I was given 3 doses of C, then three of A, and then 4 dd taxol. It made a it easier.)

NotVeryBrave

My MO recommended TC because of the similar results and less risk of serious problems, including heart and leukemia, compared to AC. He just felt that any advantage of the AC would perhaps be overshadowed by the longterm risks. I had the added advantage (?) of being HER2 + so received HP as well.

girl0097

retrobutton-

Hope all is well. I am having to make this same decision, at age 40. My oncologist recommends AC+T. Then I got a second opinion at the University with a specialist in breast cancer, who recommends TC for me, based on my nodes being negative. So, was curious what your final decision was. I'm transferring to a new oncologist, based on where I want to have my infusions, and he called me today at home, and said TC would be a fine option for me, but AC+T ok too, and that we will discuss it more tomorrow at my appointment with him.

moth

girl0097, retrobutton hasn't been on the boards since March 2017 so I'm not sure she will see/reply

fwiw, you can see I went with AC+T. I was initially recommended and signed up for TC when it was believed I was ER+. Once OncotypeDX came back indicating ER-, my MO's strong recommendation was AC+T.

yellowdoglady

I was told in 1/2009 that the A is really not good for anyone, especially for you with a family history of heart issues. I was also told that it would increase my survival by 1% or some such minimal garbage, so I was counseled by my onc not to do it. Instead I did Cytoxin and Taxotare hugely, every three weeks for six rounds. Then on to 7 weeks of daily radiation. But no A was a good call.

santabarbarian

Not sure what your TC is, mine was Taxotere and Carboplatin but some C's are Cytoxan... andyhow, I had nodes involved but very happily got a pCR from treatment with Taxotere /Carboplatin x 6, every 21 days. It was doable and I have no long term effects.