Dose Dense AC or TC regimen

Rocky41102

I had a mastectomy September 27. I had 5 sentinel nodes removed and two nodes were in the breast tissue removed. I ended up with 3 total positive and one had extranodal extension. I met with the medical oncologist last week. I liked him, he was nice and seemed to know what he was talking about. However, he is strongly recommending I do dose dense AC x 4 and then 12 weekly Taxol sessions. He said most other oncologists would normally recommend TC with my diagnosis but he thinks I should do the more aggressive treatment because I'm 45 and had lymph node involvement. I originally thought I'd just go with his recommendation and have everything scheduled but now I'm having some doubts after researching more. I had a mammaprint test done that was high risk but right on the borderline. My breast surgeon ordered an Oncotype but it won't be back for a few more weeks. I'm going to get a second opinion just to put my mind at ease but I'm wondering if anyone else had to decide between these two regimens? Why did you pick the one you did? I'm so worried I'll make the wrong decision!

gb2115

For me it was mentioned I could do TC, but MO strongly recommended the dose dense AC plus 12 Taxol if I decided to do chemo. I had a node positive recurrence in June at age 42, four years after being node positive the first time with a low risk Mammaprint (and didn't do chemo because of it). This time around I had an intermediate Oncotype but was told the research is not really based on recurrences.

So I'm doing the more aggressive regimen right now. Clearly my body is trying to kill me even with low risk numbers. The second tumor grew in the exact same spot and hid in the scar tissue and started spreading before it could be detected on imaging. Couldn't feel it on breast exam until we knew it was there because it felt like part of the scar line. What's crazy to me is neither time did the tumor show aggressive biology, yet acted aggressive. It doesn't add up to me, which is why I allowed the more aggressive chemo.

mindthief

I was given the choice between these two regimens and chose AC-T. My case was brought before the tumour board which did not reach consensus but my own MO preferred taking the most aggressive treatment option and I agreed. I had no positive lymph nodes but basically all the other high risk criteria (premenopausal, large grade 3 tumour, LVI). I'd already started chemo when my oncotype came back ridiculously high. I have one more AC treatment left and then start taxol. It’s been rough at times but I feel confident it was the right call for me.

Good luck with your decision. In many cases with this particular choice I don’t think there’s a right answer, just the one that you feel most comfortable with.

mle42

I also had to choose between the two - I wanted to do chemo before surgery (to shrink that puppy so I could get away with a lumpectomy in my small boob), so lymph node status was not definitive, but two axillary nodes were negative via needle biopsy, and one internal mammary node considered positive based on lighting up like a firecracker on PET scan. My oncologist leaned towards ACT (and I agreed) based on my high risk factors: premenopausal (40), larger tumor (2-3 cm), positive node, high grade (3), high ki-67 (80), and high oncotype (30).

I don't think anyone can know for sure what was the right decision. There are women in the same grey area situation, where multiple options are all clinically correct, some do the most aggressive treatment and end up with recurrence. Some do the minimal treatment and are fine. Pick what you're comfortable living with.

I absolutely do not regret going with dose dense AC-T. My tumor responded really well (will know for sure how much after surgery next week, but I can barely feel anything there now), which means it was acting like an aggressively growing tumor. As my oncologist said - faster growing tumors shrink faster as well, since chemo is most effective on dividing cells. The response I got makes me happy I really threw the book at this thing. But again, every situation is unique, and I don't think either choice for you is wrong.

(Oh, and if you go the AC-T route and want to get chemo done faster, ask your doc if you are a candidate to do the taxol bit as “dose dense “ as well - makes for 4 biweekly cycles AC and 4 biweekly cycles taxol, so you're done with taxol in 2 months instead of 3.)

Edited to add: I talked to two different oncologists at two different, highly respected cancer centers before deciding, which also helped enormously in being confident I was going the right route for me. so I'll second the recommendation to consult a second doc while you're waiting for the oncotype

Emily21

Hi Rocky, I did AC and taxol, I wasn't given a choice, my pathology looked mild, but a very high oncotype score and 3 positive nodes meant that I needed the strongest chemo I could have. I'm 57, I was very healthy and very strong. I got through it fine. Loosing your hair is difficult, but I'm 6months post chemo and I have a full head of hair now. My advice is take the strongest one, you get one chance at this, you can do it. Best wishes. ANNE

Spades2525

Rocky- I am 44 and currently in the middle (round 3 of 8) of dose dense AC-T .. I was not given a choice but I feel confident I would choose this again in order to reduce the risk of reoccurrence as much as possible… even though it’s an incredibly hard route. I admittedly am glad I wasn’t given an option.. I am trusting the expertise of my MO .. I want to second guess my own decision

BettyMorgan

Hi,

I am post 4 dose dense A&C and will be getting #2 of 12 weekly Taxol. Unfortunately I had a reaction and high blood sugar. Changing the cocktail mix so hopefully no reaction this time.