How was your chemo determined?

NNS121317

I meet with the MO on Monday. My Oncotype is 25, given my age and expected benefit I'll be doing chemo.

It seems like there are many variations in chemo plans, both drugs used and timing/duration of treatment. For those who have done/are doing chemo, what was the rationale/reasoning behind the chemo you got?

I have reason to question my MO, and will almost certainly get a second opinion, but thought I'd draw on the experiences of others to be better educated.

MountainMia

I had the chemo my doctor recommended. When that didn't work because I had a reaction, he changed the plan to one I could tolerate.

Sorry I don't have good information from my own experience. Here is a link that might help.

https://chemocare.com/chemotherapy/what-is-chemoth...

And for more info on the specific types of chemo, including their use and side effects, go to the main link for chemocare.com.

BtwnStars

For me, even tho I was early stage, I was an oncotype 28 and dx at 38 yrs old. I believe the rationale for chemo type/duration was to treat it as aggressively as possible with the idea that I was relatively "healthy" and could stand the effects as well as the accelerated timeline. Dose dense for both AC+T. Also heart was fine.

If there are other health issues to worry about or a history of certain type of reactions, then I think that impacts type/duration.

A friend who is a PA in oncology told me what they would prescribe as soon as I received oncotype back and it was the same that my MO recommended. Most of my research revealed same, so I trust that she made the right decision for me.

That all said, I always try to keep in mind that it is called "practicing" medicine.

KotchAJ

I am 57 and because mine was found in two lymph nodes so the decision was made to do chemo first before surgery. I had 4 dense dose AC every other week. I am now doing 12 weeks of Taxol and will have a lumpectomy in December followed by radiation. I trust the plan I am following.

LeesaD

I was originally planned for AC+T (can’t remember duration) based on 2 sentinel nodes with just micromets and after ALND they found 2 fully positive nodes. Got port and did all heart screenings and then my Oncotype score (which was ordered between BMX and ALND) came back a very low 3. My MO changed my chemo to four rounds of TC based on the low score. He felt the heart risk associated with Adriamycin was not worth it with the low Oncotype. He said he had to give me chemo with 4 involved nodes and the Oncotype is good for just 3 nodes anyway but he was encouraged by the Oncotype. I was 49 at the time and I always leaned towards being aggressive anyway. It was fine and doable. Had radiation after as well.

ThreeTree

I really knew little to nothing about chemo (except that people got it for cancer) at the time I began. I had not found anything like this site before. I had a large highly ER/PR+ tumor (no nodes or spread thank goodness!) so was given chemo before surgery. I had the 4 dose dense AC's and then 12 weeks of Taxol (Paclitaxel). I didn't know enough about chemo at the time to have any questions to ask the doctors, so I just went with what they said. I know that the oncologist I see is a totally by the book "standard of care" person, so I imagine I got what I got because it is "standard of care" for my situation. I didn't have bad enough problems with any of it that I had to quit or switch, wind up in the hospital, etc. as some do, so there was no need to change the regimen in any way.

Hope this is of some help, and good luck to you!

SpecialK

There are some more specific chemo regimens for particular arrangements of hormonal receptors and Her2 status. Triple negative patients are often offered AC-T (Adriamycin/Cytoxan, then Taxol) but some also have TC (Taxotere/Cytoxan) or an older regimen thought to be effective on TN, CMF ((cyclophosphamide, methotrexate, fluorouracil) but I don't see it used nearly as frequently. Some of these decisions are dependent on heart health as Adriamycin has cardio-toxicity issues for some. I have also seen Carboplatin added to the Taxol portion for some TN's as the platinum based agents show some effectiveness and TN's don't have any anti-hormonal drugs to rely on. Triple positives seem to get one of three regimens - AC-TH(P) (Adriamycin/Cytoxan, then Taxol/Herceptin, and possibly Perjeta), TCH(P) (Taxotere/Carboplatin/Herceptin, and possibly Perjeta), or TH (Taxol/Herceptin). These decisions are based on tumor size and nodal status. For those who are not TN or Her2+, chemo regimens seem to be AC-T or TC. The choice is dependent on tumor size, nodal status, and which regimens are favored by the oncologist or practice based on a number of factors, which can include training and geographic location. The AC-T can be all dose dense (4 AC and 4 T), or 4 dose dense AC and then weekly Taxol for 8 or 12 weeks, while the TC is usually four insusions, 21 days apart, but I have also seen six. Very occasionally, you see ACT, which is Adriamycin/Cytoxan/Taxotere, but that is a pretty intense regimen that I have not seen used as often.

WC3

I had TCHP, which is the standard protocol for her2 positive breast cancer.

T and C here are the chemotherapy drugs. T here is a taxane such as taxotere or taxol, and C is carboplatin instead of cyclophosphamide as it is with AC.

H and P are the targeted therapies for HER2 positive breast cancer and stand for Herceptin and Perjeta.

Taxanes are used instead of adriamycin (The A in AC) because adriamycin combined with herceptin has a higher chance of causing heart damage.

I'm not sure why carboplatin is used for triple positive instead of cyclophosphamide.

MountainMia

SpecialK, thanks for the run-down. Seems to me, when I see variations from this, it's for substantially more advanced cases.

Rocky41102

I had a similar experience to the post above! My oncologist recommended dose dense AC-T initially based on my age (45), 3 positive lymph nodes and tumor size. Then my oncotype score came back as a 10 and he recommended TC instead. Said it would be just as effective based on the Oncotype score and had less heart and leukemia risks. My age played a huge part in his chemo recommendation along with the positive nodes.

mle42

NNS121317, the NCCN guidelines lay out the options. For Her2-negative invasive disease the preferred regimens are 1) dose dense AC followed by either dose dense or weekly paclitaxel (T), or 2) TC. AC-T is considered a "stronger" regimen than TC, but does come with additional risks. I consulted two oncologists, they both said they would give TC if I was node-negative, and AC-T if node-positive. My oncotype score was 30. PET scan confirmed a positive node, so I was recommended and went with AC-T. Other considerations in that recommendation: my age (40, premenopausal) and high grade, high Ki67, all indicating an aggressive tumor that was worth hitting with the biggest guns available.

mle42

FYI, NCCN guidelines can be found here.

NNS121317

I met with the MO on Monday, and despite some not-so-nice things I had heard, I loved his approach and have confidence in his recommendations. It was such a relief, after my experience with the surgeon. MO believes that my cancer has demonstrated a certain persistence (not quite aggressive, but just keeps defying conventional wisdom at every turn) and when combined with my age (42) and a lengthy family history of lethal cancers, aggressive therapy is warranted. I will start dose-dense AC next week, then T, then do six weeks of radiation, then hormone therapy. I had a PET scan today to make sure we haven't missed anything, but I don't expect any issues.