Feedback needed as to which chemo to choose

jackie your ejection fraction of 67 is very good.  i had no impact on my ef from ac.  many many women have used it with no damage.  ditto with herceptin which has less cardiac toxicity than ac and tykerb has even less possibilty.  when i was dx in 06 all the docs i consulted with said ac, taxotere, herceptin so maybe it was more standard a mere 2 years ago.  i don't know. doing a trial is a very personal decision and i'm sure with input from the very smart ladies here, you'll make the right one for you.  good luck, hugs, maria

You didn't mention your diagnosis. Also, I don't quite understand the description of the study - what is the oral pill? On it do you always get herceptin? I think I'm reading that during the first period you may not get herceptin but the second period always includes herceptin.

If you are very early stage, I think the decision is pretty easy. I am stage I and less than 1 cm so my risk of mortality or recurrence without chemo is fairly low - about 6% and 20%. Chemo with TCH or AC-TH drops that to about 3% and less than 10%.

The main difference between the two therapies is that AC-TH has been around longer and been in lots of studies. TCH has been in only one study that has released results I think. The results from that study, BCIRG 006, show it about equal to AC-TH. AC-TH produced slightly better results but the difference wasn't statistically significant. Different studies might produce different results and TCH doesn't have really long term follow-up yet. TCH got FDA approval for use with early stage cancers in May of this year - so it is quite new. Here is a timeline for TCH.

Given that, I chose to do TCH. We may not have certainty yet that it is better on recurrence and survival then AC-T with H, but AC has those risks of heart damage and more rarely of leukemia and heart damage from A may not be reversable. If TCH didn't exist, I might not do any chemo - the benefit might not be worth the risks - just trading possible future cancer for possible future heart problems. So to me it was worth doing a chemo that probably has about the same benefits as AC-T with H but has less long term risk (and less short term side effects too). 

If heart damage from Herceptin occurs, it is suppose to reverse after treatment is stopped. And my doctor pointed out that in Europe they give Herceptin for only a few months with good results so even if Herceptin has to be stopped before the year is over, I probably will have gotten most of the benefit. So, I am less worried about the heart risk from Herceptin.

Perhaps if I had a more advanced cancer with higher risk of recurrence and mortality, I would want to go with AC-T with H because it has more study and history to confirm its results even if it also carried some risk. 

 I also had to make a decision about participating in a trial - one testing the effect of adding Avastin to the chemo. Half the group would be selected to get Avastin and half not. On this trial, I still would have gotten TCH. Despite also feeling that I would want to participate in a trial to advance cancer treatment, the risks of Avastin aren't worth the gain for me. It has a risk of high blood pressure and stroke and I already take blood pressure medication. So I decided not to participate. 

I have  been approced to do the same trial here in the boston area. I am just starting chem next week, AC for 8 weeks then Taxol then herceptin, thats when I can get a lottery into one of those catagories you mention. I am going back and forth about it also. It would so fabulous if it helped me but even more if it help many many women in the future. It is so scary to think about trying something experimental but isn't it all experimental!! From what I have read the oral dosed drug has had positive responses in most that have taken it. I can't remember the name of the drug and my paper work is on my desk at work....Anyway, I just found out today that I am BRCA2 positive so I have some more decisions to make...