TCH: 4X or 6X?

I was given six TCH and am node negative, I chose that instead of the 4 a/c followed by 4 taxol.  I don't have any research or anything to back it up.  It is what both oncologists recommended as an alternative to 4 adriamycin/cytoxin followed by 4 taxol/herceptin.

Sorry I can't be more help. 

I was scheduled for 6 but quit at 5 after receiving good scans, onc said that there was no evidence to prove 6 were better than 4 and at stage IV, he didn't want to subject me to any more chemo than necessary since I would eventually need more in the future.

I had the same 4 vs. 6 concerns when I first started treatment in July.  I finished TCH #4 on 9/12.  When I asked my onc why 4 treatments and not 6 she said that with the size of my tumor (1.6cm) and no positive nodes, 4 treatments was enough and more toxicity was not always better.   She also said that the year of Herceptin I will be getting every 3 weeks was the most important part of treatment.  I trust her opinion and guidance as she is THE breast cancer onc in our area.

I finished 4x TCH in September...my "c" was cytoxan, not carboplatin. I got 2 opinions, both were for 4, not 6, rounds.  In my case, the reasoning for 4 seemed to be the tumor size more than anything else. Below 1cm is still a bit of a gray area, and I believe it's only in the last couple of years that these smaller HER2 tumors are getting the full court press (I feel lucky!). My understanding is the most important part is the continuing Herceptin. So I look at the chemo more as a Herceptin delivery system and felt that 4 would give me the right amount...not too much, not too little.

I saw my onc today,he is very interested in knowing more about the 4 versus 6.I am receiving carboplatin and taxotere.He wanted me to ask if there are any studies or other info regarding 4 versus 6.Also where you are located.If I can get him something concrete,he will consider letting me do the four.He also feels less toxicity is better,but  wants me to have the best regimen.I am node negative, but tumor was over 2 cm,clean margins.Hope to hear from you all!! Jackie

As you can see by my signature line, I too am an early stager.  I received 4 treatments of taxotere/carboplatin, along with herceptin weekly and now every three weeks.  I finished my chemo in May.  The oncologist initially talked about doing six treatments, but after two said that she had such good results with four only and the research was compelling enough to suggest that we should not "overdo" the chemo.  She also felt that in the long run, tamoxifen and herceptin would be key in staying cured.  I like that word - cured!

I asked my onc about the 4 vs 6 and he said that although there are some trials going on, right now being node negative, the standard of care is 4. I had #3 yesterday and my last will be 12/5. Then...my year of Herceptin followed by 5 yrs of anti-hormone therapy. It's a long road for early detection cancer!

I met with my onc on Monday and due to the extreme fatigue I suffer the weekend after tx's, he said we could do four instead of six treatments.  I am unsure what to do?  I don't want to be in the position years down the road to regret not doing the six and having another tumor show up.  I am not really sure...

Hi azunn,

So even though you are node negative they offered you 6 cycles of TCH?  I wonder what scientific studies they are basing this on?  What are recurrence rates....and so forth?

Dianne

notlucky

 Not Lucky

I was originally advised I would have 4 then, my Oncotype came back high and he decided on 6. I had no nodes just wanted to be aggressive as it was aggressive cancer, Her2 and all.

I was upset when they changed it, but in retrospect I want to feel like I did everything I could.

I am trying to last through 6 TCH. I have already had the change the regimen to the lower dose weekly Herceptin, and lower the carboplatin dose due to kidney failure after the first treatment.

I had a .9 cm, grade 3, 0/3 nodes, wide clean margins, double mastectomy, strongly ER +, PR-, HER2 +  lesion, Oncotype 23, no known mets at the time of decision about chemo.

I had a very strong intuition, based on how my body felt, that I still had cancer after my bilateral mastectomy. I also have an overwhelming family history of unstoppable and rapid death by cancer, it is the only cause of death in my extended family. All the cancers have been in the HER2 "family" of cancers; breast, ovarian, lung, and gastric. I have no idea whether I have any risk of cardiovascular disease, because no one in my family lives long enough to develop it, we die from cancer first. Based on my intuition and family history, my oncologists offered the full 6 treatments, and willingly acceded to my request for the more frequent, dose dense Herceptin.

They did my tumor markers right before starting the chemo regimen, and found my CEA, a marker usually used to determine whether cancer has metastasized, elevated. We now feel all the more strongly that the more aggressive regimen is justified. I feel certain we are doing the right thing, even with the Oncotype DX of 23, which should have been a good prognosis for relatively low recurrence risk. I don't believe the Oncotype is reliable in my case, and I'm glad I shared my perceptions with my oncologists, who respected and honored them, and have quietly done their best to fight for me to receive all the diagnostic assays and treatment that would oherwise be reserved for more obviously high risk patients. 

I am very much in the camp of "alternative/complementary natural health care", so for me to listen to my body give me strong signals that it could not deal with this affliction without chemotherapy has been a huge stretch. It was not a message that I wanted to hear, but was clear and unmistakable. I will use alt/comp methods to recover from my chemo, but my body is thanking me already after two treatments of TCH. Something radically shifted following the first treatment, and some small, medically insignificant skin lesions that had appeared at the time I discovered my cancer, and persisted after my bilateral mastectomy, completely disappeared three days after my first TCH. It felt like my body gave a sigh of relief.

Now I just have to find a way to survive the TCH, which is provoking renal failure for me. I hope to get through the full 6 treatments.

I hope everyone here can survive your course of treatment, whatever you decide is best for you, and thrive when it is all complete!

I had 4 cycles of TC with 1 positive node.  When I learned a few women on the TC thread here were getting 6 txs, I asked my onc (at one of the top bc places in the country), who assured me that 4 was right for me.  I have since heard of the same onc giving another women who is younger than me (I'm post & she's pre-menopausal) 6 cycles, but she also had a larger tumor and more node involvement.  Unless my onc was wrong about my situation  -- which I don't think she was, although tx recommendations are constantly evolving based on new research -- I can't help but feel that the 6 cycles are only prudent in pre-menoupasal women with node involvement, and that even then, other factors come into play, such as tumor grade.

Since TC is a newer regimen, and since some of the older regimens were based on 6 cycles, I think many oncs feel safer with 6.  But I don't believe there's any proof at all for that theory at this point.  The major study that showed TC superior to AC (as well as a higher than previously believed risk of heart damage with A) was based on 4 vs. 4: 

http://www.breastcancer.org/treatment/chemotherapy/new_research/20071213b.jsp

But, of course, we all have to go with our gut feelings, and if you can tolerate 6 txs and will sleep better knowing you took your body to that point, then that's definitely something to consider.  On the other hand, because there are SEs with chemo, if your onc can't tell you why you need 6 and you are doubting the benefit of that many txs for your particular situation, you can certainly seek a second opinion, to see what another onc would recommend.     Deanna

Dear Deanna,

I forgot to ask you a question. How long does the hair start to grow back. Does it start once the treatment is over? How does Herceptin affect hair? I read that Femara is terrible and stunts hair growth? What about the other aromatase choices?

Thanks!

I was diagnosed in Feb 08 and because this was the second occurence of breast cancer (the first was very small and DCIS so the HER2 test was not done), I went to the Mayo Clinic in Jacksonville.  Dr. Perez is in charge of clinical trials there, although she no longer practices.  I was prescribed 6 X TCH based on the European clinical trials.  (Using Taxotere instead of Taxol).  My nodes were not positive.  I hope that helps.