TCH x4 vs x6 -- revisited

Hi Jenbal

Very hard decision, very personal and am firm believer that your gut will lead you the right way.

I was originally supposed to get 4xTCH, however my ONCOTYPE came back very high so my Onc switched me to 6x. Since then my 2nd Onc who is famous and administers the Bisphos trial to me states 4x could have been enough and may have been overtreated as I had no lymph nodes and no LVI. In many ways I am glad I pushed it because of all of the fear that comes after treatment, I can truly say I did everything. (bilat Mast, chemo, Hercpetin, AI, Trials etc etc.) The only thing that is tough is that it did a number on my white counts and I struggled with them for a year. (So I worry about my immune system)

One thing for you to consider is that you are not ER positive so chemo and Herceptin is your big gun to fight this. Try to meditate on this and see what your internal spirit/intuition says.

Good luck

jenbal, my oncologist said the same as Jaimieh's - there have been no studies of TCH x 4 so she only does x6 even in early stages. When I was starting out, I wanted to do 4, but by the time I got to 4, I felt that as long as I had gone that far, I might as well finish it up and be sure that I had done everything possible to prevent a recurrence. I did have a hard time with Tx 5 and 6 - partly because I got a cold during Tx 5 which made it hard to keep hydrated. But now it is 5 months later and that is becoming a distant memory. I feel fine. The bit of neurapathy that I had in my fingertips has been gone for a couple of months, my red blood cell count is back up and I feel fine. My creatinine is still slightly elevated but it is close to normal - I'm on the bisphosphonate trial too and the drug I'm taking on that may be keeping it from dropping the last bit into the normal range. I'm now glad that I did all 6. The extra 6 weeks of being very uncomfortable was very little compared to worrying that I hadn't gone the full course.

Wanting to do x6 is very understandable.

I also ended up doing 6X TCH, along with a bilat mastectomy and the balance of the year on Herceptin. The Chemo was awful, replete with bouts of kidney failure, and now after 7 months of weekly Herceptin I'm having signs of heart failure - my MUGA dropped from 67.8 down to 57, so I only have 2 more points to go before they will have to take me off it to give my heart a chance to recover. All this for a 9mm T1b N0M0. But I wanted to hit it with everything possible, because every single woman in my family has died from highly aggressive cancers in the HER2 family of afflictions. If 4 TCH would have been enough I will never know, but I am certain that we have done everything possible for this, so if I get mets it won't be because we spared any expense or trouble...

For me, the fatigue lasted longer in cycles 5 and 6.  I had a cold at the beginning of cycle 5 which may have contributed to that. (I don't think that was due to low WBC since my husband and DIL also had the cold which we may all have been exposed to by my granddaughter.)

I had nausea late in the cycle which was probably a reaction to Neupogen but may have been due to the Carboplatin and that was worse on the last cycle. The vomiting made me low on magnesium, which also probably contributed to the fatigue I had at the end. When they gave me a transfusion and IV magnesium 3 weeks after the last chemo (which was the first time they tested my magnesium level), the fatigue and nausea went away almost immediately. I felt much better by the next day. (Vomiting can cause low magnesium and low magnesium can cause nausea and vomiting. Isn't that lovely?) I wish they had tested my magnesium level earlier.

I didn't get any new symptoms the last two cycles except the last cycle I had the muscle weakness too. By 5 weeks after my last chemo, that was much better and in a few more weeks I was pretty much back to normal.

I will start the 6X - TCH tommorrow.  But wanted to tell you I asked my onco about 4 verses 6.  She said we can do that, but there is just no evedience that it has been proven to work.  And she said If I were doing it I would think why not 2 more just to be safe, whats 2 more?  It has been proven that 6 cycles work.  I guess I will just see how I feel, I can always stop at the 4.   Hope this helps.....Tanya

This topic is close to my heart since I only had 4 tx and was not even offered 6. Due to pre existing neuropathy issues, I was able to get Abraxane rather then Taxotere. So, I'm not sure if that makes a difference since Abraxane is usually not given to early stagers. My protocol was unusual as well. I went every week (Abraxane, Carboplatin and Herceptin) for 3 weeks with one week off in between. I went with that schedule because the lighter doses (instead of one blast every 3) was more likely to keep me at work due to less se's.

I trust my Onc. implicitly and he has a stellar reputation also in the area of research. I guess my question here is to make me feel better . I never did have an Oncotype test done because chemo was a given as an HeR2 pos gal. Without that, I may have been on the fence. So my thought is that it is really the Herceptin and the Aromison (ER and PR 90%) rather then the chemo that is my real defense against reoccurance. Hoping that someone with lots of research knowledge might validate that so that I don't have to start worrying that I didn't have 6tx!!

Can anyone here make me feel a little better?