AC-TH VS TCH...I don't know what to choose

TCH is only (I believe .6% less effective) and in some trials it was just as effective but without the SE's.  Don't get me wrong it's still tough (that's what I did) but it has less chance of damaging your heart or you getting leukemia.  I do think there are times when it is needed but I would do the TCH. 

BTW, I fought with my oncologist that I wanted the AC/TH and afterwards I thanked him because I didn't know that it carried a higher risk of some unwanted SE (not that TCH doesn't have it's risk). 

REMEMBER, whatever route you chose is the right route because it is yours.  ((hugs))

I had TCH which my oncologist thought was the best protocol for me.  However, I was stage IV from the start and I will have to get Herceptin forever.  So, I could not risk any cardiac issues which are heightened by using AC.    I had liver and bone mets and after three cycles of TCH, there was no cancer to be found. So, I think it is indeed very effective!!    That was 2 1/2 years ago and I am still on just Herceptin and still cancer free.  

Good luck with whatever you chose to do!!

Jennifer

"A retrospective analysis of Breast Cancer International Research Group trial 006 found that anthracycline-based chemotherapy was associated with increased disease-free survival among patients with HER2-positive tumors that overexpressed topoisomerase II and HER2/neu but not among patients with tumors that only overexpressed HER2/neu (70). Other trials have found similar results (71)."

Full article is at http://clincancerres.aacrjournals.org/content/14/1/14.full

I've read this in other places as well. I could be wrong but I also remember reading that 2/3 of patients had the second overexpression and 1/3 didn't. I don't know if there is a test available to find out for sure if you have it. I had AC and I'm just crossing my fingers I'm in the 2/3 group. This might be something to discuss with your oncologist.

This is reposted from the Herceptin site: http://alturl.com/6x9gy

------------------ repost --------------------------------------
Who is Herceptin for?

Herceptin is approved for the treatment of early-stage breast cancer that is Human Epidermal growth factor Receptor 2-positive (HER2+) and has spread into the lymph nodes, or is HER2+ and has not spread into the lymph nodes, but has one high risk feature.† Herceptin can be used in several different ways:

* As part of a treatment course including the chemotherapy drugs doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel. This treatment course is known as "AC→TH"

* With the chemotherapy drugs docetaxel and carboplatin. This treament course is known as "TCH"

* Alone after treatment with multiple other therapies, including an anthracycline-based therapy (a type of chemotherapy)

† High-risk is defined as ER/PR positive with one of the following features: tumor size >2 cm, age <35 years, or tumor grade 2 or 3.

* Herceptin has 2 approved uses in metastatic breast cancer:

* Herceptin in combination with the chemotherapy drug paclitaxel is approved for the first-line treatment of Human Epidermal growth factor Receptor 2-positive (HER2+) metastatic breast cancer

* Herceptin alone is approved for the treatment of HER2+ breast cancer in patients who have received one or more chemotherapy courses for metastatic disease

Herceptin is approved, in combination with chemotherapy (cisplatin and either capecitabine or 5-fluorouracil), for the treatment of HER2+ metastatic cancer of the stomach or gastroesophageal junction (where the esophagus meets the stomach) in patients who have not received prior treatment for their metastatic disease"
----------------------end of repost ---------------------------------

I was hoping for TCH, but my Oncologist told me they rather put me on AC-TH. I had a second opinion and the result was the same.

Both said they cold do TCH if that was what I wanted, but they said that "I'm a young 56" and I should be able to handle the ACTH.

When I asked my Oncologist the reason he wanted to treat me with AC-TH, he said that he didn't want to look back and regret he didn't use the most effective treatment for me.

In Australia they seem to give AC-TH to node positive patients and TCH to node negative patients. I absolutely didn't want AC-TH because I had read about the heart problems caused by Andriamycin. Luckily my onc wanted to give me TCH.

Sue

Laura I had surgery before chemo. I too wonder if the chemo will work but at the same time I'm glad the tumor is gone and they know how to stage me. The upside of having surgery first is they know what they are dealing with and can choose the right treatment.

Had I had chemo 1st and it worked we would have never known the true size of my tumor or node status. Going in they thought the tumor was 7cm or 6.5cm. My BS really thought I would have a micro invasion in my nodes. A tumor my size usually does but it ended up my nodes were clear.

The other upside is if the chemo didn't work then your tumor would have more time to grow etc. In my case I feel it was only a matter of time before it got into the nodes. I'm glad they got it out first.

``````````````````````````````````````

But of course there is the upside of doing chemo first too. One thing I have learned with this disease is there seem to be both an up and downside to every decision. Try and focus on the upside.

BTW I've done 3tx of 6 (TCH). I'm not sure my onc was considering AC-TH. I'm in excellent health, age 49 with no heart issues but there is one big difference between you and me. I will be doing hormone therapy for 5 years after chemo. You don't have that gun so maybe that's why your onc wants to use a slightly bigger gun. I also had no nodes.

Good luck and don't second guess yourself. 

I had Stage 2B cancer that was node positive.  My doctor recommended AC/TH.  I did my own research and requested TCH instead. I had 6 treatments of TCH and one year of Herceptin.  After completing my year of Herceptin, the Her2+ cancer returned within months.

My doctor at Memorial Sloan Kettering, promptly put me on AC-TH. I didn't disagree with her this time and did exactly what MSK considers "gold standard" for Her2+ cancer.  This regimen was much easier to handle than the TCH.  I had a cardiologist do an echo every three months while I underwent the chemo and she gave me the "thumbs up" each time.  I think as long as your heart is strong and you have a professional who can check it regularly, this will ease your mind a bit.  I will continue to have the cardiologist check my heart on a regular basis until I am finished with Herceptin and Tykerb.

Having completed both regimens, I would say that the AC-TH is easier.  Not as much fatigue and no neuropathy. Don't like to play shoulda, coulda, woulda, but if I had it to do all over again, I would have listened to my doctor's recommendation from the start.

My onc said the same thing about TCH.  She thought it was more important to get the herceptin started immediately.  Herceptin and chemo work in synergy, but it is really the herceptin that has made HER2+ a better scenario to be dealing with.

LauraGI,

I agree, I noticed exactly the same thing.I am also noticing that ER/PR + gets AC-T most of the time and TC for ER/PR -.

I had AC-TH, 2 nodes, triple + ,neoadjuvant chemo.

I have noticed this too.

I got ACTH and I had 7 of 29 nodes involved. AC 4*3 and then T 4*3 with H every week and then H every 3rd week for a total of one year.

Hi Deenah,

Hope you are well and Rads are almost over or over.  I just read your post about meeting with Dr Slamon...so exciting.  I'm so glad you are getting the best advice there is!  I was wondering if you talked at all with him about Neratinib and if he had any thoughts?  I am in the clinical trial and am just curious.  Thanks for any info and happy holidays!

katalina