CMF vs TC for stage 1

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annapc
annapc Member Posts: 10
Hello!

I visited my ONC yesterday for treatment recommendations.  I am 47, pre menopausal,  stage 1, 1cm tumor, no nodes, ER/PR+ and oncotype 20.
 
She said that  based on my low-mid range Onco score she could not be 100% sure I would benefit from chemo. However due to my age and the fact that some tumor cells were found near blood vessels, she would recommend  I do it.  
 
She recommended CMF as it is milder than TC.  Her feeling was that while TC may be 2-3% more effective, in my case the risks of the side effects from TC did not outweigh that benefit. 
 
So, I am now concerned that I SHOULD be pushing for the TC as I want to be as aggressive as possible. But is this just my lay person's naivete ?   She said that if it were her personally in my situation, she would opt for the CMF.
 
 Has anyone been in a similar situation?  What did you do?
 
Also, to get it over with more quickly (4 months vs 6), I asked for the higher dose option which includes a shot of Neulasta that I may have to self administer.  Has anyone done that?  
 
Oh--one more thing...  Is it a bad idea not to get a second opinion?  I was dx in October, and had to have 2 surgeries.  At this point I just want to "get going" with treatment. I live in NYC and am being treated at Sloan, so am hardly getting 2nd rate care. 
 
 

Comments

  • DiDel
    DiDel Member Posts: 1,329
    edited January 2011

    Anna  Sorry you are here but glad you found this site for support. I was about the same as you my oncotype score was 17 (which is the last number in the low category) and I did 4 rounds of TC. I was relieved to do this treatment 1. because it was a shorter treatment 2. It was a newer more agressive treatment. I would ask your BS for his opinion on treatment. I am very close to my BS and trust him explicitely. I made my onc talk to my BS to make sure everyone was on board with my treatment. 2-3% difference is big when you are talking about your health.

    I found the TC very doable, I made sure I had an extremely healthy diet avoided crowds and did all the things they tell you to do or not do to maintain my blood levels during treatment and never required Neulasta shots which I hear are horrible. I went to Chemocare.com for information on chemo treatments and side effects and was very prepared when I went to my first treatment.

    new members are limited to a 5 post maximum every 24 hrs so if you have any questions and can't post feel free to send a private message (PM). you do this by clicking on the members name then it will direct you to send a PM.

    Good luck with your decision and with your treatment!

    Diane

  • Sharon789
    Sharon789 Member Posts: 56
    edited January 2011

    Hi Anna,

    I'm 46 with stage 1 (1.2cm), ER/PR +, Her2 -, no nodes and an oncotype score of 24.  I've just finished 2 of 4 rounds of TC (Taxotere and cyclophosphamine).  There are so many different names to the same drugs I don't know if the exact drug used can change when you get TC.  I'm also in Canada so check with your onc to see if that is her suggestion.

     The onc recommended chemo and really only suggested the TC option.  I have had no nausea but some heartburn with the first round but it was controlled with meds during the second round. I take Neulasta and have not had side effects from that at all.  The hair is gone and I am now getting hot flashes but otherwise I haven't had a bad time of it so far.

    After reading all the posts, it seems that the reaction to chemo is completely specific to the individual. Maybe it is my dosage that makes me have milder side effects but there was never a discussion that I shouldn't receive the regular dose so I don't know if that is the case. I'm just lucky.

    Good luck with your decision.

    Sharon

  • Anonymous
    Anonymous Member Posts: 1,376
    edited January 2011

    Anna - I had an oncotype of 23  was 44 and did CMF.  I also go to a large NCI hospital (top on the west coast from what I have read in the rankings).  My onc. recommended CMF and said she would do CMF with my stats.  It was 6 months, but very easy for me to tolerate.  I am pretty sure that the chemo the oncotype is calculated on is CMF. 

    I have found that in my area, CMF is very popular with the breast cancer oncologists.  I did have two opinions early on, and my sister works at Stanford so they had all of my records, films and lab info and gave me an opinion as well.

    My onc. likes weekly CMF as kind of a metronomic chemo and said that the longer time frame would work best for my cancer as it was not really a fast grower.

    I have had lots of friends that I have met on here that have done TC and tolerated it really well.  Either way, you will be fine!

    There is a CMF dedicated thread under the forum "help me get thru treatment" which may be helpful if you decide on CMF.

    Good luck with your decision!

  • annapc
    annapc Member Posts: 10
    edited January 2011
    THanks for your responses!
     
    Aprilgirl--did you ask about TC?
     
    I am going to try to speak to my ONC again this week to clarify everything one more time... What a ride! 
  • Anonymous
    Anonymous Member Posts: 1,376
    edited January 2011

    Anna - yes, I asked about TC.  My oncologist said that CMF was the best choice for me and TC was overkill for my case, and with my mitotic rate TC would not necessarily be the best at hitting cancer cells if any really did get into the blood stream.  This is for my case and it is really hard not to generalize on here, but each of our tumors and cases are so different.  She went into a long explanation about my tumor, its mitotic rate, how chemo works and why she felt that weekly CMF would be best. She left the decision up to me and did not push it, but the offer was CMF or no chemo (tamox or an A/I was absolutely necessary in her opinion).  Once I asked her what she would do if she were me and she said she would do CMF.

    Now, I am one of the few on here that had weekly CMF - most have it every other week, or every third week.  My onc. happens to love weekly CMF.  I took the cytoxan orally and had the M and F in a weekly infusion.  The infusion is fast - a shorter infusion then my friends who have done TC (but I had many more infusions as it was weekly for 6 months).

    At the time I did not see anyone on here having CMF until someone pointed me to the thread.  I found another CMF'e, who had recently finished BUT lives about 15 minutes from me.  She was so helpful.  Neither of us experienced many side effects and most don't which is why I didn't post on the "starting chemo 1/2009" thread.  I really had nothing to say, and most on the chemo thread are discussing hair/wig care and side effect management.  I took zofran on the day of infusion, did not need steroids or neulesta, your hair thins but you do not lose your hair, so that was not an issue.  No one noticed my hair thinning, except me!  I felt a bit "off" the day of infusion, but otherwise felt fine. 

    CMF is really popular in my area, but I assure you I go to a top rate cancer center.  

    I hate that they leave these decisions up to us!  TC or CMF you will be fine.  Both are successfully used for breast cancer.  

  • otter
    otter Member Posts: 6,099
    edited January 2011

    aprilgirl1 said, "I have found that in my area, CMF is very popular with the breast cancer oncologists."  I've heard and read that same thing about the oncologists in the northeastern U.S., particularly at Sloan-Kettering.

    To me, that's one of the most interesting and frustrating aspects of this chemo stuff.  When I met with my "oncology team" the first time, I pressed the med onco about what type of chemo he would recommend.  He said, "Well, if it turns out that you need chemo, I'll be recommending A/C (Adriamycin/Cytoxan)." He then said he would not talk about chemo anymore until after my surgery (mast/SNB), because the preliminary information we had (tumor was Grade 2 and likely Stage I with ER+ PR- HER2-) was not enough. 

    He and I met again shortly after the surgery. My nodes were negative, so the tumor was officially Stage I and the original markers were confirmed.  He again said he would use A/C, if I needed chemo -- but he wanted to order an Oncotype DX test to see if chemo was warranted.  I asked him about CMF, and he dismissed it immediately:  "We don't use that anymore."  I did not ask him about Taxotere/Cytoxan (T/C), because once again he didn't want to talk further about chemo until he had the Oncotype DX results.

    I fired him for that and other reasons, and met with another med onco.  My Oncotype DX score turned out to be 26 (17% risk of mets in 10 years).  The new onco (at the same cancer center) also said she recommended A/C.  I asked about cardiac risk, and the possibility of using T/C instead of A/C.  We discussed my medical history and she offered that, knowing all those things, T/C was a good alternative to A/C for me.  "The effectiveness of T/C might even be better than A/C with tumors like yours," she said. (That was what the early studies were showing.)

    So I went with T/C. 

    It was funny (peculiar-funny), though, that the oncos at my cancer center weren't even considering CMF for me.  I was treated at an NCI-designated Comprehensive Cancer Center in the southeastern U.S.  Preference for chemo regimens appears to be very regional, and I don't know what affects those differences.

    otter

  • Anonymous
    Anonymous Member Posts: 1,376
    edited January 2011

    Otter - I agree!  It seems  odd that there are regional preferences.  I am also at a NCI-designated Comprehensive Cancer Center, but in the NW US.

    At one point on the boards I read that CMF is no longer standard of care and my oncologist literally bristled when I told her that.  She told me that it is absolutely standard of care.  There are many options as we can read on here!  I also asked about A/C and she was adamant about that not being a choice in my case.  This center, of course uses all three with breast cancer patients, and I'm sure many more combinations that I am not aware of.

  • Hortense
    Hortense Member Posts: 982
    edited April 2012

    Well, I just got off the phone with my oncologist at Sloan Kettering who has left the choice of using CMF, TC or AC-T up to me, just as she told me at our last meeting. I wanted to clarify that I would get an extra 2-3 % better chance of no recurrence with TC than CMF which is a good thing, but she said Sloan Kettering absolutely will not allow using cold caps, so I would have to lose my hair if I went with TC. Apparently they have discussed it and decided against them. They are considering some sort of gel cap, but have not started any studies so none is available. Now I have to decide if I will stay with her and do the CMF, or switch doctors and do the heavier chemo with cold caps.

    This is so complicated. 

  • chacha311
    chacha311 Member Posts: 1
    edited May 2013

    Anna,

    which treatment plan did you decide on and how did it go?  I am in the midst of having to make the same decision...  Sloan says CMF X 8 over 24 weeks but Hopkins says TC x 4 over 12 weeks or CMF x 6 over 18 weeks.  I am completely overwhelmed with the decision!!  The surgery itself was way easier than this...

    Char

  • stjs11
    stjs11 Member Posts: 4
    edited June 2013

    Char,

    I am curious which chemo treatment did you end up choosing? Have you started the treatment?

  • jennyunderthesun
    jennyunderthesun Member Posts: 54
    edited November 2015

    I'm in the same boat-- trying to make a decision between TC and CMF...

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