Choosing AC/TH or TCH chemo regimens

Hi Debbie, sorry you haven't got any advice yet. I was not given a choice like you, but I did trust my onco and the regimen she would give me. Except Herceptin,( I am HER2 -), I received Adriamicin, Cytoxan for neoadjuvant and Taxotere for adjuvant. I tolerated most of them ok. My C was on the left side too, and neither Adriamicin, nor radiation affected my heart. Hopefully it will not cause you any trouble either. Yes, it's quite a choice to make, so let's see what other ladies will come up with.

Wishing you good luck and lots of strength to go through the chemo. Whatever regimen you have, just remember, that you will get through it and one day it will be behind you. Concentrate on your treatment, take each day as it comes, rest, eat well and just be kind to yourself. 

Hugs. 

Hello, and sorry to meet you here!  If you want the most aggressive treatment then go with AC (adriamycin/cytoxan) every 3 weeks and then 4 cycles of TH with Herceptin.  THAT is the most aggressive regimen.  Now having said that, you are aware of the potential affects that adramycin can have on the heart, and that some oncologist are concerned that using it with Herceptin (which you know also can cause heart issues) is a double whammy for the heart.  Add radiation to this, and that will be three things that could potentially be bad for your heart. Adriamycin also can have the late effect of causing a secondary leukemia in the future, though this is rare.

The TCH combo (which I did) is only slightly less effective than the ACTH combo. Taxotere also does not have the same effect on the heart as adriamycin does.I handled it very well with little side effects but others have had more of a hellish experience with Taxotere (not to deter you, but more to say that Taxotere is no walk in the park so you don't see it as less powerful than Adriamycin). I believe the difference is not significant in forms of one being better than the other. But one HAS been shown to be slightly better in terms of recurrence.  

 As Carboplatin is also an alkylating agent, I believe it could also rarely cause leukemia so doing the TCH does not get you out of this long term very rare occurrence.  

I also read  that dose dense chemo is very affective.  I was never given this choice. I had orginally been set to receive the ACTH combo, as it was thought I was going to participate in a clinical trail being offered.  When I decided not to do the trial, I received the TCH combo. At the time, I did worry that I was not getting the most aggressive treatment. I was never included in the decision process.

Studies also say that using Herceptin with chemo is most affective. 

There are soo many factors to figure in!!! If you do the TCH combo, you will get Herceptin the entire time, if you do the first one, you will not get Herceptin with chemo for four cycles or you will get it in the second leg of your chemo treatments?

 When I received radiation at the mastectomy site, I asked about the heart.  They said that they are soo good now at aiming the beams (better equipment) that they are not concerned with the heart or lungs as they used to be.  Despite this, my ejection fraction went down to 45 during radiation.  I still got Herceptin.  I asked if it could have anything to do with the radiation and the oncologist wasn't really sure either way.  But....it went back up to 55 when radiation was over.....

Good luck with your decision. How is your heart at the moment?  If you have a low normal ejection fraction, and treatment brings it lower, this could affect your getting Herceptin. I would factor that into your decision as well. Getting the Herceptin is very important in your treament plan. 

I think any treatment we have can have a long term impact on our future health.  I have a friend who was treated with adriamycin for stage III breast cancer nine years ago.  She does have congestive heart failure due to this treatment.  She is no longer able to work, but otherwise is leading a full life and has survived her stage III cancer!!!. I have lymphedema which will be life long. The uncommon heart effects from Herceptin are thought to be temporary and go away after treatment. Herceptin is relatively new though and they really don't know the long term effects yet in my opinion (and I'm not a doctor). The uncommon heart effects from adriamycin are permanent but not common.

I just PET scan a couple of weeks ago, got good results last week (YAY!!). I'm not sure what other "whole body" the doc may be suggesting, as I thought PET was the most sensitive. However, I'm pretty new to this too, so I may be wrong about that.