TC vs ACT Chemo for Triple Negative?

chachingqueen · October 2009

Here's a short history. I'm 31 and diagnosed with breast cancer. It's stage 1, grade 3, triple negative, BRCA1 positive. I had a double mastectomy. After the surgery, the report showed clear margins and clear lymph nodes (3 removed). The only cancer they saw was the 1.3cm tumor. I will be having a bone scan next week to make sure none has spread there.

Now it's time to make a chemo decision. I have talked with 3 oncologist (Dallas onc, Austin onc, my cousin who is an oncologist).

My cousin and Dallas recommend the TC every 3 weeks for 4 cycles.

Austin recommends AC+T - AC every 3 weeks for 4 cycles then T weekly for 12 weeks.

I'm torn about which to go with. I have been told ACT is more agressive, yet harder on your body and has more serious side effects. The ACT has about a 5% advantage over the TC.

I'm trying to decide if the TC is a good choice even though it won't be quite as aggressive - something to worry about since the triple negative.

I would like to know what you have found through either research or experience. What have you found or your doctors told you about the pros and cons of each? Which treatment regimen did you do and how was it?

thanks

-Rachel

lexislove · October 2009

Im not Tn, but I was diagnosed at 30 with Her2+ disease...which is crazy agressive. I was perscribed ACT. I did 4 AC and 4 T every 3 weeks, 6 months of chemo. The AC has a slight increase in potential heart problems but that is mostly seen in older woman and woman who already have heart issues.

If you do AC they will monitor your heart. A 5% is not a big difference, its just what you feel is good.

I had no problems with AC.Being 30, I bounced back and my heart was and is fine. I know youb want to be the most agressive as possible being TN and so you should be.

Your lymph nodes were clear, so that is good. I guess its up to you really. For me...5% is 5%. Im agressive ...I would do it. But thats me.

You will get a lot of other opinions. But either is good really.

LRM216 · October 2009

Hi, I am triple negative as well and am a "young" 62. My onc gave me the choice of TC (which she said was the mildest of the three), then the AC& T (more agressive) and the TAC. Since I am a widow, work full time as a legal asst. and raise my 14 yr. old grand-daughter, she felt the AC&T was very agressive and the way to go. That is what I chose. I had an echocardiogram first, bone scan and ct. I completed all my chemo 5 weeks ago and had no major problems at all. Had it on Thursday, side effects would hit over the weekend, and returned to work on Monday. Wishing you the best through your journey.

Linda

edited for typo

unklezwifeonty · October 2009

Dear Rachel,

I am also a triple negative and am getting AC-->T. See my signature for my tumor info.

But if I were stage I with a 1.3 cm tumor and node negative I think I'd opt for TC. Your chances are very good with any chemo, A is hard on your body and has serious side effects and it is the T that gives you the biggest insurance.

The opinions of the practitioners are all over the map on whether to use A or not for HER2- BC. That said, I think they are missing an important marker or two that would help them predict with higher certainty whether A is useful. Having a cousin oncologist is valuable. Trust his/her advice and your own instinct. Ask your cousin to share the studies that compare these and other similar regimens with you.

If you want to treat this very aggressively and leave no stone unturned, then use AC-->T. If you go this route, ask for Dose Dense AC, ie AC __2__ weeks 4 times before moving onto T weekly 12 times.

Good luck and keep us posted.

unklezwifeonty · October 2009

Dear Laura,

How are you? I need a favor. I need to have DH review articles comparing TAC, Regular AC-->T and Dose Dense AC-->T and TC. Can you point me to any studies please?

Love

TNBC_in_NS · October 2009

Hi: 57 y-old worked medical job and a half (60 hrs week) just finished TC every three weeks for two tx and two tx at four weeks. Last tx last Thursday. I had a hard time with it because I was allergic to the Taxotere. Not good. See my diag. below at signature. I now have 16 rads to do, then hopefully I will be done. I might add that after my first chemo I ran an infection and had to have an abscess removed from my breast where the tumour was. That is still open and 1.1cm deep and 2 cm wide. I have had a hard time of it but I am coming out of the dark hole now. Also, was on Neupogen for 5 days after three chemos. I was out today for a hour, still very weak and SOB. TC was the only avenue for me here in NS, Avastin study was not available to me here. There were two other areas of concern under my armpits both sides, and my PET scan showed that whatever it is is shrinking so we know the meds are working so far. I will keep you all posted as I go along! Take care and keep us up-to-date. xoxo Cool

unklezwifeonty · October 2009

SOB?

TNBC_in_NS · October 2009

Unklezwifeonty: Short of Breath.. Sorry... Wink

unklezwifeonty · October 2009

LOL.....Ok.

PatriciaPrijatel · October 2009

unclezwifeonty:

Here's a study on TAC for TNBC: http://hormonenegative.blogspot.com/2009/03/tac-improves-disease-free-survival-for.html

And another one on ACT:http://hormonenegative.blogspot.com/2007/12/reduce-recurrence-buzz-from-white-coats.html

And this is an excellent overview article on TNBC treatment overall: http://www.cancernetwork.com/display/article/10165/1340727?pageNumber=2

I had AC only, not T because I was node-negative. I am not BRCA1, though. This article evaluates this issue and, in typical research-ese, says that, while AC works for node-negative, adding T is a good idea for high risk cases, such as TNBC. http://jnci.oxfordjournals.org/cgi/content/full/96/24/1801

Hope that helps.

Pat

hormonenegative.blogspot.com

unklezwifeonty · October 2009

Thanks a lot Pat.

chachingqueen · October 2009

Thank you.

I talked to my oncologist today and I'm most likely going to do the TC treatment. My dad is really worried about heart problem risks if I take A. His sister had breast cancer in the 70s and they believe what ultimately killed her was the chemo - she had heart problems at the end. He's very concerned about that happening to me. I know drugs have changed since then.

justpayton1 · October 2009

Hi

38 years old at time of dx

I am also BRCA 1. I did dose dense. ACX 4 TAXOL X4 each dose was followed with a shot of neulasta. I had chemo on Thursdays and used the weekend to recover.

I had swelling from the taxol and was given a water pill halfway through treatment which helped.

I finished my chemo in June and seem to be okay so far...

I do notice shortness of breath when walking though

I am told my treatment has been aggressive but I have 2 kids to raise.

I might add I am a single Mom and was able to get the kids to school, pick them up etc...Fridays were the worst days for me so we would have ' pizza night'

Hugs to you

vbabey · October 2009

justpayton1 - Pizza night is my favorite also, though now I have switched to vegetable pizza! anyway, your regime is the same as mine, except there has been mention of Gemzar added to the Taxol, which I will start in three weeks or so, has anyone ever taken that? Also, did your oncologist suggest chemo again after surgery if there was not a complete response? Thanks and have a good day all...

unklezwifeonty · October 2009

Dear ChachingQueen,

TC is an excellent choice. Good luck with your treatment.

yananma · December 2012

I am newly diagnose with tn, 1.2 cm tumor, facing the same 2 treatment plans, TC or AC-T! So any follow up? Any s 2nd thought? Advise on which one I should take?

HollyHopes · December 2012

I had dose dense AC/T. I have 5+ years out. No regrets!!

yellowdoglady · December 2012

I was told that the A was too hard on the heart and would have a benefit of only 1%. Not worth the toxicity, at least for people like me. I did Cytoxin and Taxotare all day every three weeks for six rounds. Then went on to seven weeks of daily radiation, five days a week. It did the deed. Four years later, the beast has been declared well and truly gone, forever. I hope that is true.

yellowdoglady · December 2012

TNBS in NC:

I want you to hear this because I've heard of people pulling out of treatment because Taxotare is hard. Yes, it is. Every person alive who had that has felt like it was too much for them at one time. That said, I'd grip the sides of the chair and hold my breath for a few seconds, then do deep breathing for a minute. After a minute or three of sweating from every pore I'd be just fine. And that was at the end, when it got hard.

Still, nothing is better for TNBC.

yananma · December 2012

Thank you, Hope and Yellow. I decided to go with TC treatment. Starting this Thursday. Wish me luck! Anything I should prepare myself for? What could be worst?

yellowdoglady · December 2012

Yananma,

If you have a lot of hair, you might consider donating it to Locks of Love. That also makes it easier to make the transition to losing hair. If you haven't done so already, look for some transitional hair or head scarfs, and get a couple nice knit caps to wear at night so your head won't get cold. Other than that, just prepare to see it through. I did my food shopping at night so as not to encounter kids who carry illness. You might feel terrible for a day or so here and there, but do not alter your treatment schedule unless the doc suggests that. There is a reason they space treatments out the way they do. It's to get the maximum result.

Good luck to you!!

yananma · December 2012

I had 1st TC on 12/13, shot on 12/14, today 12/15, so far so good. Cut hair short, waiting what is next? My heart goes out to every sister on this blog! Enjoy a restful day

yellowdoglady · December 2012

Yananma,

The hair loss usually follows the second dose. Everyone is different, but expect that. Your eyebrows and eyelashes won't fall for a long time if they do. That's usually after you think you are done but the medicine is still working.

Not a bad thing, because often it indicates a complete response to treatment.

SherylB · December 2012

Met with my oncologist yesterday and I am going to have Taxotere and Cytoxan every 3 weeks times 4. I am having a port placed on 12/28 and first chemo 1/10. Not going with the A due to diabetes and I have to many risk issuses with heart disease. I like everyone else am afraid of how I will feel while receiving the chemo and the after effects. I also am concerned about the Neulasta injection. The mention of bone pain is what concerns me as I ache in bones and joints already from arthritis and other non specific issues. So many unknows are my biggest fears.

IDC, 1.1 cm, stage I, grade 3, nodes 0/3, ER-/PR-/Her2-, Ki-67- 96 TNBC

12/6/12 Left partial mastectomy and SLNB.

Thanks for letting me share, Sheryl

anamerty · December 2012

i was to have taxetore cytoxen every 3 weeks x4 but ended up in the hospital for 14 days one week aftef 3rd tx due to interstital pneumonia which is caused by taxetore so needless to say my oncologist has stopped my last tx all this hospital stuff was from dec4-18 so im still recovering believe me it was bad on 70% oxygen etc i have a few questions if somebody could help #1 will me not having last tx cause the 3 i did have becomd useless ? #2 obviously i cang takd taxotere again so what happens if i need chemo again?will i be able to take another chemo?i know that the tx i got is known to be best on tn cancers but is there anothef one just as effective that wont make me have anothef allergic reaction to? i think i may have posted something abouf this before but donf know where it is but im in such fear right now over this whole thinv so if anybody has answers for me it would help me make it through the weekend i do see my mo on monday thanks Brenda

SherylB · December 2012

anamerty, obviously these are questions for your oncologist, however, (in my opinion) what about adriamycin? I too am TN and it was the first choice for my aggressive case but due to having poorly controlled diabetes, mother and brother with heart disease and both had coronary bypass grafting it was not an option for me as it is hard on the heart. That is a question I would ask the MO.

Good luck, Sheryl

PS. I assume you were on steroids too. Seems taxotere can cause allergic reactions/ SE commonly and the steroids help with that.

anamerty · December 2012

i will talk to mo on monday as i do have apt yes i was treated with massive amounts of steroids while in hospital as well as antibiotics i also have a heart issue that they found after doing a couple of echocardiograms seems that my heart pumps all the blood in but leaks a bit they dont know if the taxatere caused it but they told me it wouldnt cause a heart attack or anything more just swollen ankles which i hsve had for a long time so this may have been there anyways i guess im just really scared cuz i have heard of people not able to do chemo because it could kill them but that the cancer would kill them anyways

yananma · January 2013

Brenda, sorry to hear about the allergic reaction you had with T. I have similar dx and I am going to 2nd TC on 1/3/13! Did you have trouble with your first 2 rounds of TC? My 1st TC went well, the shot gave me more SE than the TC itself... Best of luck. Do keep us posted what your mc recommend and your progress. Yes, do ask about adrianmycin. My mc recommend AC as alternative to TC!

anamerty · January 2013

yananma:yes my first 2 rounds went well enough, I did have a lot of bone pain with the neupogen shots so decreased them to every other day. This is why the 3rd round I knew something was going on cuz i was feeling ill the day after, but I was told that se were cumulative and thought that was what it was. In hind sight I didnt have a fever and constantly was taking tylanol because I was having headaches all the time which I didn't have before. The dr. said it probably masked the pnemonia . So I went to my oncologist yesterday, he said that having one chemo short from protocol, should not make a difference, he also said had he tried to give me the last one, he said it would have killed me.He said if there was a recurrance there is other drugs, I'm just so hoping it doesnt come back!!He also told me it was going to take a good year to recover from everything I've gone through, and not to be in a hurry to get back to work.I am covered by my extended health but it on pays 60%, and I think if I'm not sitting around thinking all the time I might recover a bit better. He said he'd consider me going back to work part time in a few months, but I will see him in 3 months again. Maybe I will have the energy to return to work. Because my job is so pysically demanding, I guess I better take it easy

yananma · January 2013

Ana

I had my 2nd TC today, so far so good. Glad to here that your MC is ok with 3 rounds TC only. Are you still having pneumonia? I am an accountant, desk work and I am giving the choice to work at home through the treatments luckily. It does help me to take my mind off cancer... I hope you can find a good option with your job!

Luah · January 2013

Taxol may be an alternative to taxotere, and can be given on a more frequent (milder) dosage. Also, abraxane is like taxotere but suspended in a different substance, which does not cause allergic reactions. Ask your onc about these options. Taxotere, taxol and similar drugs have been shown to be particularly effective for some TNs, so it's worth trying to find an option that works, imho.

TC vs ACT Chemo for Triple Negative?

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